How do you mistake windshield wiper fluid for Kool-Aid? -or- What do we do in cases of methanol poisoning?

This is just unbelievable. At a day care center in Arkansas, 10 kids were accidentally given windshield wiper fluid instead of Kool-Aid:

Child welfare investigators plan to talk to the owner of an Arkansas daycare center where 10 children were sickened after they were given windshield wiper fluid to drink.

"They'll go out, they'll get an explanation and they'll try to sort (it) out preliminarily," said Julie Munsell, spokeswoman for the state Department of Human Services.

Hospital officials say a staffer mistakenly put the blue liquid in the refrigerator after shopping and later served it thinking it was Kool-Aid. Doctors estimate the children, ages 2 to 7, drank about an ounce of the fluid.

Only one child remained hospitalized Friday morning after blood samples showed "measurable levels" of methanol, a highly toxic alcohol that can induce comas and cause blindness, officials said.

Arkansas' Department of Human Services said depending on the results of the investigation, the daycare operator Carolyn Bynum could have her license revoked or suspended.

How could you possibly not know the difference? I mean, I know they are both colored fluids, but windshield wiper fluid has a very distinctive smell because it contains methanol.

Setting aside how the hell this happened, I thought this would be a nice time to explain what we do in the case of methanol poisoning.

Methanol poisoning happens primarily because of three reasons. First, lots of stuff around the house has methanol in it: windshield wiper fluid, antifreeze, some paint thinners, copy machine fluid, etc. Kids can get into them and drink them. Also, if you are trying to brew alcohol and you don't know what you are doing, sometimes the resultant moonshine can have methanol in it. Finally, there are people who try and kill themselves this way, but that is pretty rare.

Methanol is a problem because it exploits the pathway that is involved in degrading ethanol in your body and produces toxic byproducts. During ethanol metabolism, ethanol is first converted by your liver to acetaldehyde by an enzyme called alcohol dehydrogenase (ADH). Acetaldehyde is then converted to acetic acid by aldehyde dehydrogenase. Acetic acid can be used in cellular metabolism to make energy (which is why alcohol has calories). This is how it normally works. Acetaldehyde as a compound is not great for you. We think that accumulation of it may be why people get hangovers, and prolonged exposure to it damages your liver and kidneys. But people can metabolize ethanol without too much of a problem.

Methanol is also metabolized by these enzymes. ADH changes methanol to formaldehyde and aldehyde dehydrogenase changes it to formic acid. But formic acid is bad news. It is eventually oxidized down to carbon dioxide, but this is a slow process. While it accumulates it can be toxic to a variety of body systems.

For one, it is an acid. Accumulation of an acid in your blood causes metabolic acidosis -- where you blood pH is too low. This is a medical emergency because it causes respiratory distress and also cardiac arrhythmias that can result in death. Also, formic acid is directly toxic to your eyes and brain. We are not exactly certain why but methanol poisoning can cause blindness by killing cells in the retina and brain damage by killing neurons in a movement initiating part of the brain called the putamen. Symptoms also include nausea, coma, seizures, headaches, and pain.

So clearly this is a serious business. Particularly in children where it takes very little methanol to be toxic, this is a medical emergency.

That being said, patients with methanol poisoning can be hard to diagnose. Obviously in this case someone realized they had given them the wrong thing and called poison control. But say someone walks in who looks intoxicated with ethanol -- which they do -- and you don't know it is methanol poisoning. Further, it can take 12-24 hours to present with methanol poisoning symptoms because it takes the body a while to convert the methanol into formic acid. So it can be tough.

How do we treat it? Well, first of all, you want to provide respiratory support if necessary. If the patient is running a metabolic acidosis, we give them bicarbonate -- a base -- to correct the pH in their blood. Then the issue is getting the methanol out of their system. If they have a lot of it, you can do this with dialysis. Another option is to wait until they urinate it out.

This gets to one of the more interesting treatments I have read about in medicine: one option is to give them ethanol. Ethanol has a much higher affinity for the enzymes that degrade it than methanol, so you can use it as a competitive inhibitor to prevent methanol from being degraded into formic acid. Now, I once saw an episode of House where the case was one of methanol poisoning. House treats it by doing shots of whiskey with the guy. To the best of my knowledge that is not how we administer the ethanol. You administer it through the IV. (Also, there is another competitive inhibitor of ADH called fomepizole, but it is pricey and ethanol works just as well.)

Anyway, I hope upon hope that someone had the sense to treat these kids for methanol poisoning as soon as possible -- clearly the day care people are clueless. If you want more information on diagnosis and treatment, read this.

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I could easily see this happening. The original writer hasn't ever smelled Blue Wiper Fluid or tasted it? I have had it splashed as I was pouring, it is slightly sweet tasting. I wouldn't know the smell of methanol from anything. Cold fluid in a fridg won't have a huge smell anyway.

