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Boissière C, Bacle A, Pelletier R, Le Bouedec D, Gicquel T, Lurton Y, Le Daré B. In vitro assessment of isopropanol leakage from antiseptic barrier caps into commonly used needleless connectors. Infect Control Hosp Epidemiol 2024; 45:576-582. [PMID: 38213184 PMCID: PMC11027082 DOI: 10.1017/ice.2023.285] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2023] [Revised: 11/08/2023] [Accepted: 11/28/2023] [Indexed: 01/13/2024]
Abstract
BACKGROUND Needleless connectors (NCs) can be disinfected using antiseptic barrier caps (ABCs) to reduce the risk of catheter-related bloodstream infections. However, recent evidence suggests that isopropanol can leak from the ABC into the NC, posing concern about their safe use. We sought to determine in vitro which ABC and NC parameters influence the leakage of isopropanol through the infusion circuit. METHODS We assessed 13 NCs and 4 ABCs available in the European market. In vitro circuits consisting of an isopropanol cap, a NC, and an 11-cm catheter line were created. The circuits were left in place for 1 to 7 days at room temperature to assess the kinetics of isopropanol leakage. Isopropanol content in ABC and in circuit flushing solutions (5 mL NaCl 0.9%) after exposure to the cap were measured using gas chromatography with a flame ionization detector. RESULTS The leakage of isopropanol from the cap to the NC was dependent on the NC, but not the cap. The NC mechanism did not predict the leakage of isopropanol. The Q-Syte NC exhibited the most isopropanol leakage (7.01±1.03 mg and 28.32±2.62 mg at 24 hours and 7 days, respectively), whereas the Caresite NC had the lowest isopropanol leakage at 7 days (1.69±0.01 mg). CONCLUSION The use of isopropanol ABCs can cause isopropanol leakage into the catheter circuit according to NC parameters. Caution should be exercised when using these devices, especially in the pediatric and neonatal population.
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Affiliation(s)
- Camille Boissière
- Centre Hospitalier Universitaire de Rennes, Service Pharmacie, Rennes, France
| | - Astrid Bacle
- Centre Hospitalier Universitaire de Rennes, Service Pharmacie, Rennes, France
- University of Rennes, CHU Rennes, INSERM, EHESP, IRSET (Institut de recherche en santé, environnement et travail), Rennes, France
| | - Romain Pelletier
- Laboratoire de Toxicologie biologique et médico-légale, CHU Pontchaillou, Rennes, France
- University of Rennes, INSERM, INRAE, CHU Rennes, Institut NuMeCan (Nutrition, Metabolisms and Cancer), Réseau PREVITOX, Rennes, France
| | - Diane Le Bouedec
- Laboratoire de Toxicologie biologique et médico-légale, CHU Pontchaillou, Rennes, France
| | - Thomas Gicquel
- Laboratoire de Toxicologie biologique et médico-légale, CHU Pontchaillou, Rennes, France
- University of Rennes, INSERM, INRAE, CHU Rennes, Institut NuMeCan (Nutrition, Metabolisms and Cancer), Réseau PREVITOX, Rennes, France
| | - Yves Lurton
- Centre Hospitalier Universitaire de Rennes, Service Pharmacie, Rennes, France
| | - Brendan Le Daré
- Centre Hospitalier Universitaire de Rennes, Service Pharmacie, Rennes, France
- University of Rennes, INSERM, INRAE, CHU Rennes, Institut NuMeCan (Nutrition, Metabolisms and Cancer), Réseau PREVITOX, Rennes, France
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Abstract
Ethanol intoxication of infants and young children can be a challenging diagnosis in the pediatric emergency department, and features of the poisoning may differ in comparison with adolescents. The sources of ethanol exposures in this age are varied and include unintentional, malicious, and iatrogenic etiologies. Young children exposed to ethanol often present with mixed clinical signs and symptoms that may not fit the traditional ethanol or sedative-hypnotic toxidrome. Pediatric ethanol intoxications are often managed supportively, and recovery is usually rapid. The purpose of this review is to describe the sources of ethanol poisoning among children 6 years and younger, highlight presenting symptoms and pharmacokinetic considerations unique to this age group, and review management strategies. In addition, published cases of ethanol poisoning due to ingestion among young infants are compiled for presentation.
