3 Things You Should Know About Ingestion of Alcohol-Based Hand Sanitizer

MARCH 07, 2017
Ingestion of alcohol-based hand sanitizer can cause serious adverse effects in children, which may include apnea, acidosis, and coma. Many hand sanitizers contain up to 60%-95% ethanol or isopropyl alcohol by volume and are often packaged in brightly colored bottles with scents that are appealing for young children.1 Unfortunately, this can lead to both accidental and intentional ingestion among children.  Pharmacists can play an important role in counseling patients on appropriate use and storage of hand sanitizers.  Check out these 3 important points regarding ingestion of alcohol-based hand sanitizers:
  1. Recent report demonstrates adverse effects are occurring in young children.
The Centers for Disease Control and Prevention (CDC) studied data reported to the National Poison Data System to analyze adverse effects in children 12 years of age and younger associated with exposure to alcohol-based hand sanitizer.1 The study found that 70,669 exposures to alcohol and nonalcohol hand sanitizers were reported between 2011-2014.1 Most (90%) exposures occurred in children 0-5 years of age through oral ingestion.1 Children 6-12 years of age had more intentional exposures of alcohol hand sanitizers. The most common adverse effects included eye irritation (31.4%) and vomiting (22.8%).1 Conjunctivitis, oral irritation, cough, and abdominal pain were also reported.  Rare side effects included coma, seizures, hypoglycemia, metabolic acidosis, and respiratory depression.
 
This CDC report sheds light on the fact that alcohol hand sanitizers may be abused by children. Pharmacists can play an important role in educating parents and children on the dangers of ingestion. 
 
  1. Educate parents and teachers on appropriate storage of hand sanitizers.
These products should be kept out of reach of children and used only with adult supervision. Children can be at risk for alcohol poisoning if any more than a taste of hand sanitizer is ingested. Symptoms of alcohol poisoning include confusion, vomiting, drowsiness, respiratory arrest, and death. Most hand sanitizer products contain over 60% ethyl alcohol, which is a stronger alcohol concentration than most hard liquors.2 Wine and beer contain approximately 10-15% and 5-10% alcohol, respectively.2 
 
Keep in mind that a hand sanitizer pump dispenses about 2.5 ml of liquid.3 If an average 2-year-old child weighing 33 pounds (15 kg) ingested one pump of a 62% alcohol-based hand sanitizer, then a blood alcohol level of 17.3 mg/dL would be expected. This is below a toxic level of 80-100 mg/dL. The same child would have to drink about 4-5 squirts of the sanitizer to cause toxic effects requiring medical attention.3 Hand sanitizers produce a burning sensation when swallowed, which can prevent children from ingesting harmful amounts. However, some children will drink anything or they may be abusing the products. Educate parents and teachers to contact the Poison Help Line at 1-800-222-1222 immediately if they suspect their child has ingested hand sanitizer.
 
  1. Discuss appropriate use of hand sanitizers.
Instruct patients to apply a dime-sized amount to dry hands and rub the hands together until completely dry.  Children should avoid placing hands wet from sanitizer in their mouths. Remind patients that washing hands with soap and water is the best way to reduce the number of germs  Alcohol-based hand sanitizer should only be used if soap and water are not available.

References
  1. Santos C, Kieszak S, Wang A, et al.  Reported Adverse Health Effects in Children from Ingestion of Alcohol-Based Hand Sanitizers-United States, 2011-2014.  MMWR Morb Mortal Wkly Rep. 2017;66:223-226. doi;http://dx.doi.org/10.15585/mmwr.mm6608a5.   
  2. Hand sanitizer.  AAPCC website.  http://www.aapcc.org/alerts/hand-sanitizer/.  Accessed March 2, 2017.
  3. Hand sanitizers: how toxic are they?  Texas Poison Center Network website.  http://poisoncontrol.org/hand-sanitizers-how-toxic-are-they/.  Accessed March 3, 2017.


Jennifer Gershman, PharmD, CPh
Jennifer Gershman, PharmD, CPh
Jennifer Gershman, PharmD, CPh, received her PharmD degree from Nova Southeastern University (NSU) College of Pharmacy in 2006 and completed a 2-year drug information residency. She served as a pharmacy professor at NSU’s College of Pharmacy for 6 years, managed the drug information center, and conducted medication therapy management reviews. Dr. Gershman has published research on prescription drug abuse, regulatory issues, and drug information in various scholarly journals. Additionally, she received the Sheriff’s Special Recognition Award for her collaboration with the Broward, Florida Sheriff’s Office to prevent prescription drug abuse through a drug disposal program. She has also presented at pharmacist and physician continuing education programs on topics that include medication errors, prescription drug abuse, and legal and regulatory issues. Dr. Gershman can be followed on Twitter @jgershman2
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