What are the adverse effects of ethanol used as an antidote in the treatment of suspected methanol poisoning in children?
BACKGROUND
Ethanol used as an antidote is said to have various adverse effects, particularly in children. The rate of these adverse effects is not known.


METHODS
Twenty-one-year retrospective chart review (1980-2000) from suspected methanol poisoning patients treated with ethanol in two large pediatric tertiary care centers.


RESULTS
A total of 60 children (median age of 24 months) received ethanol for suspected methanol poisoning: 39 orally and 21 intravenously. Median initial methanol level was 4.16 mmol/L (13.3 mg/dL) (range 0 to 87.5 mmol/L or 0 to 280 mg/dL). Median duration of ethanol treatment was 16 hours (range 1.5 to 72 hours). None [0% (95% CI 0-5%)] of the 60 patients developed symptomatic hypoglycemia. Of the 50 patients that had a glucose level measured, none [(0% [95% CI 0-6%)] had a serum glucose concentration < 2.78 mmol/L (< 50 mg/dL). Eight patients [16% (95% CI 8-30%)] had at least one serum glucose concentration between 2.78-3.61 mmol/L (50-65 mg/dL), but none of those had symptoms compatible with hypoglycemia. A total of 42 patients [84% (95% CI 70-92%)] had all their serum glucose concentrations > 3.61mmol/L (> 65 mg/dL). There was no identifiable difference in the glucose intake between the serum glucose concentration groups. Six out of the 60 patients [10% (95% CI 4-21%)] were described as more drowsy after ethanol but none was comatose or needed intubation. No child showed signs of hypothermia [0/40 (95% CI 0-8%)] (rectal temperature < 35 degrees C), hepatotoxicity (0/12) (AST or ALT > 100 U/L) or even thrombophlebitis (0/21). None of the 22 patients with toxic levels of methanol (> or = 26.2 mmol/L- > or = 20 mg/dL) died or had ethanol-induced morbidity despite wide variation in ethanol levels.


CONCLUSIONS
The rate of clinically important adverse effects related to ethanol used as an antidote to treat methanol poisoning in children was either absent or low in a tertiary care pediatric hospital setting. There was no morbidity or mortality associated with ethanol when it was used despite wide variation in ethanol levels. These results suggest that with appropriate monitoring and intravenous glucose intake in a controlled environment such as a pediatric intensive care unit, ethanol therapy does not carry as many risks as currently believed.
Division of Emergency Medicine, Department of Pediatrics, Hôpital Ste-Justine, Université de Montréal, Montréal, Quebec, Canada.
Michel
M
Roy
Benoit
B
Bailey
Dominic
D
Chalut
Pierre-Etienne
PE
Senécal
Pierre
P
Gaudreault
D000293:Adolescent; D000931:Antidotes / Q000008:administration & dosage / Q000009:adverse effects* / Q000627:therapeutic use*; D001639:Bicarbonates / Q000378:metabolism; D001786:Blood Glucose / Q000378:metabolism; D002648:Child; D002675:Child, Preschool; D003243:Consciousness / Q000187:drug effects; D000431:Ethanol / Q000008:administration & dosage / Q000009:adverse effects* / Q000627:therapeutic use*; D005260:Female; D006801:Humans; D007003:Hypoglycemia / Q000097:blood / Q000139:chemically induced; D007223:Infant; D007275:Injections, Intravenous; D008297:Male; D000432:Methanol / Q000506:poisoning*; D012189:Retrospective Studies; D016896:Treatment Outcome
D000931:Antidotes; D001639:Bicarbonates; D001786:Blood Glucose; D000431:Ethanol; D000432:Methanol