Features of acute ethanol poisoning of children

• Published in: Clinical toxicology (Philadelphia, Pa.) Vol. 43; no. 5; pp. 469 - 470
• Main Authors: Sukhodolova, G N, Luzhnikov, E A, Ostapenko, Y N
• Format: Journal Article
• Language: English
• Published: 01.05.2005
• ISSN: 1556-3650

Data from the paediatric poisoning treatment centres in Moscow, Omsk, Irkutsk and Voronezh suggest that the number of cases of acute ethanol poisoning in children is increasing. They account for 12 to 16% of all hospitalized patients with exogenous intoxications. Acute ethanol poisoning is common in children of various ages, but the risk group is schoolchildren aged from 7 to 15 years. The aim of the study was to identify the concentration thresholds for key clinical syndromes of ethanol poisoning in children. The ethanol concentration in blood was measured by gas liquid chromatography and matched against clinical features. The observation group totalled 47 Russian children aged from 7 to 15 years. It was found that at ethanol concentrations from 0.4 to 2.0 g/L children usually remained conscious. Coma was reported at ethanol concentrations from 2.0 to 5.4 g/L. Poisoning of moderate severity (0.9 to 1.9 g/L) was accompanied by apathy and, less frequently, psychoactive agitation, reduced muscle tone and tendon reflexes. Skin colour was normal or pale. Arterial pressure remained unchanged in 70% of cases but was reduced in 30% of patients. The most common ECG findings were rhythm disturbances manifested by sinus brady- and tachycardia, and signs of variably expressed metabolic changes. All children with severe ethanol poisoning in the resorption stage (1.64 to 5.4 g/L) had a considerably depressed level of consciousness, with reduced muscle tone and tendon reflexes. Deep coma (2.0 to 5.4 g/L) was accompanied by loss of sensitivity to pain, a sharp reduction in pupillary and tendon reflexes, muscular hypotonia and hypothermia. Several patients developed acrocyanosis (2.6 to 5.4 g/L) and marble skin (4.2 to 5.4 g/L). Patients in deep coma had central respiratory failure (above 3.8 g/L). Patients had variable haemodynamics: 80% of cases showed hyperkinetic changes, 20% had decreased cardiac output. This group of patients had arterial hypotonia (1.9 to 5.4 g/L) and tachycardia (1.0 to 5.4 g/L). On ECG there were signs of reduced intrasystolic conductivity with 1-st degree atrioventricular block and, rarely, transitory prolongation of the Q-T interval. There were no lethal cases. Ethanol concentrations at which poisoning signs appeared in children were extremely variable from 0.4 g/L to 5.4 g/L. However at ethanol concentrations exceeding 2 g/L one could expect deep coma characterized by reduced reflexes, hypothermia, respiratory deficiency and cardio-vascular disturbances. These changes required emergency corrective measures.