A young child is brought to you after accidentally drinking a shot of alcohol at a wedding party. Here is what you need to consider:
Infants and young children who have ingested enough ethanol to cause a peak serum level ≥50 mg/dL (11 mmol/L) are at risk for profound hypoglycemia, in addition to the other effects of alcohol seen in adults The key is that the dangerous serum level is MUCH lower in children than in adults, and children require FAR smaller volume than what may be considered dangerous by adults.
Supportive care is the key to good outcomes, with particular focus on treating hypoglycemia - check your D-sticks early and often.
Consider child protective services involvement in every case of pediatric intoxication, and consider measurement of serum acetaminophen levels as well as other possible toxic ingestion candidates.
Activated charcoal cannot adsorb ethanol and should only be used if other substances are being considered.
Children who are asymptomatic for six hours, and have a safe home environment, may be discharged.
References
Chyka, PA, Seger, D. Position statement: single-dose activated charcoal. American Academy of Clinical Toxicology; European Association of Poisons Centres and Clinical Toxicologists. J Toxicol Clin Toxicol 1997; 35:721.
Morgan, DL, Durso, MH, Rich, BK, Kurt, TL. Severe ethanol intoxication in an adolescent. Am J Emerg Med 1995; 13:416.
Vogel, C, Caraccio, T, Mofenson, H, et al. Alcohol intoxication in young children. J Toxicol Clin Toxicol 1995; 33:25.
