Alcohol intoxication among Dutch adolescents: acute medical complications in the years 2000-2010

A comprehensive health effects assessment of the use of sanitizers and disinfectants during COVID-19 pandemic: a global survey

COVID-19 has affected all aspects of human life so far. From the outset of the pandemic, preventing the spread of COVID-19 through the observance of health protocols, especially the use of sanitizers and disinfectants was given more attention. Despite the effectiveness of disinfection chemicals in controlling and preventing COVID-19, there are critical concerns about their adverse effects on human health. This study aims to assess the health effects of sanitizers and disinfectants on a global scale. A total of 91,056 participants from 154 countries participated in this cross-sectional study. Information on the use of sanitizers and disinfectants and health was collected using an electronic questionnaire, which was translated into 26 languages via web-based platforms. The findings of this study suggest that detergents, alcohol-based substances, and chlorinated compounds emerged as the most prevalent chemical agents compared to other sanitizers and disinfectants examined. Most frequently reported health issues include skin effects and respiratory effects. The Chi-square test showed a significant association between chlorinated compounds (sodium hypochlorite and per-chlorine) with all possible health effects under investigation (p-value <0.001). Examination of risk factors based on multivariate logistic regression analysis showed that alcohols and alcohols-based materials were associated with skin effects (OR, 1.98; 95%CI, 1.87-2.09), per-chlorine was associated with eye effects (OR, 1.83; 95%CI, 1.74-1.93), and highly likely with itching and throat irritation (OR, 2.00; 95%CI, 1.90-2.11). Furthermore, formaldehyde was associated with a higher prevalence of neurological effects (OR, 2.17; 95%CI, 1.92-2.44). Furthermore, formaldehyde was associated with a higher prevalence of neurological effects (OR, 2.17; 95%CI, 1.92-2.44). The use of sodium hypochlorite and per-chlorine also had a high chance of having respiratory effects. The findings of the current study suggest that health authorities need to implement more awareness programs about the side effects of using sanitizers and disinfectants during viral epidemics especially when they are used or overused.

Elevated creatinine kinase levels amongst Dutch adolescents with acute alcohol intoxication

This study aims to explore the prevalence of creatinine kinase elevation amongst a sample of Dutch adolescents admitted for acute alcohol intoxication. The data on all admitted adolescents < 18 years old with acute alcohol intoxication between 2008 and 2021 were collected from a Dutch major district general hospital, Reinier de Graaf Gasthuis, in Delft. Overall, 495 adolescents who were treated for symptoms of acute alcohol intoxication during this period were included in the study. When evaluating the blood samples of the included patients, elevated creatinine kinase levels were found in 60% of the cases, with a mean of 254 U/I (normal value ≤ 145 U/I). A confirmed diagnosis of rhabdomyolysis (increase in CK > fivefold the upper limit of normal) was present in 4.4% of cases. Moreover, using a linear regression this study found that a higher blood alcohol concentration was associated with higher creatinine kinase levels, when adjusted for positive drug screenings amongst the adolescents with acute alcohol intoxication (p = 0.027; β = 66.88; 95% CI 7.68 - 126.08).    Conclusions: This is the first study focusing on how acute alcohol intoxication affects adolescents' muscle tissue. The results could potentially help to prevent alcohol use within the sports world. It could also aid understanding of how acute alcohol intoxication influences the breakdown of adolescents' muscle tissue. What is Known: • Alcohol, alongside pharmaceutical agents and illicit drugs, is a significant cause of rhabdomyolysis (increase in creatinine kinase > fivefold the upper limit of normal). • Creatinine kinase elevation in alcohol intoxicated patients may be as a result of direct "muscular" toxicity" (myotoxicity) or from prolonged immobilization and ischemic compression induced by coma. What is New: • Our retrospective cohort study is a pioneer in addressing the effect of acute alcohol intoxication amongst adolescents (< 18 years) upon muscle tissue (creatinine kinase level) within a large population. When evaluating the blood samples of the included population, elevated creatinine kinase levels were found in 60% of the cases, with a mean of 254 U/I (normal value ≤ 145 U/I). • There is an association between alcohol intoxication and elevated creatinine kinase levels amongst adolescents. Future research is needed to further understand the pathophysiology and causality of this interaction.

Mortality in Cases of Acute Alcohol Intoxication in Children: A 10-Year Retrospective Study of the Moscow Region, Russia

BACKGROUND

Russia suffers from high alcohol-related mortality. Most forensic autopsies in Russia include blood alcohol tests, but a systematic analysis of these data has never been conducted for children's deaths.