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Hon KL, Leung AK, Cheung E, Lee B, Tsang MM, Torres AR. An overview of exposure to ethanol-containing substances and ethanol intoxication in children based on three illustrated cases. Drugs Context 2018; 7:212512. [PMID: 29344053 PMCID: PMC5764489 DOI: 10.7573/dic.212512] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2017] [Revised: 11/15/2017] [Accepted: 11/15/2017] [Indexed: 11/21/2022] Open
Abstract
Alcohol addiction and intoxication are major health problems worldwide. Acute alcohol intoxication is well reported in adults and adolescents but less frequently reported in children of younger ages. We report three anonymized cases of pediatric ethanol exposure and illustrate the different mechanisms of intoxication. In all cases, a focused history is the key to prompt diagnosis and timely management. Physicians should be aware of this potential poison in children presented with acute confusional or encephalopathic state. In contrast, neonates with ethanol intoxication may present with nonspecific gastrointestinal symptomatology. Urgent exclusion of sepsis, electrolyte imbalance, drug intoxication, and surgical abdominal condition is critical. Using these illustrated cases, we performed a narrative literature review on issues of exposure to ethanol-containing substances and ethanol intoxication in children. In conclusion, a high level of suspicion and interrogation on ethanol or substance use are essential particularly in the lactating mother for an accurate and timely diagnosis of ethanol intoxication to be made.
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Affiliation(s)
- Kam Lun Hon
- Department of Pediatrics, The Chinese University of Hong Kong, Prince of Wales Hospital, Shatin, Hong Kong
| | - Alexander Kc Leung
- Department of Pediatrics, University of Calgary, Calgary, Alberta, Canada
| | | | - Bryan Lee
- Department of Anaesthesia, Princess Margaret Hospital, Hong Kong
| | - Michelle Mc Tsang
- Department of Paediatrics and Adolescent Medicine, Queen Mary Hospital, Hong Kong
| | - Alcy R Torres
- Department of Neurology, Boston Medical Center, Boston University School of Medicine, Boston, MA, USA
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Affiliation(s)
- Dianne Lee
- 1 Stony Brook University School of Medicine, Stony Brook, NY, USA
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Hon KL, Wong YCT, Chau IKY, Chau MKT, Cheung KL, Wong W. Alcohol Exposure in Breastfed Neonates Associated with Chinese Chicken Wine. Indian J Pediatr 2016; 83:1495-1496. [PMID: 27349563 DOI: 10.1007/s12098-016-2181-4] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/01/2016] [Accepted: 06/09/2016] [Indexed: 11/25/2022]
Affiliation(s)
- Kam Lun Hon
- Department of Pediatrics, The Chinese University of Hong Kong, Prince of Wales Hospital, Shatin, Hong Kong.
| | - Yik Ching Thomas Wong
- Department of Biochemistry, University College London (UCL), London WC1E 6BT, United Kingdom
| | - Ivan Ken-Yu Chau
- Department of Biochemistry, University of Illinois-Champaign, Champaign, IL, USA
| | | | - Kam Lau Cheung
- Department of Pediatrics, The Chinese University of Hong Kong, Prince of Wales Hospital, Shatin, Hong Kong
| | - William Wong
- Department of Pediatrics, The Chinese University of Hong Kong, Prince of Wales Hospital, Shatin, Hong Kong
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Accidental Acute Alcohol Intoxication in Infants: Review and Case Report. J Emerg Med 2014; 47:524-6. [DOI: 10.1016/j.jemermed.2014.06.032] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2013] [Revised: 04/08/2014] [Accepted: 06/30/2014] [Indexed: 10/24/2022]
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7
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Zaitsu M, Inada Y, Tashiro K, Hayashi C, Doi H, Hamasaki Y, Matsuo M. Acute alcohol intoxication in a 15-day-old neonate. Pediatr Int 2013; 55:792-4. [PMID: 24330291 DOI: 10.1111/ped.12134] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/26/2012] [Revised: 04/16/2013] [Accepted: 04/23/2013] [Indexed: 11/27/2022]
Abstract
We describe a 15-day-old newborn girl who was fed with formula milk that was accidentally diluted with sake (Japanese wine prepared from fermented rice). The clinical features were flushed skin, tachycardia and low blood pressure indicating circulatory failure, somnolence and metabolic acidosis without hypoglycemia. The serum ethanol concentration was 43.0 mg/dL at 3 h after intake. The patient recovered under intravenous fluid replacement without complications. Follow-up examinations at 1, 2, 3, 6 and 12 months confirmed normal psychomotor development.
