Excited to work in the ED this St. Patrick’s Day/Weekend? Me too! Keep this in mind though:
- Ethanol is found in many beverages and products (liquor, mouthwash, cold preparations, cologne, perfume, after-shave).
- The classic triad of Ethanol overdose in children is:
Hypoglycemia and Ethanol Poisoning
- The hypoglycemia is due to ethanol’s inhibition of gluconeogenesis (remember organic chemistry?).
- Ethanol also reduces the uptake of gluconeogenesis subtrates by the liver.
- The younger the child the greater the risk for hypoglycemia (they have low glycogen stores to begin with).
- While the intoxication may lead to altered mental status, keep in mind the possibility of hypoglycemia as the cause as well.
- Often the hypoglycemia may be severe enough to lead to seizures.
- The development of hypoglycemia does not correlate directly to the severity of the ingestion.
- Think about Ethanol ingestion with Anion Gap Metabolic Acidosis (MUD PILES), elevated lactate, and blunted response to glucagon.
Moral of the story: “DON’T FORGET THE SUGAR” in any patient, but particularly pediatric patients, with change in mental status, seizure, toxic appearance, or concern for overdose.
Hornfeldt, CS. A Report of Acute Ethanol Poisoning in a Child: Mouthwash Versus Cologne, Perfume and Aftershave. Clinical Toxicology; 1992, Vol. 30, No. 1 : Pgs 115-121.
Ernst, AA, Jones, KJ, Nick, TG, Sanchez, J. Ethanol Ingestion and Related Hypoglycemia in a Pediatric and Adolescent Emergency Department Population. Academic Emergency Medicine; 1996, Vol 3, No. 1: Pgs 46-49.
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