Poisoning from alcohol based hand sanitizer in a hospitalized patient

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. (This page in not part of the published article.) International Journal of Case Reports and Images, Vol. 7 No. 1, January 2016. ISSN – [0976-3198] Int J Case Rep Images 2016;7(1):40–42. www.ijcasereportsandimages.com Katikaneni et al. 40 CASE REPORT OPEN ACCESS Poisoning from alcohol based hand sanitizer in a hospitalized patient Madhavi Katikaneni, Hugo Villanueva