TOXBASEŽ - Updated 06/2003

N.B. Basildon reports Ethanol levels in mg/dL

 

Type of product:

Pure ethanol is a colourless liquid with a burning taste. It is used industrially as a solvent and in the manufacture of detergents, cosmetics and perfumes. It has wide recreational use.

 

Synonyms:

Alcohol, ethyl alcohol, grain alcohol, rectified spirit

 

Concentrations:

Beverage	Alcohol by volume (approximate)	Alcohol (mg/mL)	Serving	Alcohol (g) per serving
Spirits	40%	316	25 mL/35 mL	7.9/11
Beer	5%	39.5	545 mL	21.5
Wine	13%	103	175 mL/250 mL	17.9/25.6

Toxicity:

Ethanol is rapidly absorbed from the GI tract. Adults absorb 80-90% of ingested alcohol within 1 hour and metabolise it at a rate of 7-15 g per hour (reducing blood concentrations by approximately 150-200 mg/L (15-20 mg/dL) per hour).

The fatal dose in adults is approximately 5-8 g/kg body weight (6-10 mL/kg absolute ethanol).
The fatal dose in children is approximately 3 g/kg body weight (4 mL/kg absolute ethanol).

A blood concentration of 1.8 g/L (0.18 g/dL, 180 mg/dL, 39 mmol/L) would usually cause intoxication and concentrations of 3.5 g/L (0.35 g/dL, 350 mg/dL, 76 mmol/L) are associated with stupor and coma. Concentrations of > 4.5 g/L (0.45 g/dL, 450 mg/dL, 98 mmol/L) are often fatal.

Inhalation is not likely to cause problems unless concentrations are high. Irritating to eyes and skin.

 

NHS Direct /NHS 24/Primary Care

All children with features of intoxication should be referred to hospital.

Ethanol - features and management

Updated 6/2003

 

Features:

Ingestion:
Mild - concentration <1.8 g/L (0.18 g/dL, 180 mg/dL, 39 mmol/L)
Impaired visual acuity, reaction time and co-ordination. Emotional lability may occur.

Moderate - concentrations 1.8-3.5 g/L (0.18-0.3.5 g/dL, 180-350 mg/dL, 39- 76 mmol/L)
Slurred speech, diplopia, blurred vision, ataxia, inco-ordination, blackouts, sweating, tachycardia, nausea, vomiting and incontinence.
Acidosis (especially in children), hypoglycaemia and hypokalaemia may occur.
Hypoglycaemia may be delayed up to 36 hours in previously fasted or malnourished individuals.

Severe - concentrations 3.5-4.5 g/L (0.35-0.45 g/dL, 350-450 mg/dL, 76-98 mmol/L)
Cold clammy skin, hypothermia, hypotension, stupor, coma, dilated pupils, depressed or absent tendon reflexes.

Severe hypoglycaemia, convulsions, respiratory depression and metabolic acidosis may occur.

Cardiac arrhythmias such as atrial fibrillation and atrioventricular block have been recorded.

Potentially fatal - concentration > 4.5g/L (0.45 g/dL, 450 mg/dL, 98 mmol/L)
Deep coma, respiratory depression or arrest and circulatory failure.

Inhalation:
Ethanol inhalation causes irritation of the nose and throat with choking and coughing at higher concentrations.

Eyes: Stinging, burning and lacrimation.

Skin: Burning and stinging.

 

Management:

1. Ensure a clear airway and adequate ventilation, particularly in obtunded patients. Ventilation may be required for respiratory depression.

2. Gut decontamination is unlikely to be of benefit since ethanol is rapidly absorbed and activated charcoal does not significantly reduce the rate of absorption.

3. Observe for at least 4 hours if >0.4 mL/kg body weight of absolute ethanol had been ingested in a child (i.e. 1 mL/kg 40% spirit, 4 mL/kg 10% wine or 8 mL/kg 5% beer).

Observe adults with features of moderate or severe toxicity for a minimum of 4 hours.

4. Monitor pulse, blood pressure and body temperature.

5. Monitor blood glucose in all patients.

6. Measure urea, electrolytes, arterial blood gases and blood ethanol concentration in patients with features of moderate to severe toxicity and perform 12 lead ECG.

7. Correct hypoglycaemia as quickly as possible. If the patient is awake give oral glucose. If the patient is drowsy or unconscious give up to 500 mL 5% or 250 mL 10% dextrose IV (titrated to patient responsiveness). 50 mL 50% dextrose IV may be given but is irritant to veins and can cause skin necrosis in cases of extravasation. 5% or 10% is equally effective. Smaller quantities of glucose (0.5-1 g/kg) are required in children (e.g. 5-10 mL/kg of 10% dextrose IV. Glucagon is rarely effective.
NB Chronic alcohol abusers must also be given thiamine intravenously.

8. Correct hypotension by raising the foot of the bed and/or by expanding the intravascular volume. If severe hypotension persists despite the above measures consider use of inotropes such as dopamine (2-10 micrograms/kg body weight/minute) or dobutamine (2.5-10 micrograms/kg body weight/minute).

9. If hypothermic, rewarm slowly using conventional means.

10. Control convulsions with intravenous diazepam (0.1-0.3 mg/kg body weight) or lorazepam (4mg in an adult and 0.05 mg/kg in a child). Correct acid base and metabolic disturbances. Phenytoin (loading dose 15mg/kg IV infusion in adults and children) may be useful if fits are unresponsive to above measures.

If seizures persist consider the need for intubation, paralysis and ventilation (remember that there may continue to be cerebral activity and measures to control this will require active management).

11. Consider haemodialysis if blood ethanol concentration > 5g/L (0.5 g/dL, 500 mg/dL, 108.5 mmol/L) or if arterial pH <7.0 (H+ > 100 nmol/L). Discuss with your local poisons service: in the UK NPIS 0870 600 6266, in Ireland NPIC (01) 809 2566.

Inhalation: Symptomatic and supportive treatment only.

Eye irritants

Updated 5/2002

 

Features:

This product is expected to be pH neutral but may be irritating to the eyes causing an immediate stinging and burning sensation with lachrymation.

 

Management:

If symptomatic, immediately irrigate the affected eye thoroughly with water or 0.9% saline for at least 10-15 minutes. If symptoms persist check for corneal damage by instillation of fluorescein and refer for ophthalmological assessment if necessary.

End

Skin decontamination - solvents

10/96

SAFETY FIRST

• Avoid contaminating yourself. Wear protective clothing.
  
• Do NOT allow smoking nearby. There may be a risk of fire.
  
• Carry out decontamination in a well-ventilated area, preferably with its own ventilation system.
  
• The patient should remove soiled clothing and wash him/herself if possible.
  
• Put soiled clothing in a sealed container to prevent escape of of volatile substances.
  
• Wash hair and all contaminated skin with liberal amounts of water (preferably warm) and soap.
  
• Pay special attention to skin folds, fingernails and ears.