12-128-18 What holiday hazards are in the home?

Toxicology Question of the Week

December 18, 2018

What holiday hazards can be found in the home?

With the holiday season in full swing, it is a good time to remember that children may have easier access to some dangers that are kept out of reach during other times of the year.

Although it is common knowledge that alcohol and children do not mix, many parents might be surprised at how small of an amount can harm a child – as little as a mouthful depending on the type of alcohol and size of the child. Hand sanitizers typically contain one of two alcohols in high concentrations: isopropyl alcohol 70-75% or ethyl alcohol 60-70%. Isopropyl alcohol is up to three times as potent as ethanol. A much smaller amount of isopropyl alcohol ingested can cause serious symptoms of alcohol intoxication in children. Ethyl alcohol is the same alcohol that we find in liquors; however, it is much more concentrated in hand sanitizers. One mouthful of hand sanitizer can often be as potent as a shot of moonshine or other high proof liquor. Clinical effects with more than a mouthful in a child of either alcohol include symptoms of intoxication including ataxia, confusion, hypoglycemia, and severe CNS and respiratory depression. Quick and emergent supportive care may be required for treatment in deliberate or large accidental exposures. During the holidays, alcohol is often more easily accessible to children than it is during other times of the year. This holiday season, remind parents to keep all alcohol out of reach, or ideally, locked away from children. Promptly put away any alcohols or flavor extracts that are used for baking, received for gifts, or otherwise in use. If children will be present during a holiday party, remind guests to not set drinks down and make sure to do a check after guests have left to make sure there are no forgotten drinks sat on any surfaces where a child could find them.

The holidays are also a time where families are often hosting friends and relatives. These guests may be bringing their prescription medications with them. Remember- no pill bottle or pill minder is truly child proof - at best, they are only child resistant. The holidays also present many more instances where parents may be distracted – hosting guests, preparing holiday meals, etc, -giving children time to wander away and explore bedrooms and bathrooms, potentially finding medications. While a child can tolerate some adult medications, in many cases one pill can kill. Many of these medications are commonly prescribed and accessible in most households. One pill can kill medications include: calcium channel blockers (diltiazem and verapamil are the most concerning), beta blockers, sulfonylureas, opioids, antiarrhythmics (flecainide, sotolol, and propafenone are very dangerous), and more. Clinical effects include bradycardia, CNS and respiratory depression, heart block, dysrhythmias, seizures, and cardiac arrest. Treatment may require aggressive symptomatic and supportive care with the possible need of antidotal therapies depending on the ingestion. It often only takes a minute or two for a child to wander off and find things that they were not meant to find. Remember - an ounce of prevention is worth a pound of cure!

The poison center is always ready to help with any questions, concerns, and cases you may have. Merry Christmas!

Question prepared by Kathryn Ryan, PharmD,  Specialist in Poison Information

I am interested in any questions you would like answered in the Question of the Week.  Please email me with any suggestion at donna.seger@vanderbilt.edu

Donna Seger, MD

Executive Director

Tennessee Poison Center

www.tnpoisoncenter.org

Poison Help Hotline: 1-800-222-1222

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