• Alcohol intoxication is the ingestion of toxic quantities of ethanol (ethyl alcohol), which results in common signs, including lack of coordination, slurred speech, ataxia, nausea, vomiting, increased urination, vasodilatation, coma, shock, hypoglycemia, and seizures.
• Ingestion of 1 g/kg yields peak blood level 100 mg/dL (legal limit defining intoxication).
• Blood level of 50 mg/dL can cause intoxication in children.

• Alcoholic beverages contain 20% to 50% alcohol (hard liquor), 10% to 14% (wine), and 3% to 8% (beer); 1% = 1 mg/dL.
• Ethanol is also in liquid cold remedies, mouthwashes, aftershave lotion, liniments, tinctures, some rubbing alcohols, perfumes, colognes, glass cleaners, and paint removers.
• When ingestion is intentional, it often occurs concurrent with multiple drug ingestion and trauma from risk-taking behaviors.

• Ethanol is rapidly absorbed (20% in stomach, 80% in small intestine)
• Blood levels peak 30 to 60 minutes after ingestion
• It is metabolized primarily in the liver utilizing alcohol dehydrogenase
• 2% to 10% of ethanol is excreted unchanged by the kidneys
• Ethanol depresses the central nervous system (CNS) via the reticular activating system by interfering with ion transport at the cell membrane and interacting with g-aminobutyric acid receptors.
• Hypoglycemia is caused by impaired gluconeogenesis and lactic or keto-acidosis may develop. Seizures are a frequent manifestation of hypoglycemia in children.

• Intentional intoxication is most common in adolescents
• Accidental intoxication occurs most frequently in toddlers

• Death: associated with ingestion of >3 g/kg (which corresponds to an approximate serum level of 300 mg/dL)
• CNS depression: apnea, hypoxia, poor judgment, and risk taking
• Vomiting and aspiration
• Vasodilatation and hypotension
• Increased urinary losses and dehydration
• Hypoglycemia and seizures and coma

• Blood levels <300 mg/dL: survival expected if treated
• Blood levels >500: high risk of death despite therapy

• Meningitis
• Encephalitis
• Overwhelming infection

• Inhalations and toxic exposures (e.g., carbon monoxide poisoning)
• Other ingestions

• Brain tumor and sudden increase in intracranial pressure secondary to obstruction by mass

• Head trauma

• Other causes of hypoglycemia
• Ketoacidosis
• Hyperammonemic states

Question: Assess the quantity and time of ingestion
Significance: May help in determining expected blood level and the development of additional symptoms.

Question: Other possible ingestions?
Significance: Concurrent ingestions are common and effects can vary as well as treatment.

Question: Did the ingestion occur as an intentional or unintentional act?
Signficance: Assess risk of suicidal ideation

Question: Past medical problems?
Significance: Because alcohol may exacerbate underlying conditions (e.g., diabetes, liver disease, renal failure), it is important to obtain a history on past medical problems.

Question: When did the patient last eat?
Significance: Determines the risk for aspiration.

Finding: Complete neurologic examination
Significance: Assesses level of consciousness, ability to protect airway

Finding: Signs of trauma
Significance: Head trauma can occur concurrently or mimic symptoms of ethanol intoxication. Falls and motor vehicle accidents are also common secondary problems.

Test: Estimated peak ethanol level
Significance: Calculated as mg ingested/(volume of distribution × body weight), where volume of distribution is 0.6 L/kg in adults and 0.7 L/kg in children

Test: Drug screen
Significance: Usually includes drugs of abuse, antidepressants, benzodiazepines, and others.

Test: Electrolytes, glucose, renal function (BUN, creatinine), liver enzymes, arterial blood gas
Significance: Dehydration, hypoglycemia, renal impairment, liver toxicity, metabolic and respiratory acidosis can occur.

• ABCs (airway, breathing, circulation); life support measures including mechanical ventilation may be required.
• Gastric lavage if within 30 to 60 minutes of ingestion (do not induce emesis because of CNS depression).
• Activated charcoal if ingestion of other substances suspected; not useful in alcohol intoxication alone.
• Treat hypoglycemia with IV dextrose. Treat until clinically stable and blood ethanol level is <50 mg/dL.
• Treat dehydration and hypotension with intravenous fluids.
• Monitor for hypothermia.
• Hemodialysis may be required if levels exceed 300 to 350 mg/dL.
• No specific antidote exists

• If ingestion was intentional, psychiatric evaluation is highly recommended.
• Accidental ingestions require parental education about child safety.

• Child safety caps on medicine bottles
• Locks on medicine and liquor cabinets
• Avoid purchasing medicines containing alcohol for use by children

Ernst AA, Jones K, Nick TG, Sanchez J. Ethanol ingestion and related hypoglycemia in a pediatric and adolescent emergency department population. Acad Emerg Med 1996;3(1):46–49.

Leung AK. Ethyl alcohol ingestion in children. Clin Pediatr 1986;25(12):617–619.

Raroque SSU, Weibe, RA. Household products and environmental toxins. In: Levin DL, Morriss, FC, eds. Essentials of pediatric intensive care, 2nd ed., New York: Quality Medical Publishing and Churchill Livingston. 1997:922–923.

Rodgers GC, Matyunas NJ. Handbook of common poisonings in children, 3rd ed. Committee on Injury and Poison Prevention. Evanston, Illinois: American Academy of Pediatrics, 1994:149–152.