Hand Sanitizer: What's the Real Story?

hand sanitizer

The Bottom Line

Hand sanitizers usually contain alcohols that have been FDA approved for topical use. These can be hazardous in larger quantities, but a taste amount usually does not cause serious symptoms. Even so, check here to make sure it is not a product contaminated with methanol. Methanol will not be listed on the label.

hand sanitizer

The Full Story

Hand sanitizers usually contain alcohols that have been FDA approved for topical use. Such products usually contain ethanol (ethyl alcohol), isopropanol (isopropyl alcohol) or benzalkonium chloride (a detergent). Drinking alcohol-based hand sanitizers can cause intoxication and coma. Ethanol-based products in particular can cause low blood sugar which can lead to seizure in children. Until recently, the risk of hand sanitizer exposure was not considered more dangerous than exposure to other sources of alcohol in a child's environment. All alcohol-containing products such as: beer, wine, liquor, rubbing alcohol, mouthwash, facial toner, or hair tonics that contain alcohol should be stored out of sight and out of reach of children. However, in June 2020, the FDA announced that some popular hand sanitizers are contaminated with methanol (methyl alcohol). This news has prompted health care providers to be more cautious.

Methanol has a much narrower range of safety compared to ethanol and isopropanol. Too much methanol can cause permanent blindness and death secondary to severe changes in body chemistry that happen as our bodies metabolize it. Even if your hand sanitizer label says it contains alcohol, ethanol, isopropyl alcohol, or benzalkonium chloride, it is important to check here to make sure it is not one of the contaminated products. Methanol will not be listed on the label.

Children will most commonly access hand sanitizer by putting their mouths on the pump, or by licking what was pumped out on their hands by parents. Serious toxicity would not be expected in either of these situations, even if it was a methanol containing product.

When hand sanitizers are properly produced and do not contain methanol, there are two potentially serious problems when children ingest them. The first is that it can lower their blood sugar. In extreme, untreated situations, that can lead to coma and seizures. That's why the first treatment instruction after a child drinks alcohol, from any source, is to give something sweet to drink. The second problem is that it can make kids drunk. That doesn't just mean woozy; it means slow heart rate and breathing. Call Poison Control, and the poison specialist will calculate the amount of alcohol swallowed compared to the child's body weight. If it's really too much, the child will be sent to the emergency room so that they can be safely monitored and treated if any of these problems occur.

Another issue with hand sanitizers is that they can be irritating to the stomach, causing nausea or vomiting. BUT, a lick of hand sanitizer should not do this.  

Even a sip of methanol-tainted hand sanitizer can cause poisoning in a small child. Long-term chronic use on the skin could also be a problem. The likelihood of toxicity must be considered on a case by case basis.

Some people abuse hand sanitizer to try to become intoxicated or drunk. If someone you know is abusing hand sanitizer, get help. While it is never safe to intentionally drink hand sanitizer, if a person is abusing a methanol-containing hand sanitizer, this behavior could be deadly.

Remember, the products that are contaminated with methanol are much more dangerous than those made with approved hand sanitizer ingredients. Smaller quantities need to be ingested before they can cause serious, sometimes permanent health effects and even death. Methanol will not be listed as an ingredient. If someone ingests a product with methanol (see this list) get help right away. Don’t wait until symptoms develop as they could become permanent! Get help online with webPOISONCONTROL® or call 1-800-222-1222.

(updated July, 2020)

Rose Ann Gould Soloway, RN, BSN, MSEd, DABAT emerita
Clinical Toxicologist

Poisoned?

Call 1-800-222-1222 or

HELP ME online

Prevention Tips

  • Supervise young children when they use hand sanitizer.
  • Between uses, keep it out of sight and reach of young children.

This Really Happened

Case 1: A 3-year-old girl had the 16-oz pump dispenser bottle of hand sanitizer containing 68% alcohol in her hands. She had squirted it on her hands, face, clothing and hair. Her mom called Poison Control, concerned that she may have swallowed some. The child didn't remove the pump attachment and had only about a minute to swallow anything. She appeared fine. Poison Control reviewed the concerns with alcohol ingestion in small children but reassured her mom that the small amount she may have swallowed would not poison her. A bath, sweet fluids and a snack were recommended. Two hours later in a follow-up call to the home by Poison Control, her mom reported that she had followed Poison Control's advice and the child was fine.

Case 2: A 2-year-old boy tasted what his mom estimated was a dime-size amount of hand sanitizer containing 62% alcohol one evening. He squeezed some on his hands and then licked them. His mom called Poison Control and was advised to keep him awake for an hour and give sweet fluids and a snack, and to watch for symptoms of inebriation (acting drunk), though no symptoms were expected with this amount. In a follow-up call from Poison Control to his mom an hour later, his mom reported he was a little sleepy, but it was past his bedtime. He had had some juice and appeared his normal self.


For More Information

FDA Updates on Hand Sanitizers with Methanol. https://www.fda.gov/drugs/drug-safety-and-availability/fda-updates-hand-sanitizers-methanol. Accessed 7/29/2020.

A science-based look at when to use hand sanitizers (CDC)


References

FDA issues final rule on safety and effectiveness of consumer hand sanitizers. https://www.fda.gov/news-events/press-announcements/fda-issues-final-rule-safety-and-effectiveness-consumer-hand-sanitizers. Accessed 7/29/2020.

Engel JS, Spiller HA. Acute ethanol poisoning in a 4-year-old as a result of ethanol-based hand-sanitizer ingestion. Pediatr Emer Care. 2010;26:508-509.

Miller M, Borys D, Morgan D. Alcohol-based hand sanitizers and unintended pediatric exposures: a retrospective review. Clinical Pediatrics. 2009;48(4):429-431.

Rayar P, Ratnapalan S. Pediatric ingestions of household products containing ethanol: a review. Clinical Pediatrics. 2013;52(3):203–209.

Poisoned?

Call 1-800-222-1222 or

HELP ME online

Prevention Tips

  • Supervise young children when they use hand sanitizer.
  • Between uses, keep it out of sight and reach of young children.

This Really Happened

Case 1: A 3-year-old girl had the 16-oz pump dispenser bottle of hand sanitizer containing 68% alcohol in her hands. She had squirted it on her hands, face, clothing and hair. Her mom called Poison Control, concerned that she may have swallowed some. The child didn't remove the pump attachment and had only about a minute to swallow anything. She appeared fine. Poison Control reviewed the concerns with alcohol ingestion in small children but reassured her mom that the small amount she may have swallowed would not poison her. A bath, sweet fluids and a snack were recommended. Two hours later in a follow-up call to the home by Poison Control, her mom reported that she had followed Poison Control's advice and the child was fine.

Case 2: A 2-year-old boy tasted what his mom estimated was a dime-size amount of hand sanitizer containing 62% alcohol one evening. He squeezed some on his hands and then licked them. His mom called Poison Control and was advised to keep him awake for an hour and give sweet fluids and a snack, and to watch for symptoms of inebriation (acting drunk), though no symptoms were expected with this amount. In a follow-up call from Poison Control to his mom an hour later, his mom reported he was a little sleepy, but it was past his bedtime. He had had some juice and appeared his normal self.