eMedicine Specialties > Pediatrics: Cardiac Disease and Critical Care Medicine > Toxicology

Toxicity, Ethanol: Follow-up

Author: Elizabeth Brothers, MD, Resident Physician, Department of Emergency Medicine, State University of New York Downstate Medical Center
Coauthor(s): Christopher I Doty, MD, FACEP, FAAEM, Assistant Professor of Emergency Medicine, Residency Program Director, Department of Emergency Medicine, Kings County Hospital Center, State University of New York Downstate Medical Center
Contributor Information and Disclosures

Updated: Oct 14, 2009

Follow-up

Further Inpatient Care

  • Observe the patient with ethanol toxicity until his or her mental status has returned to normal.
  • Monitor the patient's blood glucose level until it is stable and is within the normal range.
  • Correct any electrolytic disturbances.
  • Watch for signs of ethanol withdrawal in patients who have abused alcohol for several years.
    • Sympathetic discharge and tremor are typical; sometimes, hallucinations occur.
    • Seizures are possible.
  • Pediatric intensive care unit (PICU) monitoring is recommended in all patients who have continuing CNS or respiratory depression.
  • Indications for hospital admission include the following:
    • Presence of hypoglycemia
    • Suspected neglect or inadequate social support at home
    • Unstable home environment or unreliable caregiver at home
    • Presence of focal neurologic signs
    • Need for supportive care

Further Outpatient Care

  • Patients who chronically abuse alcohol should be referred to an outpatient treatment group. Family counseling is also helpful.8
  • Patients who had an unintentional ingestion may follow up with their primary pediatrician; a safe home environment must be emphasized.

Inpatient & Outpatient Medications

  • Thiamine administered daily on an inpatient basis is recommended in patients who have chronically abused ethanol. The length of therapy is well documented.

Transfer

  • Children requiring PICU monitoring, respiratory or cardiovascular support should be transferred to a facility with the appropriate resources.

Deterrence/Prevention

  • In cases involving toddlers or young children
    • Keep all ethanol-containing fluids (eg, perfumes, aftershaves, colognes) out of the reach of young children.
    • Do not leave unfinished alcoholic beverages unattended, especially during and after parties.
    • Keep alcoholic beverages stored in locked cabinets and out of the reach of the children.
  • In cases involving the adolescents
    • Areas where alcoholic beverages are stored should be kept locked.
    • Have the parents or pediatrician talk to the patient about his or her experiences with alcohol and about the dangers of alcohol consumption.

Complications

  • Short-term complications include risky behaviors (eg, increased risk of illicit drug use), an increased risk of trauma, and legal consequences.
  • Long-term complications of chronic ethanol abuse in children are not well described in the medical literature.
    • Complications usually develop over several years.
    • Because most pediatric patients do not start abusing ethanol until later in their adolescence, they do not present with long-term complications such as liver dysfunction (eg, cirrhosis) and cardiac problems until after they become adults.
    • Recent research has confirmed that intense neurologic development occurs both in utero and during adolescence. Heavy drinking in adolescents has been associated with deficits in visuospatial function. However, heavy drinking in adolescents may also lead to chronic neurologic damage of a similar mechanism to that seen in fetal alcohol syndrome. Current research is focusing on the effects of adolescent binge drinking on the hippocampus and frontal cortex, which appear to be particularly sensitive to the binge pattern of drinking, which predominates in adolescents.9

Prognosis

  • The prognosis is excellent, provided the patient can avoid both the chronic use of alcohol and the short-term complications of alcohol abuse.

Patient Education

  • Parents should be taught to prevent accidental ingestion at home by storing ethanol-containing liquids out of the reach of their children and by disposing of unfinished alcoholic beverages.
  • Few data indicate that educational programs to control drinking among adolescents are effective. However, the parents or pediatrician should still educate the patient about the dangers of alcohol consumption, including fetal alcohol syndrome in the pregnant patient.
  • Approaches that have traditionally been successful in adults, such as 12-step programs, are not as successful for adolescents. In fact, after treatment in aftercare or 12-step programs, only half of adolescents comply with the behavioral changes required by the program. However, about one third of adolescents are able to decrease their drinking using their own methods; exactly what these methods are has not been well studied. This is an area that may benefit from further study in order to design more effective treatment programs.9

Miscellaneous

Medicolegal Pitfalls

  • Failure to manage hypoglycemia in younger patients
  • Failure to treat iatrogenic respiratory depression, which is often secondary to the use of sedatives to control hostile inebriated adolescent patients
  • Failure to obtain an accurate history of possible ingestion (Patients may be evasive because they fear possible legal consequences.)

