Many thanks to Pediatric Emergency Medicine Physician and Toxicologist Shan Yin for helping me out with this post and supplying the relevant information and references.
Ethanol levels are ordered for many reasons in the Pediatric Emergency Department. Perhaps the patient has altered mental status of unknown etiology. maybe they’re just super drunk? Or perhaps they are being ordered as part of a broader workup. Generally ethanol levels are reported as mg/dL. And, did you know that the method by which one lab analyzes ethanol may have a different threshold than another – even within the same facility at different care sites?
A newer chemical analyzer in use in many facilities sets the threshold for detection >10mg/dL. Older models set the threshold at 3 mg/dL. Depending on how you lab reports the data, the newer model may report a value under 10 mg/dL anywhere between 3-8 mg/dL. Anecdotally unexpected ethanol levels in this range (no or low suspicion that the patient actually ingested alcohol) have resulted in social services involvement and child abuse investigations.
- Remember, the driving limit in most states in the United States is 80 mg/dL – which is equal to 0.08%. A value of 8 mg/dL is 0.008%. Levels of 3-8mg/dL are inconsequential and would not be the cause of any alteration in mental status.
- In a study where children were given ethanol to treat a toxic alcohol poisoning, 60 children had an average peak level of 80 +/- 70 mg/dL and only 6/60 were noted to be drowsy, 0 were comatose or intubated including levels in the 200s
- There is a low level of ethanol production (By colonized bacteria and yeast) and studies looking at nondrinking adults will find levels between 0-4 mg/dL. This can be clinically relevant in children with short gut or other cases of bacterial or yeast overgrowth particularly after a high carb meal. This is called auto-brewery syndrome.
- Using ethanol based wipes could cause falsely elevated ethanol levels, but our department uses chlorhexidine. The alcohol wipes in our department are isopropyl which should not cause an ethanol level
- In a German study, fruit juices could contain ethanol up to about 0.08 g/dL and some bakery products up to 0.12 g/dL. (A Miller Lite would be 4.3 g/dL of ethanol). 240 mL (16 ounces) of 0.08 g/dL ethanol injected intravenously would be expected to produce an ethanol level of around 5 mg/dL in a 10 kg child. Obviously oral intake would not be expected to produce this level depending on the time it took to drink, food in the stomach, etc.
Goldfinger et al, A Comparison of Blood Alcohol Concentration Using Non-Alcohol and Alcohol-Containing Skin Antiseptics, Annals of Emergency Medicine, 1982.
Gorgus et al. Estimates of Ethanol Exposure in Children from Food not Labeled as Alcohol-Containing, Journal of Analytical Toxicology, 2016.
Jannsson-Nettlebladt et al., Endogenous ethanol fermentation in a child with short bowel syndrome, Acta Pediatrica, 2006.
Liebich et al, Quantification of endogenous aliphatic alcohols in serum and urine, Journal of Chroatography, 1982
Ragab et al. Endogenous Ethanol Production Levels in Saudi Arabia Residents, J Alcohol Drug Depend, 2015.
Roy et al., What Are the Adverse Effects of Ethanol Used as an Antidote in the Treatment of Suspected Methanol Poisoning in Children? Journal of Toxicology, 2003.
Tucker et al., Lack of effect on blood alcohol level of swabbing venepuncture sites with 70% isopropyl alcohol, Emergency Medicine Australasia, 2010.