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February 02, 2007

Jello shots in jail

This is another in our ongoing series on intoxication and incarceration...

According an upcoming article in the New England Journal of Medicine, hand sanitizer is the latest inmate craze:

A usually calm 49-year-old prisoner prompted a call to the Maryland Poison Control Center after guards found him red-eyed, combative and "lecturing everyone about life." [SPI]

Jellied hand sanitizer is approximately 70% alcohol by volume.

A separate incident with an isopropyl-alcohol based hand sanitizer led the authors of another forthcoming NEJM article to offer one of the most touchingly naive recommendations in the history of public health:

The second case involved a 43-year-old alcoholic in Cincinnati who was admitted to a hospital for chest pain.

By the time the man was treated and discharged, he was delirious.

He was readmitted for tests, but before the results came back, "the patient was seen in the bathroom drinking the alcohol-based hand wash from its dispenser," write Ashkan Emadi, MD, PhD, and LeAnn Coberly, MD, of the University of Cincinnati.

"When asked why he ingested the hand cleaner, he pointed to the label, which read, 'Active ingredient 63% v/v isopropyl alcohol.' He explained that this percentage is higher than that in vodka," write Emadi and Coberly.

"Perhaps changing the description on the container from isopropyl alcohol to isopropanol or propane-2-ol would decrease the attraction of these hand sanitizers for potentially dangerous abuse," write Emadi and Coberly. [WebMD] (Emphasis added.)

I wonder if they asked him whether he would have consumed the hand sanitizer knowing it contained rubbing alcohol instead of ethanol. I suspect the answer was "yes."

[HT: Loren]


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Wow - just, yuck.

This is worse than the woman who was busted in my hometown driving down the road, swigging mouthwash.

Is traditional rotgut that expensive these days? In Brooklyn, 1.5 liters of cheap wine is $10, I expect cheaper elsewhere. Certainly more than enough to knock out anyone not horribly acculturated to drinking, and enough to be life threatening for some.

I think that the idea behind the suggested labeling change is to get the word "alcohol" off the label, under the presumption that anyone dumb enough to drink hand sanitizer isn't going to realize that isopropanol is an alcohol.

I just don't think most people who drink hand sanitizer do so because they read the label and discover that it contains some kind of alcohol. I think most people who drink household products learn which ones will get you drunk from their peers.

I'll bet even the guy in the hospital didn't just glance at the ingredients on the hand sanitizer and think "SCORE!" He was scanning the substances in his vicinity for something "drinkable" and noticed that this one contained alcohol. That's why I'm wondering whether he would have consumed a bottle of rubbing alcohol or mouthwash, or something else if he found it first.

Even if you changed the labeling of all isopropanol-containing substances, institutionalized alcoholics would figure it out pretty quickly.

There's also the scent, which in most hand sanitizers is a pretty recognizable odor.

I don't think there's anything wrong with the other scientifically acceptable names for Isopropanol, but I just don't expect more than a handful of cases to be averted.

I'm confident that they don't care which type of alchohol it is. My uncle once told me a story about when he served in the Pacific during WWII. When they were particularly hard up for alchohol (which was most of the time), they'd drink aftershave. My uncle was never even a serious drinker. I remember looking at him like he had five heads. Desperate times call for desparate measures? Dunno but it has gotta be murder on yer liver to metabolize isopropyl achohol

I never participated when my friends indulged in weird inhalants in the '70s. I've never spent more than a night in jail. Regardless I won't be drinking Purel or Old Spice in this lifetime. There are a few lines that even I won't cross.

According to Wikipedia, Isopropyl alcohol metabolizes into Acetone. Fun fun fun.

Kitty Dukakis drank a small amount of rubbing alcohol in 1989 and it sent her straight to the hospital. Why she would do so 56 years after prohibition ended God only knows. An alcohol is basically any old organic molecule with a hydroxyl group (-OH)tacked on somewhere. There's only one kind worth drinking.

I've read of resourceful prisoners making mash from corn flakes in a toilet reserved for the purpose and distilling it using a jury-rigged alembic fueled with toilet paper. I guess even in prison you got your tonier booze and you got your rotgut.

I (sort of) work on alternative fuels, and have heard the argument that we shouldn't seriously consider methanol fuel cells because people will think "Alcohol!" and drink out of the pump or something. It's depressing that it might be correct.

The article is not about drinking rubbing alcohol, the hand sanitizer contains ethanol alcohol, just like vodka.

It was a snafu on the part of the prison staff, who ordered drinkable hand sanitizer, instead of the poisonous isopropyl rubbing alcohol hand sanitizer.

These inmates are apparently good at reading when it means that they can get drunk.

The the PI article talks about two different cases hand sanitizer poisoning that were described separate papers in the next issue of the New England Journal of Medicine. The title of one paper is Intoxication of a Hospitalized Patient with an Isopropanol-Based Hand Sanitizer.

This WebMD article confirms Loren's hypothesis. The prison incident involved ethyl alcohol and the hospital incident involved isopropyl alcohol.

Yes, the ignorance of the difference between "drinking alcohol" (Ethanol) and all other alcohols (there are a bunch) leads to some interesting therapies.

We had one patient in the ICU on IV ethanol. The patient had injested methanol (I think that was the injested poison but it's been a number of years)

The rationale was that occupying the binding sites in the liver with ethanol would block damage to the liver by limiting the sites where the contaminated alcohol would be metabolized.

A protocol similar to using Potassium Iodine to protect the thyroid during nuclear contamination events.

We kept the patient at 0.20 for about five days, as I remember.

Looking up and seeing an IV on the pole that says "ethanol" is something you don't see everyday.

Yes, the patient sang a great deal of the time.

Another point:

Even if a substance states that it has "ethyl alcohol" or "ethanol" (same thing), the purity of the ethanol can be so low as to introduce contaminants (other organic compounds) which can be present in the jell in sufficient amounts to poison.

You can confirm this by comparing cheap liquors with more refined liquors. Part of your hangover is due to these contaminants.

Not to mention other components of the jelly, which are made with absolutely no intention for human ingestion.

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