When children or adolescents presentwith a change in mental status, respiratory depression, gastrointestinal complications, orpancreatitis, consider alcohol abuse as an underlying cause
When children or adolescents presentwith a change in mental status, respiratory depression, gastrointestinal complications, orpancreatitis, consider alcohol abuse as an underlying cause: Excerpt from Avoiding Common Pediatric Errors
Author:
Michael S. Potter and Anthony Slonim, MD
What to Do -Gather Appropriate Data,
Interpret the Data
Alcohol abuse is becoming more and more prevalent in the pediatric population,andchildrenarebeingintroducedtoalcoholatyoungeragesthanbefore.
Approximately 40% of nonautomotive accidental deaths are attributed to alcohol abuse, and alcohol, as a legal drug, contributes to more deaths in young
people than all illegal drugs combined. Therefore, pediatricians need to be
familiar with the effects of alcohol overdose syndrome and the complications
of chronic exposure.
Because alcohol depresses the central nervous system, euphoria, grogginess, talkativeness, impaired short-term memory, and an increased pain
threshold are commonly exhibited in patients suffering from alcohol overdoses. Respiratory depression can occur if serum levels are significant. Furthermore, alcohol inhibits the normal operation of the pituitary antidiuretic
hormone. When alcohol is consumed in a large quantity at one time, gastrointestinal complications are not uncommon. Acute erosive gastritis is the
most common of these complications, and it manifests itself as epigastric
pain, anorexia, vomiting, and guaiac-positive stools. Be aware, however, that
vomiting and midabdominal pain can also be the result of acute alcoholic
pancreatitis. If elevated serum amylase and lipase levels are detected, then a
diagnosis of acute alcoholic pancreatitis becomes more likely.
There are also social manifestations associated with alcohol overdose,
and although it is not common for younger adolescents to become alcoholics,
if the following social symptoms are observed, then the patient should be
considered as having an impairment from alcohol: having been drunk several
times in a single year, having problems with school authorities and the police,
having problems with peers, having been criticized about drinking habits by
members of the opposite sex, and having driven while drunk.
Diagnostically, children are three to four times as likely to develop an
alcohol-related disorder if their parents are alcoholics. If children present
with disorientation, lethargy, or coma, then alcohol overdose syndrome
shouldbesuspected.Thesmellofalcoholcanbehelpfulformakingapositive
diagnosis, but blood tests can confirm the diagnosis. Although in most jurisdictions a serum level >80to 100 mg/dL corresponds to intoxication, serum
levels >200 mg/dL pose a significant risk of death, and levels >500 mg/dL,
are generally fatal.
The primary mechanism of death by alcohol overdose is respiratory
depression. Therefore, ventilatory support is essential while the liver works
to eliminate alcohol from the body. Approximately 20 hours is required to
reduce the blood-alcohol level from 400 mg/dL to 0 mg/dL in nonalcoholic patients. If the patient has a blood level >400 mg/dL, dialysis may be
warranted.
When consumed in moderation by adults, alcohol represents negligible
health risks. However, children metabolize this drug differently than adults
and may lack the appropriate social and developmental attributes to manage their behavioral changes, effectively leading to both physical and social
complications or abuse.
Suggested Reading
Jenkins RR. Substance Abuse. In: Behrman RE, Kliegman RM, Jenson HB. Nelson Textbook
of Pediatrics. 17th ed. Philadelphia: Saunders; 2004, pages 653–61.
Book Source Details
- Book Title: Avoiding Common Pediatric Errors
- Author(s): Anthony D Slonim MD, DrPH; Lisa Marcucci MD
- Year of Publication: 2008
- Copyright Details: Avoiding Common Pediatric Errors, Copyright © 2008 Lippincott Williams & Wilkins.
More About Alcohol abuse
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Copyright notice for book excerpts: Copyright © 2008 Lippincott Williams & Wilkins. All rights reserved.
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More About This Book:
Title: Avoiding Common Pediatric Errors
Authors: Anthony D Slonim MD, DrPH; Lisa Marcucci MD
Publisher: Lippincott Williams & Wilkins
Copyright: 2008
ISBN: 0-7817-7489-6
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