International Journal of Case Reports and Images - IJCRI - Case Reports, Case Series, Case in Images, Clinical Images

   
Case Report
 
Poisoning from alcohol based hand sanitizer in a hospitalized patient
Madhavi Katikaneni1, Hugo Villanueva1
1M.D, Montefiore Medical center-Wakefield Campus, Attending physician, Nephrology, Bronx, New York, U.S.A.

doi:10.5348/ijcri-201608-CR-10595

Address correspondence to:
Madhavi Katikaneni
4141 carpenter avenue
Bronx, NY
USA

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How to cite this article
Katikaneni M, Villanueva H. Poisoning from alcohol based hand sanitizer in a hospitalized patient. Int J Case Rep Images 2016;7(1):40–42.


Abstract
Introduction: Alcohol based hand sanitizers help to decrease infection rates in hospitals. They contain isopropanol (isopropyl alcohol) or ethanol (ethyl alcohol) in high concentrations, and are easily accessible to patients and staff in health care settings.
Case Report: A 31-year-old female with history of alcohol abuse, seizure disorder and depression presented with symptoms of alcohol intoxication. Initial laboratory results were normal except an ethanol level of 311 mg/dl. She was admitted to the detoxification unit for ethyl alcohol intoxication. It was noted by the staff that she was trying to drink from the wall mounted hand sanitizers and was also seen sucking on alcohol wipes intermittently. On the third day in the detoxification unit, she was found to have lethargy, disorientation, tachycardia, hypotension, and tachypnea. She was given intravenous fluids and intubated for airway protection and transferred to intensive care unit. Laboratory tests showed normal pH, negative anion gap, normal glucose, large serum ketone, measured serum osmolality 340 mOsm/kg, osmolal gap 53 mOsm/kg, ethanol 13 mg/dl. She was treated for supraventricular arrhythmia, aspiration pneumonia. She did not require hemodialysis as acute kidney injury was mild, and osmolal gap and ketones came down with supportive care. Subsequently, she was extubated and recovered completely.
Conclusion: Alcohol based hand sanitizers should be used carefully under surveillance in detoxification and psychiatric units. Poisoning due to isopropanol can be managed effectively if recognized early. Elevated osmolal gap, absence of acidosis, and positive ketones are important clues which help in diagnosing isopropanol poisoning.

Keywords: Alcohol, Hand sanitizer, Isopropyl alcohol poisoning, Osmolal gap, Poisoning


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Author Contributions
Madhavi Katikaneni – Substantial contributions to conception and design, Acquisition of data, Analysis and interpretation of data, Drafting the article, Revising it critically for important intellectual content, Final approval of the version to be published
Hugo Villanueva – Substantial contributions to conception and design, Drafting the article, Revising it critically for important intellectual content, Final approval of the version to be published
Guarantor of submission
The corresponding author is the guarantor of submission.
Source of support
None
Conflict of interest
Authors declare no conflict of interest.
Copyright
© 2016 Madhavi Katikaneni et al. This article is distributed under the terms of Creative Commons Attribution License which permits unrestricted use, distribution and reproduction in any medium provided the original author(s) and original publisher are properly credited. Please see the copyright policy on the journal website for more information.



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