title: Severe alcohol hand rub overdose inducing coma, watch after H1N1 pandemic.
abstract: BACKGROUND
  Alcoholic hand rubs (AHRs) have been proven effective in preventing nosocomial infections, and healthcare authorities include AHRs use among quality-of-care criteria. Since the onset of the influenza A (H1N1) pandemic, AHRs have gained considerable popularity among the general public.
  
  
  METHODS
  We report a case of intentional AHRs self-poisoning inducing rapid coma with hyperlactatemia, and a full recovery. The relevant literature was reviewed. To our knowledge, this is the third reported case of intentional AHRs poisoning. 3 patients presented with a picture of acute alcohol intoxication, of variable severity depending on the amount ingested and speed of ingestion.
  
  
  RESULTS
  The blood alcohol level was 414 mg/dl and tests for other drugs were performed 30 min after admission. The blood lactate level increased briefly to 4.8 mmol/l, without renal or hepatic function disturbances. She regained consciousness after 6 h then achieved a full recovery allowing extubation and readmission to the psychiatric ward after 24 h. She reported gulping down the entire contents of the Aniosgel bottle.
  
  
  CONCLUSIONS
  Whereas overdrinking in social settings (wine and liquor) leads to a gradual increase in blood alcohol levels, AHRs poisoning is usually characterized by a sudden massive alcohol load. The unusual nature of the alcohol source may lead to diagnostic wanderings. AHRs are currently available in bottles that facilitate the ingestion of large amounts. Unit-dose packaging or dispensing might decrease the risk of AHRs poisoning.
authors.affiliation: Service de Réanimation, Centre Hospitalier de Versailles, 177 Rue de Versailles, 78157 Le Chesnay, France. mhenry-lagarrigue@ch-versailles.fr
authors.forename: Matthieu
authors.initials: M
authors.lastname: Henry-Lagarrigue
authors.forename: Magali
authors.initials: M
authors.lastname: Charbonnier
authors.forename: Fabrice
authors.initials: F
authors.lastname: Bruneel
authors.forename: Stéphane
authors.initials: S
authors.lastname: Legriel
authors.forename: Gilles
authors.initials: G
authors.lastname: Troche
authors.forename: Hager
authors.initials: H
authors.lastname: Ben Mokhtar
authors.forename: Aihem
authors.initials: A
authors.lastname: Yehia
authors.forename: Pierre
authors.initials: P
authors.lastname: Guezennec
authors.forename: Jacques
authors.initials: J
authors.lastname: Merrer
authors.forename: Catherine
authors.initials: C
authors.lastname: Palette
authors.forename: Jean-Pierre
authors.initials: JP
authors.lastname: Bedos
mesh_terms: D000328:Adult; D000435:Alcoholic Intoxication / Q000097:blood / Q000209:etiology*; D003128:Coma / Q000097:blood / Q000139:chemically induced*; D003428:Cross Infection / Q000517:prevention & control* / Q000635:transmission; D004196:Disease Outbreaks; D004202:Disinfectants / Q000506:poisoning*; D062787:Drug Overdose / Q000097:blood / Q000209:etiology*; D000431:Ethanol / Q000097:blood / Q000506:poisoning*; D005260:Female; D006235:Hand Disinfection; D006801:Humans; D053118:Influenza A Virus, H1N1 Subtype; D007251:Influenza, Human / Q000517:prevention & control* / Q000635:transmission; D019344:Lactic Acid / Q000097:blood; D009460:Neurologic Examination / Q000187:drug effects; D013406:Suicide, Attempted
chemical_list: D004202:Disinfectants; D019344:Lactic Acid; D000431:Ethanol