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Affiliation(s)
- Masafumi Zaitsu
- Department of Pediatrics, Faculty of Medicine, Saga University, Saga, Japan
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March SM, Abate P, Molina JC. Acetaldehyde involvement in ethanol's postabsortive effects during early ontogeny. Front Behav Neurosci 2013; 7:70. [PMID: 23801947 PMCID: PMC3685812 DOI: 10.3389/fnbeh.2013.00070] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2013] [Accepted: 06/01/2013] [Indexed: 11/29/2022] Open
Abstract
Clinical and biomedical studies sustains the notion that early ontogeny is a vulnerable window to the impact of alcohol. Experiences with the drug during these stages increase latter disposition to prefer, use or abuse ethanol. This period of enhanced sensitivity to ethanol is accompanied by a high rate of activity in the central catalase system, which metabolizes ethanol in the brain. Acetaldehyde (ACD), the first oxidation product of ethanol, has been found to share many neurobehavioral effects with the drug. Cumulative evidence supports this notion in models employing adults. Nevertheless very few studies have been conducted to analyze the role of ACD in ethanol postabsorptive effects, in newborns or infant rats. In this work we review recent experimental literature that syndicates ACD as a mediator agent of reinforcing aspects of ethanol, during early ontogenetic stages. We also show a meta-analytical correlational approach that proposes how differences in the activity of brain catalase across ontogeny, could be modulating patterns of ethanol consumption.
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Affiliation(s)
- Samanta M March
- Laboratorio de Alcohol, Ontogenia y Desarrollo, Instituto de Investigación Médica Mercedes y Martín Ferreyra Córdoba, Argentina ; Department de Psicología, Facultad de Psicología, Universidad Nacional de Córdoba Córdoba, Argentina
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Lachenmeier DW. Safety evaluation of topical applications of ethanol on the skin and inside the oral cavity. J Occup Med Toxicol 2008; 3:26. [PMID: 19014531 PMCID: PMC2596158 DOI: 10.1186/1745-6673-3-26] [Citation(s) in RCA: 151] [Impact Index Per Article: 9.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2008] [Accepted: 11/13/2008] [Indexed: 01/01/2023] Open
Abstract
Ethanol is widely used in all kinds of products with direct exposure to the human skin (e.g. medicinal products like hand disinfectants in occupational settings, cosmetics like hairsprays or mouthwashes, pharmaceutical preparations, and many household products). Contradictory evidence about the safety of such topical applications of the alcohol can be found in the scientific literature, yet an up-to-date risk assessment of ethanol application on the skin and inside the oral cavity is currently lacking.The first and foremost concerns of topical ethanol applications for public health are its carcinogenic effects, as there is unambiguous evidence for the carcinogenicity of ethanol orally consumed in the form of alcoholic beverages. So far there is a lack of evidence to associate topical ethanol use with an increased risk of skin cancer. Limited and conflicting epidemiological evidence is available on the link between the use of ethanol in the oral cavity in the form of mouthwashes or mouthrinses and oral cancer. Some studies pointed to an increased risk of oral cancer due to locally produced acetaldehyde, operating via a similar mechanism to that found after alcoholic beverage ingestion.In addition, topically applied ethanol acts as a skin penetration enhancer and may facilitate the transdermal absorption of xenobiotics (e.g. carcinogenic contaminants in cosmetic formulations). Ethanol use is associated with skin irritation or contact dermatitis, especially in humans with an aldehyde dehydrogenase (ALDH) deficiency.After regular application of ethanol on the skin (e.g. in the form of hand disinfectants) relatively low but measurable blood concentrations of ethanol and its metabolite acetaldehyde may occur, which are, however, below acute toxic levels. Only in children, especially through lacerated skin, can percutaneous toxicity occur.As there might be industry bias in many studies about the safety of topical ethanol applications, as well as a general lack of scientific research on the long-term effects, there is a requirement for independent studies on this topic. The research focus should be set on the chronic toxic effects of ethanol and acetaldehyde at the point of impact, with special regard to children and individuals with genetic deficiencies in ethanol metabolism.
