Drugs containing benzyl alcohol:
(1) atropine sulfate
(2) heparin
(3) crystalloid solutions
(4) diazepam
(5) metoclopramide
(6) physostigmine
(7) succinylcholine
(8) pancuronium
(9) phenobarbital injection
(10) flushing solution (heparinized bacteriostatic sodium chloride)
(11) multivitamin solutions
(12) solu-cortef and dexamethasone
Clinical findings in premature infants:
(1) progressive neurologic deterioration, with hypotonia, seizures and coma
(2) intraventricular hemorrhage
(3) hypotension and cardiovascular collapse
(4) metabolic acidosis with increased anion gap
(5) leukopenia and thrombocytopenia
(6) hepatic failure with hyperbilirubinemia and elevated serum ammonia
(7) respiratory distress with gasping
(8) renal failure
(9) skin breakdown
where:
• The birthweight of affected infants was usually < 1,250 grams.
• In addition to the low birthweight, premature infants are more likely to require prolonged intensive care, which would increase the period of exposure.
• There is multiple organ failure (respiratory, cardiac, hematologic, hepatic, renal, dermatologic).
Other patients at risk include patients with status epilepticus receiving infusions of diazepam > 1 mg/kg/hour.
Doses seen in affected infants: 99 to 234 mg/kg/day
Monitoring:
(1) serum benzyl alcohol
(2) serum and urine benzoic acid
(3) urine hippuric acid
The condition can be prevented by using drugs formulated without benzyl alcohol in infants and by limiting the infusion in adults.