METHODS

We performed an analysis of juvenile mortality using autopsy reports from the Moscow Region Bureau of Forensic Medical Examination from January 1, 2009, to December 31, 2018.

RESULTS

Despite a decrease in incidence ( Rs = -0.661), the number of cases of alcohol intoxication in minors was still high. The mean age of children in our study was 14.77 years (95% confidence interval [CI], 14.31-15.23). Death was predominantly among boys (72%) and those with higher blood alcohol concentrations (mean difference [MD], 0.295; 95% CI MD , 0.012-0.58). The number of cases of unnatural death increased with age ( Rs = 0.746, P = 0.001). Accidents were the most predominant cause of death, followed by suicide, homicide, and natural causes. Fatal alcohol intoxication was observed at an average blood alcohol concentration of 3.58 g/L (95% CI, 1.46-5.7), without any specific signs on autopsy. Even a strong smell of alcohol is an unreliable sign in the clinic.

CONCLUSION

A systematic study of alcohol in forensic autopsy shows that the number of children who die with alcohol intoxication is high. Teenagers are the predominant age group experiencing alcohol intoxication. In our opinion, an alcohol blood test should be performed in all suspicious cases, especially in teenagers.

QTc prolongation in adolescents with acute alcohol intoxication

In adults, alcohol intoxication is associated with prolongation of the QT interval corrected for heart rate (QTc). The QTc is influenced by age and sex. Although alcohol intoxication is increasingly common in adolescents, there are no data on the prevalence of QTc prolongation in adolescents with alcohol intoxication. This study aimed to determine the prevalence of QTc prolongation in adolescents with alcohol intoxication and identify at-risk adolescents. In this observational study including adolescents aged 10-18 years, heart rate and QT interval were automatically assessed from an electrocardiogram (ECG) at alcohol intoxication using a validated algorithm. The QTc was calculated using both the Bazett formula (QTc_B) and Fridericia formula (QTc_F). If present, an ECG recorded within 1 year of the date of admission to the emergency department was obtained as a reference ECG. A total of 317 adolescents were included; 13.3% had a QTc_B and 7.9% a QTc_F longer than the sex- and age-specific 95th-percentile. None of the adolescents had a QTc_B or QTc_F > 500 ms, but 11.8% of the adolescents with a reference ECG had a QTc_B prolongation of > 60 ms, while no adolescents had a QTc_F prolongation of > 60 ms. QTc prolongation was mainly attributable to an increase in heart rate rather than QT prolongation, which underlies the differences between QTc_B and QTc_F. Male sex and hypokalaemia increased the likelihood of QTc prolongation.Conclusion: QTc prolongation was seen in approximately 10% of the adolescents presenting with alcohol intoxication, and although no ventricular arrhythmias were observed in this cohort, QTc prolongation increases the potential for malignant QT-related arrhythmias. Clinicians must be aware of the possibility of QTc prolongation during alcohol intoxication and make an effort to obtain an ECG at presentation, measure the QT interval, and give an adequate assessment of the findings. We advocate admitting adolescents with alcohol intoxication and QTc prolongation. During hospital admission, we recommend limiting exposure to QTc-prolonging medication, increasing potassium levels to a high-normal range (4.5-5.0 mmol/L) and obtaining a reference ECG at discharge.

Pediatric Acute Alcohol Intoxication Admitted to the ICU: A Review of 102 Cases in France

OBJECTIVES

To describe the profile and clinical outcomes of children (<18 yr) admitted to intensive care for acute alcohol intoxication, with special attention to complications and to the subgroup that required intubation.

DESIGN

Retrospective observational study.

SETTING

Seven pediatric and three adult ICUs in France.

PATIENTS

Children 1-17 yr admitted to intensive care for acute alcohol intoxication between January 1, 2010, and December 30, 2017.

INTERVENTIONS

The study was observational and patients received standard care.

MEASUREMENTS AND MAIN RESULTS

We included 102 patients, with 71 males (69.6%) and 31 females (30.4%). Mean age was not different between males and females (14.0 ± 3.0 yr [range, 2-17 yr] and 14.2 ± 1.3 yr [range, 11-17 yr]; p = 0.67); six children were younger than 10 years. Mean blood alcohol concentration was not significantly different in males and females (2.42 ± 0.86 and 2.20 ± 0.54 g/L, respectively; p = 0.51). Of the 102 patients, 58 (57%) required intubation. Factors significantly associated with requiring intubation were lower Glasgow Coma Scale score (p = 0.002), lower body temperature (p = 0.045), and higher blood alcohol concentration (p = 0.012); vascular filling, and electrolyte disturbances were not associated with needing intubation. Mean intubation time was 9.7 ± 5.2 hours. Among the 59 patients with Glasgow Coma Scale score less than 8, 12 did not require intubation. The most common metabolic disturbance was a high lactate level (48%), followed by hypokalemia (27.4%); 59 (58.2%) patients had hyperglycemia and three had hypoglycemia.

