Hosts: Dr. Pradip Kamat (Children’s Healthcare of Atlanta/Emory University) and Dr. Rahul Damania (Cleveland Clinic Children’s Hospital)
Mission: A podcast dedicated to current and aspiring pediatric intensivists, exploring intriguing PICU cases and acute care pediatric management
Focus of the Episode: Managing toxic alcohol ingestion in the PICU with emphasis on ethanol, methanol, ethylene glycol, propylene glycol, and isopropyl alcohol

Patient Details: A 7-month-old male presented with accidental ethanol ingestion after his formula was mixed with vodka
Key Symptoms: Lethargy, uncoordinated movements, decreased activity, and ethanol odor
Initial Labs & Findings:
EtOH level: 420 mg/dL.
Glucose: 50 mg/dL.
Normal CXR and EKG.
PICU Presentation: Tachycardic, normotensive, lethargic, with signs of CNS depression
Initial Management: Dextrose infusion, glucose monitoring, neurological observation, and ruling out complications

Toxic alcohol ingestion in pediatrics requires rapid stabilization and targeted interventions
Hypoglycemia and CNS depression are common features of ethanol toxicity in infants
Management prioritizes glucose correction, airway support, and close neurological monitoring

1. Ethanol

Typical Presentation in Infants/Toddlers: Hypotonia, ataxia, coma, hypoglycemia, hypotension, and hypothermia
Diagnostic Workup:
Focus on CNS and metabolic effects
Labs: Glucose, electrolytes, bicarbonate, anion gap, ketones, toxicology screen
Imaging (head CT) if indicated
Management: Stabilization, IV dextrose for hypoglycemia, NPO status until alert, and consultation with poison control and social work

2. Methanol

Approach Toxic Alcohol Ingestion in the PICU

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