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Affiliation(s)
- Dirk W Lachenmeier
- Chemisches und Veterinäruntersuchungsamt (CVUA) Karlsruhe, Weissenburger Strasse 3, D-76187 Karlsruhe, Germany.
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Molina JC, Spear NE, Spear LP. The International society for developmental psychobiology 39th annual meeting symposium: Alcohol and development: beyond fetal alcohol syndrome. Dev Psychobiol 2007; 49:227-42. [PMID: 17380525 PMCID: PMC1976664 DOI: 10.1002/dev.20224] [Citation(s) in RCA: 42] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
As has been repeatedly demonstrated, alcohol can exert deleterious morphological and physiological effects during early stages in development. The present review examines nonteratological links existing between alcohol and ontogeny. Human and animal studies are taken into consideration for the analysis of fetal, neonatal, infantile, adolescent, and adult responsiveness to the drug. Sensitivity to alcohol's chemosensory and postabsorptive properties, as well as learning and memory processes mediated by such properties, are examined from this developmental perspective. The studies under discussion indicate that, within each stage in development, we can trace alcohol-related experiences capable of determining or modulating alcohol seeking and intake patterns.
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Affiliation(s)
- Juan Carlos Molina
- Department of Psychology, Binghamton University, PO Box 6000, Binghamton, NY 13902-6000, E-mail:
| | - Norman E. Spear
- Department of Psychology, Binghamton University, PO Box 6000, Binghamton, NY 13902-6000, E-mail:
| | - Linda P. Spear
- Department of Psychology, Binghamton University, PO Box 6000, Binghamton, NY 13902-6000, E-mail:
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Spear NE, Molina JC. Fetal or Infantile Exposure to Ethanol Promotes Ethanol Ingestion in Adolescence and Adulthood: A Theoretical Review. Alcohol Clin Exp Res 2005; 29:909-29. [PMID: 15976517 DOI: 10.1097/01.alc.0000171046.78556.66] [Citation(s) in RCA: 155] [Impact Index Per Article: 8.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Abstract
BACKGROUND Despite good evidence that ethanol abuse in adulthood is more likely the earlier human adolescents begin drinking, it is unclear why the early onset of drinking occurs in the first place. A review of experimental studies with animals complemented by clinical, epidemiologic and experimental studies with humans supports the idea that precipitating conditions for ethanol abuse occur well before adolescence, in terms of very early exposure to ethanol as a fetus or infant. Experimental studies with animals indicate, accordingly, that ethanol intake during adolescence or adulthood is potentiated by much earlier exposure to ethanol as a fetus or infant. METHODS Two broad theoretical frameworks are suggested to explain the increase in affinity for ethanol that follows very early exposure to ethanol, one based on effects of mere exposure and the other on associative conditioning. Studied for 50 years or more in several areas of psychology, "effects of mere exposure" refers to enhanced preference expressed for flavors, or just about any stimuli, that are relatively familiar. An alternative framework, in terms of associative conditioning, is guided by this working hypothesis: During ethanol exposure the fetus or infant acquires an association between ethanol's orosensory (odor/taste) and pharmacological consequences, causing the animal subsequently to seek out ethanol's odor and taste. RESULTS AND CONCLUSIONS The implication that ethanol has rewarding consequences for the fetus or young infant is supported by recent evidence with perinatal rats. Paradoxically, several studies have shown that such early exposure to ethanol may in some circumstances make the infant treat ethanol-related events as aversive, and yet enhanced intake of ethanol in adolescence is nevertheless a consequence. Alternative interpretations of this paradox are considered among the varied circumstances of early ethanol exposure that lead subsequently to increased affinity for ethanol.