CONCLUSIONS

Male adolescents make up the majority of pediatric patients admitted to intensive care for acute alcohol intoxication. A need for intubation was associated with a worse Glasgow Coma Scale, lower body temperature, and higher blood alcohol concentration. Intubation was usually required for less than 12 hours. Other acute medical complications reported in adults with acute alcohol intoxication, such as electrolyte disturbances and aspiration pneumonia, were rare in our pediatric patients.

Clinical and Social Characteristics of Deliberately Intoxicated Minors Treated in Pediatric Intensive Care

BACKGROUND

The aim of the study was to determine and compare the clinical and social characteristics of minors using alcohol and drugs for inebriation, and the same for those using them for suicide.

METHODS

This study includes an analysis of case histories of adolescents hospitalized in the Pediatric Intensive Care Unit because of acute alcohol or/and drug intoxication in 2015 to 2017. Two groups (group I: inebriation, and group II: suicide) were compared on age, sex, severity of intoxication, used substances, presence of other self-harm evidence, and social status.

RESULTS

A total of 390 cases were registered: 78.21% in Group I and 21.79% in Group II. The Glasgow-Coma-Scale scores showed that patients from Group I were more severely intoxicated, with an average score of 11.47, whereas patients from Group II averaged 13.45 (P < .001). Self-harm was more prominent among minors from Group II, with an incidence of up to 65.09%. The most common substance used to become inebriated was alcohol (72.79%), and for committing suicide was medication (88.24%). Patients who were living in children's care homes composed 13.33% of all cases included into the study, despite the low frequency of these minors in Lithuania (0.8%).

CONCLUSIONS

The substance used for deliberate intoxication was mostly alcohol. Minors experiencing inebriation were hospitalized in worse clinical condition in comparison to those who had attempted suicide. Other signs of self-harm were significantly more common among suicidal minors. Living in children's care homes is a possible risk factor for deliberate intoxication among young people in Lithuania.

Excessive use of disinfectants against COVID-19 posing a potential threat to living beings

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The severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) emerged in Wuhan city of China in late December 2019.

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The rapid spread of the COVID-19 across the communities shock the entire population, because of no existing therapies.

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Health professionals recommended frequent washing of hands with soap and alcohol-based sanitizers, but these disinfectants has worst effects on human health.

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Precautionary measures should be ensured to protect ourselves and the community from the possible risk associated with disinfectants.

The severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) emerged in Wuhan city of China in late December 2019 and identified as a novel coronavirus disease 2019 (COVID-19). On January 30, the World Health Organization (WHO) declared the coronavirus outbreak a global public health emergency. The rapid spread of the pathogen across the communities shock the entire population. As no existing therapy were available during the pandemic. Health professionals recommended frequent washing of hands with soap and alcohol-based sanitizers. Disinfectants were extensively sprayed to minimize the possibility of getting COVID-19. Despite the potential benefits of these germicidal agents against COVID-19. Alcohol-based hand sanitizers lead to dry skin, infection, and alcohol poisoning. Children are considered more prone to alcohol poisoning and other major health concern. Precautionary measures should be ensured to protect the community from the possible risk associated with disinfectants.

COVID-19 and frequent use of hand sanitizers; human health and environmental hazards by exposure pathways

Till date no medication or vaccine is available to cope with the COVID-19 infection and infection rate is increasing drastically across the globe. Only preventive measures and healthy life style with efficient immune system have been suggested by WHO to fight and stay safe from COVID-19. WHO recommended alcohol based hand sanitizers for frequent hand hygiene, which are mainly made up from ethanol, isopropyl alcohols, hydrogen peroxides in different combinations. These preparations may become toxic to human health and environment when misused. These chemicals have known toxic and hazardous impact on environment when released by evaporation. In early five months of 2020, American Association of Poison Control Center reported 9504 alcoholic hand sanitizer exposure cases in children under the age of 12 years and recognized that even a small amount of alcohol can cause alcohol poisoning in children that is responsible for confusion, vomiting and drowsiness, and in severe cases, respiratory arrest and death. Furthermore, frequent usage of said hand sanitizers has reported increased chance of antimicrobial resistance and chance of other viral diseases. Current review is designed with main objective to highlight the toxic and serious health risks to human health and environment by frequent using hand hygiene products with alcohols based formulations.

