Accidental Ethanol Ingestion in a 32 Day Old Infant

Abstract

Alcohol exposure can occur in all age groups but occurs much less commonly in infants. Prior studies have shown that no level of alcohol exposure is safe, and can affect the brain and other areas of development. We report a 32 day old previously healthy male who presented to an outside hospital early morning for "not acting normal". Earlier that morning, mom had fed him 3 ounces of formula mistakenly prepared with a clear liquid thought to be water, but later confirmed to be gin. The baby was mildly agitated on arrival, and the blood alcohol level 4 hrs postingestion was 230 mg/dl. This is one of the youngest documented cases of alcohol ingestion, and was remarkable for having a mild course with normal vital signs and electrolytes, and a non-focal physical exam. This case highlights the importance of having a high level of suspicion for alcohol exposure and a low threshold for checking blood ethanol levels in infants presenting with altered mental status, as there may be no hallmark signs, symptoms, or electrolyte abnormalities. Keywords: Ethanol; Bayley scales; Intoxication CaseWe report a case of a 32 day old previously healthy male who presented to an outside hospital in the early morning with chief complaint of "not acting normal". The mother reported that she woke up at 4am and prepared a 4 ounce bottle of formula with Enfamil and water for the baby, and the baby drank 3 ounces of the formula. Approximately an hour later, she observed that the baby was not acting right [1]. The baby was having excessive oral secretions, shaking his arms up and down, and was agitated. The father later recalled that he had left clear undiluted gin that he had shared with his friend earlier that evening in a disposable water bottle on the nightstand next to the formula powder. Waking up in the middle of the night and mistaking it for water, the mother then used the alcohol while mixing the patient's formula. The patient was immediately taken to an outside hospital.On arrival, the patient was afebrile with a heart rate of 150, respiratory rate of 28, temperature of 97.7, and oxygen saturation of 99%. Initial exam revealed a mildly agitated, somewhat somnolent male who appeared well hydrated. No obvious craniofacial abnormalities suggestive of Fetal Alcohol Syndrome. Head was atraumatic with a flat anterior fontanelle, and pupils were bilaterally equal, round, and reactive to light. Respirations were nonlabored and lungs were clear to auscultation bilaterally. Cardiac and abdominal exams were normal. Skin was warm and well perfused without bruises or lesions. Review of other systems yielded negative results. The mother denied any alcohol use during pregnancy or post-partum. Initial labs were drawn 3.5 hrs after ingestion of alcohol. His serum electrolytes, blood urea nitrogen, creatinine, bicarbonate, and glucose were within reference ranges. Blood alcohol level at 4 hrs post ingestion was 230 mg/dl and at 5 hrs 15 minutes was 211 mg/dl. Our institution was contacted as a tertiary care referral center and he was subseque...

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