Special Concerns

  • Pregnancy
    • A new epidemic of teenage mothers in America and widespread increase in the number of teenage mothers in other countries has engendered a growing concern about pregnant and intoxicated female patients who are examined in pediatric EDs.
    • Harm to the developing fetus in mothers who are chronic alcohol drinkers is well documented.
    • When pregnant teenagers present to the ED with ethanol intoxication, the physician has a window of opportunity in which he or she can refer the patient to social services personnel and a support group and education program for teenaged mothers. These actions can prevent harm to the unborn child.
    • Fetal alcohol syndrome is a possible consequence of alcohol intoxication or use in a pregnant patient.
  • Lactation
    • Mothers who consume alcohol secrete it in their breast milk.
    • After lactating mothers ingest alcoholic beverages, the breast milk has a detectable odor of ethanol.
    • Studies have shown that the infant's milk ingestion subsequently reduces.10
 
Acknowledgments

The authors gratefully acknowledge the previous coauthors, Dr. Sage Wiener and Dr. Binita Shah for their contributions to the development and writing of this article.



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References
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Further Reading

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Keywords

ethanol, ethanol toxicity, alcohol intoxication, ethanol intoxication, drunkenness, inebriation, ethyl alcohol intoxication, alcohol overdose, ethanol poisoning, alcohol poisoning, drinking, psychoactive drug, hypoglycemia, alcohol abuse, hypoglycemia, hypoglycemic seizures, trauma risk, over-the-counter medication, alcoholism, respiratory depression, hypoxia, urticaria, hypothermia, myocardial depression, diuresis, acute pancreatitis, lactic acidosis, congestive heart failure, pulmonary edema, arrhythmia, cardiovascular collapse, sudden death, cardiomyopathy, obesity

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Contributor Information and Disclosures

Author

Elizabeth Brothers, MD, Resident Physician, Department of Emergency Medicine, State University of New York Downstate Medical Center
Elizabeth Brothers, MD is a member of the following medical societies: American College of Emergency Physicians, Emergency Medicine Residents Association, and Sigma Xi
Disclosure: Nothing to disclose.

Coauthor(s)

Christopher I Doty, MD, FACEP, FAAEM, Assistant Professor of Emergency Medicine, Residency Program Director, Department of Emergency Medicine, Kings County Hospital Center, State University of New York Downstate Medical Center
Christopher I Doty, MD, FACEP, FAAEM is a member of the following medical societies: American Academy of Emergency Medicine, American College of Emergency Physicians, American Medical Association, Council of Emergency Medicine Residency Directors, and Society for Academic Emergency Medicine
Disclosure: Nothing to disclose.

Medical Editor

Halim Hennes, MD, MS, Pediatric Emergency Medicine Research Director, Professor, Departments of Pediatrics and Emergency Medicine, Medical College of Wisconsin
Halim Hennes, MD is a member of the following medical societies: American Academy of Pediatrics
Disclosure: Nothing to disclose.

Pharmacy Editor

Mary L Windle, PharmD, Adjunct Assistant Professor, University of Nebraska Medical Center College of Pharmacy, Pharmacy Editor, eMedicine
Disclosure: Pfizer Inc Stock Investment from financial planner; Avanir Pharma Stock Investment from financial planner ; WebMD Salary and stock Employment and investment from financial planner

Managing Editor

Jeffrey R Tucker, MD, Assistant Professor, Department of Pediatrics, Division of Emergency Medicine, University of Connecticut and Connecticut Children's Medical Center
Jeffrey R Tucker, MD is a member of the following medical societies: American Academy of Clinical Toxicology, American Academy of Pediatrics, and Massachusetts Medical Society
Disclosure: Merck Salary Employment

CME Editor

Paul D Petry, DO, FACOP, FAAP, Consulting Staff, Freeman Pediatric Care, Freeman Health System
Paul D Petry, DO, FACOP, FAAP is a member of the following medical societies: American Academy of Osteopathy, American Academy of Pediatrics, American College of Osteopathic Pediatricians, and American Osteopathic Association
Disclosure: Nothing to disclose.

Chief Editor

Timothy E Corden, MD, Associate Professor of Pediatrics, Co-Director, Policy Core, Injury Research Center, Medical College of Wisconsin; Associate Director, PICU, Children's Hospital of Wisconsin
Timothy E Corden, MD is a member of the following medical societies: American Academy of Pediatrics, Phi Beta Kappa, Society of Critical Care Medicine, and Wisconsin Medical Society
Disclosure: Nothing to disclose.

 
 
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