Trends of Hospitalization for Acute Alcohol Intoxication in Slovenian Children and Adolescents with and without Dual Disorder. Implications for a Correct Intervention

Background: Binge drinking and other forms of ethanol abuse are, when present, a serious problem in preteens and adolescents worldwide. Aim: The present study has analyzed the trend in alcohol-related intoxications requiring the hospitalization of children, adolescents and young adults aged less than 21 years in Slovenia in the 1999–2018 period. Methods: We performed a retrospective study on patients discharged after hospitalizations due to mental and behavioral disorders due to acute alcohol intoxication (MBDAAI) or hospitalizations due to the toxic effects of alcohol (TEA We considered three groups: children (aged 10–14), adolescents (aged 15–19) and young adults (20–21 years old). Hospitalization rates and time trends were analyzed using joinpoint regression to obtain the annually calculated age- and sex-specific rates and the annual percentage of change (APC). Results: Considering a total of 2912 MBDAAI-hospitalizations, 15–19-year-old subjects showed a significantly higher hospitalization rate compared to the immediately younger and older age groups and a significant increase in hospitalization rates in the period 1999–2011, followed by a significant decrease. Considering 1143 TEA-hospitalizations, we observed a continuous decrease in the hospitalization rates for children and young adults and, conversely, a continuous even if less than significant increase for adolescents aged 15–19. Conclusions: Alcohol consumption in Slovenian children and adolescents is a highly important health concern. Special attention to public health problem of severe alcohol abuse requiring hospitalization in children and adolescents is needed, especially with possible crisis of SARS-CoV-2/Covid-19 situation.

Epidemiology and outcomes of children with accidental hypothermia: A propensity-matched study

BACKGROUND

The purpose of this study was to explore the epidemiology and outcomes of hospitalized children with a diagnosis of accidental hypothermia.

METHODS

The 2012 Kids' Inpatient Database, detailing discharge diagnoses in children admitted to US hospitals, was analyzed using International Classification of Diseases, Ninth Revision, Clinical Modification codes to filter out relevant patients. Children ages 1 month to 17 years were included in the analysis. Demographic and outcome variables in the hypothermia group were compared with the rest of the patients. In a separate analysis, children with hypothermia were matched 1:1 using a correlative propensity score using sex, age, hospital region, income quartiles, race, ventilation status, coagulopathy, drowning, and All Patient Refined Diagnosis Related Groups severity score and their outcomes were compared with controls. The sample data were weighted to get a national estimate.

RESULTS

Accidental hypothermia was present in 1,028 cases out of 1,915,435 discharges. Children with hypothermia were more likely to be males (54.7% vs. 50.9%; p < 0.05) and infants (32.6% vs. 17.5%); they were less likely to be teens (30% vs. 37.8%). Children with hypothermia were more likely to be admitted in the Southern region (48.3% vs. 38.4%; p < 0.05) and have a higher mortality rate compared to all other discharges (8.5% vs. 0.3%; p < 0.05) or when compared with the matched controls (8.9% vs. 4.4%).

CONCLUSIONS

The diagnosis of accidental hypothermia significantly increased mortality in hospitalized children. Interestingly, accidental hypothermia was more common in Southern states compared to the other areas of the United States.

LEVEL OF EVIDENCE

Prognostic/epidemiological study, level III.

Chronic alcohol consumption decreases brown adipose tissue mass and disrupts thermoregulation: a possible role for altered retinoid signaling

Retinoic acid, an active metabolite of dietary vitamin A, acts as a ligand for nuclear receptor transcription factors with more than 500 known target genes. It is becoming increasingly clear that alcohol has a significant impact on cellular retinoic acid metabolism, with resultant effects on its function. Here, we test the hypothesis that chronic alcohol consumption impairs retinoic acid signaling in brown adipose tissue (BAT), leading to impaired BAT function and thermoregulation. All studies were conducted in age-matched, male mice consuming alcohol-containing liquid diets. Alcohol’s effect on BAT was assessed by histology, qPCR, HPLC, LC/MS and measures of core body temperature. Our data show that chronic alcohol consumption decreases BAT mass, with a resultant effect on thermoregulation. Follow-up mechanistic studies reveal a decreased triglyceride content in BAT, as well as impaired retinoic acid homeostasis, associated with decreased BAT levels of retinoic acid in alcohol-consuming mice. Our work highlights a hitherto uncharacterized effect of alcohol on BAT function, with possible implications for thermoregulation and energy metabolism in drinkers. Our data indicate that alcohol’s effects on brown adipose tissue may be mediated through altered retinoic acid signaling.

