Storytime: Kindergartener with New Onset Seizure

I spent last month in the Pediatric ER up in Kansas. I saw a whole variety of illness, ranging from very serious stuff like status epilepticus, severe asthma exacerbations, and meningitis, to totally not serious stuff like viral upper respiratory infections (aka colds), ear infections, teething, and bug bites, and everything in between, like many different fractures (ranging from mild to horribly deformed), lacerations, foreign bodies (bean in ear, coin battery in esophagus, etc.), and croup attacks.

I am bad about sharing stories from work on here, but I thought I'd tell you the story of one of my most interesting cases this month. So, grab a mug of cocoa, curl up in a quilt, and settle down for a bizarre tale.



I had just finished up seeing another patient when the entourage came in... a six-year-old girl "Leticia" on a stretcher, accompanied by EMSA, her mother, who was carrying her baby brother, and a teacher from her school. I followed them into her room. Nurses were already busy getting her vital signs. Leticia was crying loudly. One of the nurses was getting the story from EMSA, so I listened in.

"We think Leticia had a seizure at school, lasting 5 to 7 minutes," the paramedic said. "She has no prior history of seizures. We already checked a blood sugar and it was 92 (a normal value)."

Meanwhile, Leticia was getting even more emotional. She kept asking to hold her baby brother, and, through her tears, told him over and over, "¡Te quiero, hermanito, te quiero!" ("I love you, little brother, I love you!"). She seemed very confused and upset.
 
The resident physician came into the room and began asking Leticia's mother and school counselor some questions in Spanish, as her mother didn't speak much English. Thankful for my basic Spanish skills, I followed the conversation pretty well. Then, he talked to Leticia's teacher on the phone, as she was the only adult who had witnessed how the event had started.

Apparently, that afternoon at school, Leticia had been very unsteady on feet and had almost fallen when she got up to go to recess. So, her teacher took her by the hand to steady her and they began to walk out to recess. Leticia fell, though, and began having rhythmic twitching movements of her left arm and leg. Her teacher rushed her to the school nurse. Leticia seemed very out of it, and the school nurse called her mother to come to the school and 911 to get an ambulance to rush her to the emergency room.

The resident and I did a quick physical exam, and then went out to talk to our attending physician. After she heard the story, she said that for a child of six to have a new onset of a partial seizure (involving only part of the brain, thus only affecting part of the body), the most likely causes were either a brain tumor or neurocysticercosis, which is a tapeworm infection of the brain that causes brain cysts. So, she ordered a CT scan of her head. She also ordered lab work, including things like checking her electrolytes and blood cell count, and a toxicology (drug) screen.

When Leticia was away getting her CT scan, the lab work came back. It was all normal except for the toxicology screen. Letician's blood alcohol level was 186 or 0.186, meaning that her blood was almost 19% alcohol!

My attending wondered if it was a mistake. She asked the nurses if they had used alcohol wipes to clean Leticia's skin before the blood draw, leading to alcohol contamination. She said she might want to get a repeat blood alcohol concentration to be sure. Just as she was saying this, she got a call from the radiologist. The CT scan was negative, meaning there wasn't a brain tumor or neurocysticercosis causing a seizure.

So, we started talking about the blood alcohol level again. It could definitely explain everything. The emotional sobbing. The staggering. The seizure.

But where would she have gotten alcohol... at school? I started asking about seemingly unlikely possibilities: An abandoned hip flask from a school employee with a drinking problem? A recipe in the cafeteria gone horribly wrong? Nothing made sense until...

"I know exactly what caused this!" my preceptor exclaimed, "Hand sanitizer! She must have ingested hand sanitizer!" Hand sanitizer is about 62-65% alcohol, making it 120-proof. Vodka is 80-proof. So, hand sanitizer is very, very strong. It would only take a little bit for a six year old who weighs less than 50 pounds to get very drunk.

We went into the room and talked to the family. Leticia's father had arrived. He said he'd often noticed Leticia licking hand sanitizer off her hands, both at school and at home. They all agreed that it was highly likely she'd ingested some at school, since the teacher routinely used it with the children, and it was easily available. We admitted Leticia for observation in the hospital overnight. Before she went up to the children's floor, one of the ER nurses saw Leticia notice hand sanitizer on the wall near her bed, and she excitedly asked for some. Of course, she didn't get any... but her reaction to seeing it and wanting it, paired with the father's story of how often she licked hand sanitizer, made the nurses wonder if she was addicted to it! A six-year-old alcoholic :-( Sadness!

I hadn't heard much about it, but apparently this problem has been on the rise, especially among teenagers. If you search online, you can find news stories about students drinking hand sanitizer. I had no idea that this was an issue!

At least Leticia's parents and teachers should be able to keep her away from hand sanitizer, now that they know she has a problem and how dangerous it is, and hopefully they can break her sanitizer habit. I am glad it wasn't a brain tumor and that Leticia is going to be just fine.

The End.