Glycerine Sodium Chloride Safety in Children Under 2 Years
Glycerine (glycerol) combined with sodium chloride should NOT be given to children under 2 years of age due to significant risk of glycerol intoxication syndrome, which can cause life-threatening complications including decreased consciousness, hypoglycemia, and metabolic acidosis.
Critical Safety Concerns with Glycerol in Young Children
Glycerol intoxication syndrome is well-documented in children under 8 years, with highest risk in those under 4 years of age. 1 The clinical presentation includes:
- Acute decreased consciousness (94% of cases) 1
- Hypoglycemia (95% of cases) 1
- Metabolic (lactic) acidosis (94% of cases) 1
- Pseudohypertriglyceridemia (89% of cases) 1
- Hypokalaemia (75% of cases) 1
The median age of affected children was 3 years 6 months (range 2-6.9 years), with 93% becoming acutely unwell within 60 minutes of glycerol exposure. 1
Sodium Chloride Considerations for Infants Under 2 Months
For sodium chloride specifically, chlorhexidine-based antiseptic solutions containing sodium chloride cannot be recommended for infants younger than 2 months due to potential systemic absorption and skin complications. 2
- Chlorhexidine was detected in blood of 70% of treated infants after application 2
- Skin erythema and irritation occurred, particularly in preterm infants under 1000g birthweight 2
- The evidence quality is rated as Level of Evidence 2-, with conditional recommendation against use 2
Appropriate Sodium Supplementation in Young Children
When sodium supplementation is medically necessary in infants and young children, parenteral or oral pharmaceutical-grade preparations should be used under strict medical supervision:
Parenteral Sodium Requirements
- Infants <1 year: 2-3 mmol/kg/day 2
- Children 1-2 years: 1-3 mmol/kg/day 2
- Chloride requirements: 2-4 mmol/kg/day for all pediatric ages 2
Critical Monitoring Requirements
Daily monitoring is essential during sodium supplementation in young children: 2
- Serum electrolyte concentrations
- Body weight
- Fluid balance (urine output and specific gravity)
- Clinical status assessment
Common Pitfalls to Avoid
Never use home-prepared sodium chloride solutions or table salt for supplementation in children, as formulation errors can cause dangerous hypo- or hypernatremia. 3, 4
Avoid products containing glycerol in children under 8 years of age, especially those under 4 years, as they lack the metabolic capacity to safely process glycerol loads. 1
Do not assume that combining glycerol with sodium chloride makes the preparation safer—the glycerol component remains the primary toxicity concern in young children. 1
Alternative Approaches
For children requiring sodium supplementation with high intestinal losses or salt-wasting conditions:
- Use pharmaceutical-grade sodium chloride capsules (500mg each) that can be opened and mixed with food or liquids 3
- Consider glucose-saline solutions (WHO oral rehydration solution: 90 mmol/L sodium, 2% glucose) for diarrheal losses 5
- Pediatric patients with chronic kidney disease may require 1-5 mmol Na/kg/day, adjusted by blood biochemistry 3
The risk-benefit analysis strongly favors avoiding glycerol-containing products in children under 2 years, given the well-documented severe adverse events and availability of safer alternatives for sodium supplementation when medically indicated.