Are Carbohydrate-Deficient Transferrin Assays Useful for the Detection of Recurrent 'Binge Drinking' in Children with an Alcohol Intoxication in the Emergency Department?

AIMS

The aim of this study was to evaluate different carbohydrate-deficient transferrin (CDT) assays for the detection of recurrent excessive alcohol abuse in adolescents prior to acute alcohol intoxication.

METHODS

Data on drinking behaviour and CDT levels of adolescents (13-18 years) registered at the outpatient clinic for youth and alcohol at three major district general hospitals in the Netherlands were retrospectively collected. CDT and disialotransferrin (DST) levels of binge-drinking teenagers were compared with non-binge-drinking teenagers.

RESULTS

In total 198 samples were collected for the N Latex CDT method (N = 83), no differences were found in mean CDT levels for binge versus non-binge drinkers (P = 0.8). The Helander HPLC (N = 78) showed significantly higher values for binge drinkers than for non-binge drinkers (mean 1.20%DST, SD 0.28 and mean 1.01%DST, SD 0.31, respectively (P = 0.01)). The Recipe ClinRep method (N = 37) also showed significantly higher values for binge drinkers (mean 1.17%DST, SD 0.36 and mean 0.89%DST, SD 0.34, respectively (P = 0.03)).

CONCLUSION

With the Helander HPLC method and the Recipe ClinRep assay higher levels are measured in binge drinkers than in non-binge drinkers.

Acute alcohol intoxication characteristics in children

AIMS

To describe clinical, mental and physical signs in children with different severity acute alcohol intoxication (AAI) determined either by serum alcohol concentration (SAC) or by blood alcohol concentration (BAC) to study the diagnostic performance characteristics of clinical assessment and to establish the ratio of SAC:BAC in children.

METHODS

Data were analysed from 256 children aged 8.4-17.9 years who were hospitalized at Estonia's two children's hospitals over a 3-year period. In each case, the on-call paediatrician completed a special form about the clinical, mental (consciousness, balance and speech) and physical (muscle tone, blood pressure, pulse and body temperature) signs of AAI. Blood samples were drawn for measurements of SAC and BAC. Diagnostic performance characteristics (sensitivity, specificity, efficiency) of the clinical assessments and the SAC:BAC ratio were calculated.

RESULTS

The most correctly described signs in children in different SAC groups were consciousness (rs = 0.16) and speech (rs = 0.13) (P < 0.0001). The severity of alteration of consciousness and degrees of disturbance in balance and speech were positively correlated with SAC (P < 0.001). The clinical judgment matched better with AAI determined by SAC rather than by BAC with the mean efficiency. The mean ratio between SAC and BAC was 1.19 ± 0.13 (P < 0.001) in children.

CONCLUSION

The level of consciousness is the leading sign in the clinical evaluation of children with AAI and correlates well with SAC. The severity of AAI judged by clinical assessment matched better with AAI severity stages determined by SAC than by BAC. For legal cases where BAC is required, the SAC:BAC ratio of 1.19:1 should be used in children regardless of their gender or age.

Serum glucose and electrolyte levels in alcohol-intoxicated adolescents on admission to the emergency department: an unmatched case-control study

Aimed at examining serum glucose and electrolytes concentrations in adolescents with acute alcohol intoxication (AAI) on admission to the pediatric Emergency Department (ED), a retrospective unmatched, case-control study was conducted. Two cohorts of adolescents were compared, patients presenting with AAI and patients presenting with non-alcohol intoxication. The study group included ED patients aged 12-18 years with AAI. The control group included ED patients aged 12-18 years who had poisoning from a non-illicit drug. Demographic characteristics and glucose and electrolyte blood levels were extracted from the medical files. The records of patients who were admitted between January 2007 and December 2009 were analyzed. The study group and the control group included 106 subjects and 27 subjects, respectively. The study subjects had serum ethanol levels in the range of 55.6-297 mg/dL. No case of hypoglycemia was recorded. The study subjects had higher glucose levels and lower potassium levels compared to the controls (p < 0.005 and p < 0.0001, respectively). No such difference was found when the levels of sodium and bicarbonate were compared (p = 0.3 and p = 0.14, respectively). In conclusion, the findings of this study suggest that at presentation to the ED adolescents with AAI are at low risk for hypoglycemia.