Alcohol ingestion in the pediatric patient can be life threatening. Younger patients consume larger volumes per
body weight with accidental ingestions, and children have more serious adverse effects at lower blood alcohol levels. Complications of alcohol
poisoning can include
hypothermia,
hypoglycemia,
seizures,
coma, and death. We present the course of a 9-month-old female infant who became unresponsive at home and presented to the emergency department
comatose. When her
blood alcohol level registered 489 mg/dL, it was revealed that she had accidentally been given a bottle of formula mixed with vodka rather than water. The infant required intubation for severely
depressed level of consciousness and aggressive fluid
resuscitation for hemodynamic instability. She had a peak
lactate level of 24 mmol/L and a peak
blood alcohol level of 524 mg/dL. Based on the severity of her initial presentation, preparations were made for
hemodialysis. The infant responded to supportive measures including
mechanical ventilation, fluids, and
dextrose, and
hemodialysis was not necessary. Her alcohol clearance followed zero-order kinetics at an average rate of 28.6 mg/dL per hour over 15.5 hours from her peak level of 524 mg/dL to the lowest measured value of 80 mg/dL. The kinetics of
ethanol clearance at this level of toxicity, which is the highest reported in an infant to date, enhance our knowledge of
ethanol metabolism and will assist in management decisions in cases of severe intoxication.