Death caused by ingestion of an ethanol-based hand sanitizer

Background: The use of hand sanitizer is effective in preventing the transmission of disease. Many hand sanitizers are alcohol-based, and significant intoxications have occurred, often in health care facilities, including the emergency department (ED).

Objectives: We present this case to highlight potential toxicity after the ingestion of an ethanol-based hand sanitizer.

Case report: A 36-year-old man presented to the ED with ethanol intoxication. Ethanol breath analysis was measured at 278 mg/dL. After 4 h, the patient was less intoxicated and left the ED. Thirty minutes later, he was found apneic and pulseless in the ED waiting room bathroom after having ingested an ethanol-based hand sanitizer. Soon after a brief resuscitation, his serum ethanol was 526 mg/dL. He never regained consciousness and died 7 days later. No other cause of death was found.

Conclusion: The case highlights the potential for significant toxicity after the ingestion of a product found throughout health care facilities. Balancing the benefit of hand sanitizers for preventing disease transmission and their potential misuse remains a challenge.