Pediatric Ethanol Toxicity Follow-up

Updated: Feb 27, 2017
  • Author: Elizabeth Fernandez, MD; Chief Editor: Timothy E Corden, MD  more...
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Follow-up

Further Outpatient Care

Patients who chronically abuse alcohol should be referred to an outpatient treatment group. Family counseling is also helpful. [9]

Patients who had an unintentional ingestion may follow up with their primary pediatrician. A safe home environment must be emphasized.

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Further Inpatient Care

See the list below:

  • 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, tremor, and tongue fasciculations are typical; hallucinations may occur; seizures are possible.

  • Pediatric intensive care unit (PICU) monitoring is recommended in all patients who have continuing CNS or respiratory depression.

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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.

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Transfer

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

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Deterrence/Prevention

With toddlers or young children, preventive measures include the following:

  • 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.

WIth adolescents, preventive measures include the following:

  • 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.

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Complications

Short-term complications include the following:

  • Risky behaviors (eg, increased likelihood of illicit drug use)
  • Increased risk of trauma
  • 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.

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. 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. These areas appear to be particularly sensitive to the binge pattern of drinking, which predominates in adolescents. [10] Magnetic resonance imaging has demonstrated that adolescents who abuse alcohol have lower hippocampal volume than healthy controls. [11]

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Prognosis

The prognosis for pediatric patients with ethanol toxicity is excellent, provided the patient can avoid both the long-term use of alcohol and the short-term complications of alcohol abuse.

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Patient Education

Parents should be taught to prevent accidental ingestion at home by storing ethanol-containing liquids out of the reach of children and by disposing of unfinished alcoholic beverages.

Educating adolescents about alcohol abuse has proved challenging, as follows:

  • 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. [10]

  • One study used a laptop-based program to educate patients in the emergency department (ED) regarding the dangers of alcohol use. The authors found no decrease in the incidence of drinking behavior at 3- and 12-month follow-up. Of note, these patients had all presented to the ED, and were not patients with complaints specific to ethanol. [12]

  • Another study found that a motivational intervention for intoxicated patients in the ED or a combination of a motivational intervention and a family intervention did result in a reduction in drinking outcomes, but the effect attenuated over time. [13]

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