Acute Alcohol in to xication Admitted to a Pediatric in tensive Care Unit

Abstract

Background: Alcohol use and acute alcohol intoxication is very common in our society, even in children and adolescents, and is frequently associated with medical problems and psychosocial comorbidity. Objective(s): To describe the characteristics and follow-up care of children and adolescents with acute alcohol intoxication admitted to a pediatric intensive care unit (PICU). Method(s): A retrospective study of children admitted in a PICU from January 1998 to September 2008 with a diagnosis of acute alcohol intoxication was conducted. Medical records were reviewed to describe presentations, clinical and biological characteristics, management and follow-up care (based on 2005 American Academy of Child and Adolescent Psychiatry Practice parameter). Result(s): A total of 53 admissions for 50 children were analysed. Fifty three percent were boys and mean age was 14.7 (+/- 1.31(SD)) years old. Coma was the most frequent presentation with a mean Glasgow Coma Score at arrival of 6.8 (+/- 4.2(SD)) and 45% required endotracheal intubation (mean duration of mechanical ventilation, 8.7 hours (+/- 3.6 (SD)). Trauma was present in 18% of cases, suicidal ideation in 13%, hypothermia in 17%. Polyintoxication was present in 41%, THC was the most frequent co-intoxicant (68%). Mean ethanolemia was high (2.11 g/l) (normal 0-0.92 g/l) (potential lethal dose > 3 g/l). Substance abuse counselling was documented in 73%: brief counselling being most frequently used (64%). Communication with family was documented in 70%, social context in 51%, history of substance use in 63%, criterias for substance abuse and dependency were documented in 13% and 8% respectively. Of concern, familial history of substance abuse, personal and familial history of mental health problems were rarely documented. Psychiatric symptoms evaluation was made more frequently: suicidal risk evaluation was in 49%, symptoms of depression in 47%, anxiety disorder in 9%, conduct disorder in 30%, Attention Deficit Hyperactivity Disorder in 9%, eating disorder in 8%, past or active physical/sexual abuse in 11%. Documentation of follow-up plan was present in 53%. All patients survived. Conclusion(s): Acute alcohol intoxication in PICU is associated with coma and short duration of mechanical ventilation. Psychiatric and behavioral problems are frequent despite sub-optimal assessment of comorbidities and risk factors for psychosocial dysfunction. Guidelines for assessment and referral must be established in PICUs.