Infants and young children exposed to ethanol often present with mixed clinical signs and symptoms that may not fit the traditional ethanol toxidrome, making it a challenging diagnosis in the ED.
Unintentional or exploratory ingestion of ethanol or ethanol-containing substances is a common means of exposure for young children. A potentially vexing problem for emergency physicians is that clear alcoholic beverages, such as vodka or gin, may be mistaken for water and used to reconstitute infant formula or to dilute juice. (Pediatr Emerg Care. 2019;35:722; J Emerg Med. 2014;47:524.) The risk for this injury mechanism increases when ethanol is stored in an accessible site, such as a refrigerator, or transferred to another container that is not labeled.
Breastfeeding infants whose mothers consume ethanol are at risk of exposure. Breast milk alcohol levels generally parallel maternal blood alcohol levels (Pediatr Emerg Care. 2019;35:722; U.S. National Library of Medicine. TOXNET. LACTMED: Alcohol. CAS RN: 64-17-5; http://bit.ly/2u24wXw), and the magnitude of exposure correlates with maternal alcohol intake and infant breastfeeding frequency.
Infants who nurse after their mothers have consumed as few as one or two alcoholic beverages have been observed to have decreased feeding efficiency, agitation, and poor sleep. Maternal ingestion of larger quantities of ethanol while breastfeeding has led to clinically significant intoxication of infants, including altered mental status, decreased reflexes, and gastrointestinal manifestations.
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