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Acute obtundation in a 9-month-old patient: ethanol ingestion
Suzanne M Edmunds1, Samuel J Ajizian, Anthony Liguori
1From the Departments of Anesthesiology and Physiology and Pharmacology, Wake Forest School of Medicine, Winston-Salem, NC.
Insights
Accidental alcohol ingestion in infants is dangerous, causing severe complications. This case highlights a 9-month-old infant with extremely high blood alcohol levels, managed successfully with supportive care, not dialysis.
Area of Science:
- Pediatric Toxicology
- Emergency Medicine
- Pharmacokinetics
Background:
- Alcohol ingestion in children poses significant risks, with younger patients experiencing more severe effects at lower blood alcohol concentrations.
- Complications include hypothermia, hypoglycemia, seizures, coma, and potentially death.
Observation:
- A 9-month-old infant presented comatose after accidental ingestion of formula mixed with vodka.
- Initial blood alcohol level was 489 mg/dL, peaking at 524 mg/dL with a lactate level of 24 mmol/L.
Findings:
- The infant required intubation and aggressive fluid resuscitation for altered consciousness and hemodynamic instability.
- Supportive care, including mechanical ventilation and dextrose, was effective, negating the need for hemodialysis.
- Ethanol clearance followed zero-order kinetics, averaging 28.6 mg/dL per hour over 15.5 hours.
Implications:
- This case represents the highest reported blood alcohol level in an infant, expanding knowledge of ethanol metabolism in this age group.
- Understanding ethanol clearance kinetics aids in managing severe pediatric alcohol intoxication.
- Highlights the critical need for vigilance in formula preparation and storage to prevent accidental ingestions.
Abstract:
Alcohol ingestion in the pediatric patient can be life threatening. Younger patients consume larger volumes per body weight with accidental ingestions, and children have more serious adverse effects at lower blood alcohol levels. Complications of alcohol poisoning can include hypothermia, hypoglycemia, seizures, coma, and death. We present the course of a 9-month-old female infant who became unresponsive at home and presented to the emergency department comatose. When her blood alcohol level registered 489 mg/dL, it was revealed that she had accidentally been given a bottle of formula mixed with vodka rather than water. The infant required intubation for severely depressed level of consciousness and aggressive fluid resuscitation for hemodynamic instability. She had a peak lactate level of 24 mmol/L and a peak blood alcohol level of 524 mg/dL. Based on the severity of her initial presentation, preparations were made for hemodialysis. The infant responded to supportive measures including mechanical ventilation, fluids, and dextrose, and hemodialysis was not necessary. Her alcohol clearance followed zero-order kinetics at an average rate of 28.6 mg/dL per hour over 15.5 hours from her peak level of 524 mg/dL to the lowest measured value of 80 mg/dL. The kinetics of ethanol clearance at this level of toxicity, which is the highest reported in an infant to date, enhance our knowledge of ethanol metabolism and will assist in management decisions in cases of severe intoxication.