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Pediatric Toxicology of Alcohols and Glycols

Introduction

  • Over 6% of poison exposures (251,012 cases) reported to the American Association of Poison Control Centers in 1983 involved alcohols or glycols.

  • 86.2% of victims were children under age 6, indicating significant pediatric poisoning risk from these substances.

Common Alcohols and Glycols

  • Isopropanol: Frequently found in rubbing alcohol, with concentrations of 70-91%.

    • Toxicity: Rapid absorption (within 30 minutes), minimal dermal absorption, inhalation can be hazardous.

    • Metabolism: Metabolized to acetone (80%), CNS and gastrointestinal effects dominate.

    • Symptoms: Nausea, vomiting, CNS depression, gastritis; severe toxicity above 400 mg/dl serum concentration.

    • Treatment: Supportive care, gastric emptying, continuous gastric lavage recommended.

  • Ethanol: Common household sources include perfumes, mouthwash, elixirs.

    • Toxicity: Rapid absorption; lethal dose: 5-10 oz of mouthwash.

    • Clinical Effects: CNS depression, hypoglycemia common in children due to impaired gluconeogenesis.

    • Treatment: Gastric decontamination; glucose for hypoglycemia; monitoring of blood ethanol concentration.

  • Methanol: Found in products like windshield washer fluid and certain illicit beverages.

    • Toxicity: Rapid absorption (30-60 min to peak levels), lethal dose as low as 15 ml of 40% solution.

    • Clinical Effects: Symptoms may be delayed (12-24 hours); visual changes (e.g., blurred vision) are key indicators.

    • Metabolism: Converted to formaldehyde and formic acid; formic acid is the main toxic agent.

    • Treatment: Ethanol as an antidote to inhibit methanol metabolism; hemodialysis for severe cases.

  • Ethylene Glycol: Commonly used in antifreeze; sweet taste increases risk for pediatric ingestion.

    • Toxicity: Rapidly absorbed; symptoms can be delayed; signs of metabolic acidosis and calcium oxalate crystals in urine.

    • Clinical Effects: CNS depression, metabolic acidosis, hypocalcemia, renal failure.

    • Treatment: Ethanol to block metabolism; hemodialysis for severe cases; thiamine and pyridoxine as adjunct therapy.

Diagnostic Considerations

  • Signs of Poisoning: Inebriation without alcohol odor, metabolic acidosis, characteristic crystal formation in urine (calcium oxalate for ethylene glycol).

  • Laboratory Findings: Osmolal gap is a significant indicator for all four alcohols; may assist with differentiating between types.

    • Acetonemia indicates isopropanol poisoning; metabolic acidosis observed with methanol and ethylene glycol.

Conclusion

  • Pediatric alcohol and glycol poisonings require timely recognition and management due to their potential severity.

  • Treatment strategies involve supportive care, targeted antidotes (like ethanol), and possibly dialysis for severe cases.