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Consider Hand Sanitizer Ingestion in Children With Unexplained Alcohol Toxicity

ATLANTA – When examining pediatric patients presenting with clinical signs and symptoms consistent with alcohol toxicity – nausea, vomiting, respiratory depression, and drowsiness or laboratory results consistent with ethanol or isopropanol toxicity – emergency physicians might ask about the possibility of alcohol hand sanitizer ingestion.

An article in the Morbidity and Mortality Weekly Report notes that many hand sanitizers contain up to 60–95% ethanol or isopropyl alcohol by volume, and often are combined with scents that might be appealing to young children.

The review, led by researchers from the national Centers for Disease Control and Prevention (CDC) and the Emory University School of Medicine, both in Atlanta, cites recent reports identifying serious consequences for young children who swallowed alcohol-based hand sanitizer. Those include apnea, acidosis, and coma.

Based on data reported to the National Poison Data System (NPDS), ingestion was the major route of exposure for both alcohol and non-alcohol hand sanitizers, with most intentional ingestion occurring in children 6-12 years of age.

In 2005, the annual rate of intentional alcohol hand sanitizer exposure was 0.68 per 1 million U.S. residents, the CDC reports, adding that, from 2005-2009, the rate increased, on average, by 0.32 per 1 million per year.


“Young children, including infants, are more likely to develop complications from alcohol intoxication than are older children and teens,” the researchers explain. “Younger children have decreased liver glycogen stores, which increase their risk of developing hypoglycemia, and have various pharmokinetic factors, which make them more susceptible to developing toxicity from alcohol.”

During 2011-2014, 70,669 hand sanitizer exposures in children 12 years of age or younger were reported to NPDS, including 65,293 (92%) alcohol exposures, and 5,376 (8%) nonalcohol exposures. Overall, 64,488 (91%) exposures occurred in children ages 5 years and younger, and 6,181 (9%) occurred in children ages 6-12 years. There was no association between sanitizer type and year.

The study points out that, among all children, ingestion accounted for approximately 95% of reported exposures, including 97% of exposures among children 5 years of age and younger, and 74% among children 6-12 years old. While a higher percentage of older children (aged 6-12 years) had intentional exposures to alcohol hand sanitizers,15%, than to nonalcohol hand sanitizers, 8%, that association was not found in children 5 years of age and younger.

The researchers add that ocular exposures to hand sanitizers were more common in older children – 24.8% overall, 24.4% alcohol, and 29.0% nonalcohol – than among younger children – 3.0% overall, 3.0% alcohol, and 3.2% nonalcohol.

In fact, the most common adverse health effects for both hand sanitizer types were ocular irritation (2,577; 31.4%), followed by vomiting (1,872; 22.8%), conjunctivitis (862; 10.5%), oral irritation (782; 9.5%), cough (705; 8.6%), and abdominal pain (323; 3.9%). Rare health effects included coma (five), seizures (three), hypoglycemia (two), metabolic acidosis (two), and respiratory depression (two).

The report notes that schools might be contributing unknowingly to the problem because many require or ask children to purchase and carry hand sanitizer. Study authors suggest that could help explain why, among older children, exposures occur less frequently during the summer months.