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Accidental isopropanol ingestion in children
1Department of Pediatric Emergency Medicine, Children's Hospital of Wisconsin, Milwaukee 53226, USA. ernest@mcw.edu
Insights
A 2-hour observation period is sufficient to rule out isopropanol toxicity in children after ingestion. Ingesting over 1 ounce increases the risk of adverse effects, with altered mental status predicting toxicity.
Area of Science:
- Pediatric Toxicology
- Emergency Medicine
- Clinical Pharmacology
Background:
- Isopropanol (isopropyl alcohol) ingestion is a common concern in pediatric emergency departments.
- Understanding the clinical course and necessary observation times is crucial for effective management.
Purpose of the Study:
- To define the clinical presentation of isopropanol ingestion in children.
- To establish the minimum observation period needed to exclude toxicity after ingestion.
Main Methods:
- Retrospective review of emergency department records for children (<6 years) with isopropanol ingestion (June 1992-December 1998).
- Data collected included demographics, ingestion details, symptoms, and laboratory results.
- Patients were categorized based on whether isopropanol levels were assayed.
Main Results:
- 91 cases were identified; 26% showed clinical toxicity.
- Symptoms included emesis, ataxia, altered mental status, and apnea.
- Ingestion of >1 ounce correlated with increased risk of symptoms (RR 4.26).
- Altered mental status predicted toxic isopropanol levels.
Conclusions:
- A 2-hour post-ingestion observation period is adequate to rule out clinical toxicity in pediatric cases.
- Altered mental status is a key indicator of potential isopropanol toxicity.
- Higher ingestion volumes (>1 ounce) warrant closer monitoring for adverse effects.
Objective:
To describe the clinical course and determine the minimal observation period required following isopropanol ingestion in children.
Methods:
The emergency department records of children less than 6 years of age with isopropanol ingestion who presented between June 1992 and December 1998 were identified. Demographics, type, and amount of ingested substance, and time of ingestion were recorded. Symptoms, time of onset, and the results of physical examination and laboratory tests were collected. Group 1 included patients who did not have isopropanol level assayed, and group 2 members had isopropanol level assayed.
Results:
Ninety-one cases of isopropanol ingestion were identified. Clinical evidence of toxicity was noted in 26 (29%) patients. Symptoms included spontaneous emesis in (24/26), ataxia (5/26), altered mental status (3/26), and apnea (1/26). Toxic isopropanol levels were noted in three patients; all had altered mental status. Clinical evidence of toxicity developed between 0.5 and 2 hours post-ingestion. Patients who ingested more than 1 ounce of isopropanol were more likely to become symptomatic (RR 4.26, 95% CI = 1.61-11.2).
Conclusions:
An observation period of 2 hours post-ingestion can be used to rule out clinical toxicity in pediatric patients with suspected isopropanol ingestion. Patients with a history of ingesting more than 1 ounce are likely to develop adverse clinical effects. The development of altered mental status is the most useful clinical predictor of a toxic blood isopropanol level.