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Hand Sanitzer Poisoning: A Real Case and Discussion

A Case Report presented at the 2007 North American Congress of Clinical Toxicology Annual Meeting, New Orleans

Sell KA. Hand Sanitizer Exposure in a Two Year Old with a Documented High Blood Ethanol Level

The Hennepin Regional Poison Center in Minneapolis was contacted by a parent 10 minutes after an exposure to an ethanol-based hand sanitizer (EBHS) by a two year old female. The child accessed the product while in a bathroom and only a small amount of the substance was likely to have been ingested per the parent’s report.

The child was reported to be sedated, had trouble walking, and her eyes were described as “glassy” by the parent and the child’s breath smelled of the product. Based on the child’s decreasing level of consciousness and history, the child was referred to an emergency department for assessment and care.

The poison center contacted the receiving emergency department and recommended a blood alcohol level, blood sugar check and observation. The child appeared intoxicated on arrival to the emergency department and did not react to pain when blood sample was drawn.

Within a few hours the child was discharged to home and the emergency department reported the child had a measured blood ethanol level of 0.1% (100mg/dL) (the legal driving limit is 0.08% or 80mg/dL).
Discussion: Children and Ethanol-Based Hand Sanitizers (EBHS)

EBHS are beneficial for killing germs on hands but like any substance placed on a child’s hands, they will likely end up in their mouths.

Many hand sanitizers contain 62% ethanol, and by comparison, most brands of hard liquor (whiskey, etc.) are 40-50% ethanol.

The main poisoning concern regarding EBHS is from people drinking these products. Ingestion of an EBHS can lead to ethanol intoxication and have all the same signs and symptoms of ethanol intoxication that results from drinking beer, wine or mixed drinks.

How Much EBHS Is Too Much?

Skin exposure

  • A single lick of a hand sanitizer that has been spread on the hands is unlikely to cause intoxication or produce symptoms more than irritation of the mouth and tongue.
  • Ethanol intoxication by absorbing the ethanol through intact skin is highly unlikely.
  • Repeated applications of EBHS to non-intact skin (i.e. burns, abrasions) can lead to absorption of ethanol. However, it is likely that the irritant effects of the EBHS would lead to stopping the application of the EBHS before a significant amount of ethanol could be absorbed.

Ingestion

  • A hand sanitizer pump dispenses approximately 2.5 mL of liquid.
  • If one pump of a 62% ethanol-containing hand sanitizer was ingested by an average 2 year old weighing 15 kg (33 lbs), a blood alcohol level of 17.3 mg/dL would be expected, considerably below a toxic level of 80-100 mg/dL.  Symptoms of ethanol intoxication in children can begin at a level of 50mg/dL.
  • The same child would have to drink approximately 4-5 teaspoons of the sanitizer to produce toxic effects requiring medical attention (data from the Texas Poison Control Network).

What are the signs and symptoms of ethanol intoxication in a child?

  • Irritability, dizziness, nausea, vomiting, unsteady gait, loss of muscle control, and sleepiness.
  • Severe ethanol intoxications can lead to coma, respiratory arrest and death.
  • Children who are intoxicated with ethanol are particularly susceptible to dropping their blood sugar and can suffer the effects of low blood sugar (irritability, seizure, coma, death).

What To Do If My Child Drinks Some EBHS?

If hand sanitizer is swallowed (or splashed in eyes), contact your local Poison Control Center at 1-800-222-1222 for advice.

How can this type of poisoning be prevented?

  • Washing hands with soap and water for 20 seconds is the best way to remove dirt and germs from the hands and is preferred to the use of EBHS. However, EBHS are an excellent choice when there is no access to soap and water (such as field trips, etc.).
  • If used, apply a dime sized amount to dry hands
  • Rub hands together until completely dry
  • EBHS should be kept out of reach of children in the same way that prescription drugs and other chemicals are.