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- Acute ethanol poisoning causes dose related CNS depression which can be life threatening
- Younger children are more sensitive to CNS and hypoglycaemic effects
- Consider co-ingestion in deliberate self-poisoning
- Treatment is supportive
- Psychosocial issues need to be considered before discharge
Ethanol dose can be estimated from the concentration of the substance
Light Beer 3.5% Regular Beer / Cider 5% Wine 12% Spirits 40% Perfumes/Fragrances 60% Mouthwash 25% Methylated Spirits 95%
5% = 50 mg/ml. 300 ml of Beer = 15,000 mg of ethanol
- One standard drink is approximately 10 g of ethanol
|Ethanol Dose (g/kg)||Ethanol Level||Clinical Features|
|1||22||0.10||- slurred speech
- altered conscious state
|2||44||0.20||- CNS depression|
|>5||> 88||>0.40||- airway compromise
- respiratory depression
- The legal driving limit in New Zealand is 11 mmol/L or 0.05% (g/dL) blood alcohol concentration
- Screening blood glucose level, ECG, paracetamol level for deliberate self poisoning
- Serum ethanol levels help with risk assessment (see above) but should NOT be used to explain CNS depression
- Patient should be managed in a monitored high acuity area
- Airway protection may be required with intubation and ventilation
- Hypotension is managed with intravenous fluids
- Seek and treat hypoglycaemia with iv dextrose (especially in younger children)
- Keep the patient normothermic
- Monitor for urinary retention and insert a catheter if needed
- Assess for toxic co-ingestion
- Assess for aspiration pneumonia
- Look for signs of injury, especially head injury if altered conscious state
- Assess for pressure sores and rhabdomyolysis if prolonged downtime
- Mild to moderate CNS depression can be managed in ED as a short stay admission
- Severe CNS depression may require intubation and PICU admission
- Patients can be medically cleared once co-operative, walking, eating, and passing urine
- A developmental and psychosocial assessment including mental state examination should be done once medically cleared
- Children and adolescents with suicidal ideation or other psychiatric concerns should be assessed by the on call psychiatric registrar
- ALL patients should be assessed by the ED social worker prior to discharge. If after hours, an ED short stay admission overnight and social work review in the morning is the safest approach. If this is not possible, a referral can be made using the social work folder in the ED doctor's office for follow up the next day.
Outpatient Follow Up
- CADS (Community and Alcohol Drug Service) Youth Service "Altered High" operates out of WDHB and covers WDHB, ADHB, and CMDHB
- Patients 13 - 20 years of age are eligible
- Patient consent is essential
- CADS Altered High provide harm minimisation strategies and support for anyone affected by alcohol misuse (patients, friends, families, carers)
- Operating hours are Monday - Friday 8:30am to 5:00pm
- Refer by calling the Altered High Duty Service on 09 845 1893
- Clients can self-refer by calling the same number
- Further information is available online (alteredhigh.com)
Information for families
- Toxicology Handbook, 2nd edition. L Murray, M Little, O Pascu, K Hoggett, M Cadogan.
- Ethanol Poisoning Clinical Guideline. http://www.rch.org.au/clinicalguide/guideline_index/Ethanol_Posioning. Royal Children's Hospital, Melbourne.
- The straight up guide to standard drinks. http://alcohol.org.nz/help-advice/standard-drinks/whats-a-standard-drink. Health Promotion Agency New Zealand.
Did you find this information helpful?
- Date last published: 14 April 2016
- Document type: Clinical Guideline
- Services responsible: Children’s Emergency Department
- Author(s): Marcus Chan
- Editor: Greg Williams
- Review frequency: 2 years
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