Don’t Drink the Hand Sanitizer

http://www.nytimes.com/2016/10/24/well/live/dont-drink-the-hand-sanitizer.html

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Alcohol-based hand sanitizer can be found in schools, offices, restrooms and restaurants and is great for cleaning hands in public places. But most of us would never think of drinking it.

But the products also contain a stronger concentration of alcohol than beer, wine and most hard liquors, and can be easily abused. The issue gained national attention recently when a former Wells Fargo banker admitted to swigging hand sanitizer at work to cope with the stress of working at the bank. A recent “Saturday Night Live” sketch also included a joke about the practice.

Ingestion of hand sanitizer can cause alcohol poisoning and even death, and the vast majority of those exposed are children under 6 who drink it by accident after finding it in the home or a parent’s purse or bag. It’s less common for adults who can buy alcohol legally to deliberately ingest hand sanitizer, unless they are in an institution like a hospital or prison where alcohol is not allowed, are trying to commit suicide, or are alcoholics who can’t obtain alcohol any other way or are trying to hide their drinking.

The problem appears to be on the rise. Last year the nation’s poison control center received 19,729 reports of exposure to hand sanitizer, up from 17,821 reports in 2011. But most exposures are accidental and the vast majority involve children who may have just licked their hands after rubbing hand sanitizer on them, tasted it by accident or inhaled it. Only 1,394 of last year’s incidents involved intentionally swallowing the liquid, according to the American Association of Poison Control Centers. There were two deaths.

Teenagers who can’t buy alcohol legally and are looking for a “high alcohol content thrill” are known to occasionally abuse hand sanitizer, said Dr. Anthony F. Suffredini, a physician who wrote a paper describing the case of a 17-year-old hospital patient who became acutely ill after putting hand sanitizer into his feeding tube while being treated for other medical problems. The boy required mechanical ventilation to assist with his breathing and dialysis to rid his blood of the alcohol.

“This young man, who was from the South, mentioned that among his circle of friends, who were all underage, if they couldn’t find alcohol any other way, this was one of the ways they tried to get high,” Dr. Suffredini said.

A 2012 study by Dr. Suffredini that examined trends in hand sanitizer incidents from 2005 through 2009 reported an increase in the number of youngsters and adults who said they deliberately drank hand sanitizer. The number of children ages 6 to 19 who said they had deliberately swallowed hand sanitizer more than tripled, to about 350 in 2009, up from just over 100 in 2005. Meanwhile, the number of adults over 20 who said they deliberately drank hand sanitizer increased to just over 200 in 2009, up from about 60 in 2005.

While the numbers are small, Dr. Suffredini said he suspects most incidents do not get reported. “Not everyone will report it and unless someone gets really ill, they won’t go to the emergency room, and even then, the emergency room may not report it as a true poisoning,” he said.

Doctors say the case of the Wells Fargo banker, reported in The New York Times, was particularly unusual. The banker, Angie Payden, of Hudson, Wis., said she started drinking hand sanitizer in the bathroom while working at Wells Fargo to cope with the intense pressure to open unnecessary bank accounts, which was causing her to have panic attacks.

Containers of hand sanitizer were kept throughout the bank, she said, on bankers’ desks, behind the tellers’ counters and in the restroom. Ms. Payden said she drank the hand sanitizer before meeting with clients, and eventually worked up to drinking “at least a bottle a day” and realized she was “completely addicted.”

“It’s interesting, because it’s not something you hear a lot,” said Alexander Garrard, a toxicologist who is director of the Washington Poison Center in Seattle, commenting on Ms. Payden’s account. “Hand sanitizer is not usually something people will resort to.”

The reason most people shy away from it? “It just doesn’t taste good,” Dr. Garrard said. “Nobody who’s not an alcoholic is going to say, ‘You know what would be really good right about now?’ ” and suggest hand sanitizer.

Purell hand sanitizer has added unpleasant-tasting ingredients to its products to make them even less palatable, said Samantha Williams, a spokeswoman for GoJo Industries, which makes Purell. She noted that published studies show the benefits of using hand sanitizer, including reduced infections in hospitals and fewer missed work and school days.

One appeal of drinking hand sanitizer may simply be that it’s easier to conceal, either from parents or from one’s boss, said William Eggleston, a clinical toxicologist at Upstate New York Poison Center and an assistant professor of emergency medicine at Upstate Medical University.

“If someone sees a little bottle of hand sanitizer in your purse, nobody’s going to think twice,” Dr. Eggleston said. “If they see a minibar bottle of vodka in your purse, it will raise questions. So I can see why someone would choose something like this in a high-stress environment.”

A study of 385 teenagers who ingested hand sanitizer in Texas between 2000 and 2013 reported that most of them said they drank it by accident, and only 18 percent said they ingested it deliberately. More than 60 percent were boys, and the average age was 15. About 5 percent suffered serious medical outcomes including vomiting, abdominal pain, nausea, throat irritation and drowsiness.

Consuming hand sanitizer can be particularly dangerous, both because the alcohol content is so much higher than in other sources of alcohol, and because some formulas use isopropyl alcohol, or rubbing alcohol, which is extremely potent, Dr. Garrard said. “You will be more impaired, with a smaller amount,” he said, which can lead more rapidly to alcohol poisoning.

Deaths are rare and unusual enough to be written up in the medical literature: In one paper, published in 2013, physicians from the University of California, San Diego, described the death of a 36-year-old man who showed up at the emergency room extremely intoxicated. Though he appeared to be less intoxicated some four hours later and left, he apparently went into the bathroom of the waiting room and started drinking hand sanitizer. Doctors attempted to resuscitate him after he was found not breathing, but he never regained consciousness and died a week later.

The Food and Drug Administration announced recently that it is studying the safety and efficacy of hand sanitizers and has asked manufacturers for information about the active ingredients, including ethanol or ethyl alcohol and isopropyl alcohol. The agency is interested in gathering more data on the long-term safety of daily use of these products by pregnant women and children.