It might not have much smell but it would be in a bottle clearly labeled "Wind Shield Wiper Fluid". This is a stretch, I know I am assuming that daycare workers in Arkansas can read.

I'm pretty sure wiper fluid is sold with a child-proof cap. I just don't see how this can go unnoticed.

Jake, in the House episode you referenced, the guy was on death row and had tried to kill himself. He was refusing medical treatment, so House tricked him into the "treatment"...

By Braxton Thomason (not verified) on 13 Mar 2009 #permalink

Smell aside, bottles of washer fluid are usually labeled something like WASHER FLUID.

There really isn't any excuse for this.

If it was labelled. Winshield washer fluid is available in bulk for oil change places to dispense... maybe the daycare worker's husband filled a random bottle at the garage he worked in and put it in his wife's trunk. Something like that happened around here once, although it was his own kids that drank it.
Just sayin... there are labeling regs for a reason... unfortunately the one that doesn't follow them isn't always the one that pays the price.

I'm looking at an MSDS for methanol. It says

If victim is conscious and alert, give 2-4 cupfuls of milk or water. Never give anything by mouth to an unconscious person. Get medical aid immediately. Induce vomiting by giving one teaspoon of Syrup of Ipecac.

The second MSDS I review reads "Ingestion: induce vomiting immediately â¦" in the first aid section.

Is there some reason not to induce vomiting if one suspects methanol ingestion?

What I want to know is what the washer fluid was doing in the fridge? Not storing poisons in with your food is kindof basic.

By intransigentia (not verified) on 13 Mar 2009 #permalink

I'm not excusing this, but the insinuation was that it was intentional. At least to me. When someone says something is "unbelieveable" to me that means things must be deliberately done. Now I don't know about this situation but a gallon bottle of blue stuff in a fridge, without looking, what would think that was? Would you even put "Windshield Washer Solution" on your list?

The fact that they are saying that the same person served it makes me suspicious that it maybe was intentional. I could see someone else not really looking at the bottle, but not the person who put it there.

One of the problems on my graduate biochem final had to do with calculating the amount of ethanol needed to prevent significant methanol poisoning (with all the fun affinity/kinetic and concentration info given). Pretty interesting... I'm pretty sure the answer would've left a person with a hefty hangover, but it'd be better than methanol poisoning.

By phishstyx (not verified) on 13 Mar 2009 #permalink

The good news this morning is that the children will (apparently) not have any permanent problems from this, AND the owner of the daycare has agreed to give up her license.

I just have to say, when I read the first line of your post I thought you wrote, "This is just inevitable" instead of "This is just unbelievable." I thought you were pretty insane for a minute. But nice post anyway.

Nice Post Jake....It is important to acknowledge that BallanJ's remarks are correct about certain Oil Change franchises dispensing methanol mixtures into unlabeled bottles as a customer gesture. Far more serious is the poorly glued paper label scenario whereby here in Wintry New York State the barely adhered paper labels on these manufacturer's 1-gal plastic jugs frequently fall COMPLETELY OFF! This happens with tremendous frequency when the bottles are display exposed to the elements. It is not uncommon to be carrying the label separate of the toxic bottle to the register for checkout. Consideration should also be given for the length of time these poorly labeled bottles would languish in a Southern home. IN CANADA, METHANOL WASHER FLUID IS SOLD IN PLASTIC JUGS SIMILAR TO THE RECTANGULAR JUG CONTAINER WE WOULD FIND PAINT THINNER IN AT HOME DEPOT. THE JUGS ARE LABELED WITH A TOUGH REMOVAL-RESISTANT PLASTIC FILM THAT IS SHRUNK ON LIKE A GIRDLE DURING MANUFACTURING. THE METHANOL CONTENT IS POTENT, DYED DARK PURPLE, AND HAS A DISTINCT UNPLEASANT CHEMICAL ODOR BEYOND THE ALCHOHOL ODOR OF THE METHANOL. LAST, THE LABELS ARE PRINTED WITH A POP-CULTURE-UNIQUE, UGLY-LARGE SKULL & CROSSBONES LOGO ON EACH OF FOUR SIDES OF THE RECTANGULAR JUG. THIS WARNING LOGO CORRESPONDS DIRECTLY TO A NATIONAL EDUCATIONAL CAMPAIGN WHICH WARNS CHILDREN AS YOUNG AS PRESCHOOL AGAINST THE DANGERS OF POISONING.

THE COST OF THIS LEVEL OF PEDIATRIC DEVOTION TRANSLATES TO ABOUT $7 FOR A 1.5 GAL. (litres) Here in the States we would balk at $3.50 for a bottle of washer fluid.

How I see it is, WHO PUTS WINDSHIELD WASHER FLUID IN THE FRIDGE!?? Are you for real, seriously...
It is a scary thing to think that, people like that are watching our children?