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Affiliation(s)
- Norman E Spear
- Department of Psychology, Center for Developmental Psychobiology, Binghamton University, Binghamton, NY 13902, USA.
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Pepino MY, Mennella JA. Advice given to women in Argentina about breast-feeding and the use of alcohol. Rev Panam Salud Publica 2005; 16:408-14. [PMID: 15673483 PMCID: PMC1772797 DOI: 10.1590/s1020-49892004001200007] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
OBJECTIVE To explore the types of advice that women in Argentina received from health professionals, family members, and friends about drinking alcoholic beverages and about alcohol usage during pregnancy and lactation. METHODS In December 2001 and December 2002, structured interviews were conducted with a total of 167 women who were then breast-feeding or who had recently breast-fed their infant. Mothers were asked about the type of advice, if any, that they had received about the use of alcohol from health professionals and from family members and friends. Also included were questions related to the usage of the traditional Argentine beverage "mate" (an infusion widely consumed in South America that is prepared from the leaves of the Ilex paraguayensis plant) and the types of advice the women had received about breast-feeding and neonatal care in general. RESULTS Of the 167 women studied, 96.4% of them reported that their physician had advised them to breast-feed their infant. In addition, 93.4% of the women said they had treated their infant's umbilical cord stump with alcohol. Fewer than half of the women (46.7%) reported that their physician had advised them about drinking alcoholic beverages during pregnancy, and even fewer (25.7%) received such advice during lactation. Family and friends were about equally likely to give advice about the consumption of alcoholic beverages during pregnancy (42.6%) and during lactation (47.9%). However, the type of advice changed, with the family and friends being significantly more likely to encourage drinking when the women were lactating than when they were pregnant (P < 0.001). Family members and friends also encouraged the drinking of mate to increase milk production. CONCLUSIONS As in other cultures, in Argentina the belief exists that alcohol enhances lactation. However, the majority of women whom we interviewed had not been counseled by their health professional about the consumption of alcoholic beverages during pregnancy and lactation. There is a need for professional development strategies that will address women's awareness of the risks of alcohol consumption and alcohol usage.
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Affiliation(s)
- M Yanina Pepino
- Monell Chemical Senses Center, Philadelphia, Pennsylvania 19104-3308, USA.
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Sudakin DL, Trevathan WR. DEET: a review and update of safety and risk in the general population. ACTA ACUST UNITED AC 2004; 41:831-9. [PMID: 14677793 DOI: 10.1081/clt-120025348] [Citation(s) in RCA: 121] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
The emergence of West Nile Virus (WNV) in North America has resulted in increased public awareness and utilization of insect repellents containing N,N-diethyl-m-toluamide (DEET) in the prevention of mosquito-borne disease. Regulatory reassessments in North American countries have recently been completed for insect repellents containing DEET as active ingredient, resulting in labeling changes intended to minimize unnecessary exposure to special populations, including children. This article describes those changes, and summarizes more recent data relating to the pharmacokinetics, toxicology, and epidemiology of adverse effects associated with DEET in humans.
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Affiliation(s)
- Daniel L Sudakin
- Department of Environmental and Molecular Toxicology, Oregon State University, Corvallis, Oregon 97331-6502, USA.
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Abstract
Visits to the emergency department (ED) by neonates and their parents can cause anxiety for parents and the ED staff. Many of the presenting complaints are unique to the neonatal population, and an understanding of both common problems and true medical emergencies is paramount. This article discusses the complaints the EDs have seen more frequently as a result of earlier newborn discharges from hospitals.
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Affiliation(s)
- Maureen McCollough
- Department of Medicine, University of California Los Angeles School of Medicine, Pediatric Emergency Medicine, Department of Emergency Medicine, Olive View-University of California Los Angeles Medical Center, Los Angeles, California, USA
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