Severe Alcohol Hand Rub Overdose Inducing Coma, Watch After H1N1 Pandemic
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PRACTICAL PEARL
Severe Alcohol Hand Rub Overdose Inducing Coma, Watch After H1N1 Pandemic Matthieu Henry-lagarrigue • Magali Charbonnier • Fabrice Bruneel • Ste´phane Legriel • Gilles Troche • Hager Ben Mokhtar • Aihem Yehia • Pierre Guezennec • Jacques Merrer • Catherine Palette • Jean-Pierre Bedos
Published online: 6 January 2010 Ó Springer Science+Business Media, LLC 2010
Abstract Background Alcoholic hand rubs (AHRs) have been proven effective in preventing nosocomial infections, and healthcare authorities include AHRs use among quality-ofcare criteria. Since the onset of the influenza A (H1N1) pandemic, AHRs have gained considerable popularity among the general public. Methods We report a case of intentional AHRs self-poisoning inducing rapid coma with hyperlactatemia, and a full recovery. The relevant literature was reviewed. To our knowledge, this is the third reported case of intentional AHRs poisoning. 3 patients presented with a picture of acute alcohol intoxication, of variable severity depending on the amount ingested and speed of ingestion. Results The blood alcohol level was 414 mg/dl and tests for other drugs were performed 30 min after admission. The blood lactate level increased briefly to 4.8 mmol/l, without renal or hepatic function disturbances. She regained consciousness after 6 h then achieved a full recovery allowing extubation and readmission to the psychiatric ward after 24 h. She reported gulping down the entire contents of the AniosgelÒ bottle. M. Henry-lagarrigue (&) M. Charbonnier F. Bruneel S. Legriel G. Troche H. Ben Mokhtar A. Yehia P. Guezennec J.-P. Bedos Service de Re´animation, Centre Hospitalier de Versailles, 177 Rue de Versailles, 78157 Le Chesnay, France e-mail: [email protected] J. Merrer Infection Control Unit, Versailles Hospital Center, Le Chesnay, France C. Palette Pharmacology Laboratory, Versailles Hospital Center, Le Chesnay, France
Conclusion Whereas overdrinking in social settings (wine and liquor) leads to a gradual increase in blood alcohol levels, AHRs poisoning is usually characterized by a sudden massive alcohol load. The unusual nature of the alcohol source may lead to diagnostic wanderings. AHRs are currently available in bottles that facilitate the ingestion of large amounts. Unit-dose packaging or dispensing might decrease the risk of AHRs poisoning. Keywords Coma Alcohol hand rub overdose H1N1 pandemic Hyperlactatemia Acute alcohol intoxication 2-Propanol overdose Intensive care unit
Introduction Alcoholic hand rubs (AHRs) have been proven effective in preventing nosocomial infections [1], and healthcare authorities include AHR use among quality-of-care criteria. Since the onset of the influenza A (H1N1) pandemic, AHRs have gained considerable popularity among the general public. We report a case of intentional AHR selfpoisoning.
Case Report A 33-year-old woman with chronic depression had been receiving psychiatric care for 10 years and had a history of multiple suicide attempts (wrist laceration and drug ov
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