Acute ethanol poisoning in a 4-year-old as a result of ethanol-based hand-sanitizer ingestion

Alcohol-based hand sanitizers have become widely available because of widespread usage in schools, hospitals, and workplaces and by consumers. We report what we believe is the first unintentional ingestion in a small child producing significant intoxication. A 4-year-old 14-kg girl was brought to the emergency department with altered mental status after a history of ingesting an alcohol-based hand sanitizer. Physical examination revealed an obtunded child with periods of hypoventilation and a hematoma in the central portion of her forehead from a fall at home that occurred after the ingestion. Abnormal vital signs included a heart rate of 139 beats/min and temperature of 96.3 degrees F, decreasing to 93.6 degrees F. Abnormal laboratory values consisted of potassium of 2.6 mEq/L and a serum alcohol of 243 mg/dL. A computed tomography scan of her brain without contrast showed no acute intracranial abnormality. A urine drug screen for common drugs of abuse was reported as negative. The child was intubated, placed on mechanical ventilation, and admitted for medical care. She recovered over the next day without sequelae. As with other potentially toxic products, we would recommend caution and direct supervision of use when this product is available to young children.