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Survival of a child despite unusually high blood ethanol levels
G P Lopez1, D M Yealy, E P Krenzelok
1Pittsburgh Poison Center, Children's Hospital of Pittsburgh.
Insights
A child survived a massive ethanol ingestion, reaching a record blood alcohol level of 455 mg/dL. This case highlights rapid ethanol elimination and successful treatment in pediatric alcohol poisoning.
Area of Science:
- Toxicology
- Pediatrics
- Pharmacokinetics
Background:
- Ethanol (alcohol) poisoning in children is a serious medical emergency.
- High blood ethanol concentrations can lead to severe toxicity, including coma and respiratory depression.
- Understanding ethanol elimination kinetics is crucial for managing pediatric poisoning cases.
Observation:
- A 30-month-old child ingested a significant amount of ethanol, resulting in a blood ethanol level of 98.78 mmol/L (455 mg/dL).
- The child presented in a comatose state but was breathing spontaneously.
- Despite the extremely high ethanol level, the child remained hemodynamically stable and without significant metabolic derangement.
Findings:
- The child recovered completely without any long-term sequelae.
- Ethanol elimination appeared to follow first-order kinetics, which is atypical for such high doses in children.
- This represents the highest reported initial blood ethanol level in a child with survival.
Implications:
- Prompt gastric decontamination and supportive care (hydration, euglycemia) are critical for managing severe pediatric ethanol ingestions.
- This case suggests that some children may exhibit atypical, rapid ethanol elimination kinetics, even at very high concentrations.
- Further research into pediatric ethanol metabolism and toxicity is warranted to optimize treatment strategies.
Abstract:
A 30-month-old, 13-kg child reportedly ingested up to 16 ounces of a wine containing 20% ethanol. The child was brought into the emergency department by paramedics, and upon arrival was found to be comatose and unresponsive to deep stimuli but breathing spontaneously. The patient remained unconscious and unresponsive for three hours after admission. Despite an initial blood ethanol level of 98.78 mmol/L (455 mg/dL), recovery was complete without sequelae. Treatment consisted of prompt gastric decontamination and maintenance of adequate hydration and euglycemia. Elimination of ethanol was rapid in this child and appeared to follow first-order kinetics instead of the zero-order kinetics usually observed. To our knowledge, this is the highest initial blood ethanol level reported in a child with survival. Additionally, no significant metabolic or cardiorespiratory derangement occurred. Ethanol toxicity, elimination kinetics, and treatment are discussed.