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Alcohol-based hand sanitiser: a potentially fatal toy

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We present a case of acute ethanol toxicity in a preschool child who developed depressed mental status and hypotension and required inotrope support as a result of ingesting an alcohol-based hand sanitiser

Clinical record

In September 2014, a 3-year-old girl was brought by her parents to the emergency department (ED) with an acutely altered level of consciousness. The history from the parents stated that the young girl had been playing with an alcohol-based hand sanitiser (ABHS; 70% ethanol, 375 mL [Figure]) with her 1-year-old sibling while the parent was in the room. Ingestion of the ABHS had not been witnessed.

On assessment she had a patent airway, a respiratory rate of 18 breaths/min, an oxygen saturation level of 96% on room air, heart rate of 97 beats per minute, blood pressure of 95/54 mmHg and a temperature of 35.5°C. Her Glasgow coma scale (GCS) score was 10/15 (motor response, 5; verbal response, 3; eye response, 2). Her eyes showed alternating disconjugate gaze, with pupils equally constricted at 2 mm. Her pupils dilated in response to noxious stimuli (eg, trapezius squeeze test). The patient’s medical history included normal development, no infectious contacts, and she was fully vaccinated and had no surgical history. No odour of ethanol was appreciated on her breath or her clothing. Her 1-year-old sibling was behaving normally.

A blood glucose test at….