Medical experts consider toxin ingestion or acute decompensation of an inherited metabolic disease (IMD) as potential diagnoses when patients present with the clinical triad of reduced consciousness, hypoglycemia, and metabolic acidosis. Proper diagnosis, along with prompt medical intervention, results in better outcomes, especially in the presence of an IMD. A series of pediatric cases illustrates acute health issues that developed shortly after patients consumed slush ice beverages prepared with glycerol.
Patient records from 2009 to 2024 documenting cases of slush ice drink-induced hypoglycemia were retrospectively analyzed. Primary facilities’ medical personnel first assessed these cases prior to the patients being treated at a tertiary metabolic center. A diagnosis of ingesting slush ice drinks requires medical professionals to identify at least two of hypoglycemia, metabolic acidosis, or glyceroluria by clinical presentation supported by lab tests. The diagnosis was further supported by laboratory findings, including biochemical analysis, enzymology assessments, and genetic testing for IMDs. The team followed the CARE (CAse REport) guidelines to document and evaluate clinical history together with biochemical information and management approaches.
The study analyzed 21 case reports collected from nine healthcare facilities based in the UK and Ireland. Sex data was available for 18 patients, of whom 10 were males (56%) and 8 were females (44%). The reviewed patients presented with a median age of 3 years 6 months, whereas case ages spanned between 2 and 6 years 9 months. Most individuals had not experienced hypoglycemia and lacked important medical backgrounds; however, some patients were diagnosed with fasting periods and minor illnesses shortly before drinking slush ice.
Patients who consumed the slush ice drink experienced a rapid loss of consciousness shortly after ingestion within one hour of ingestion in 94% of cases. The patient experienced a generalized tonic-clonic seizure. Neuroimaging tests performed immediately after symptoms started showed no other causes for these symptoms in certain patients. Hypoglycemia (blood glucose lower than 2.6 mmol/L) developed in 95% of patients, while severe hypoglycemia (blood glucose below 1.5 mmol/L) affected 65% of affected patients. The median blood glucose measurement revealed 1.2 mmol/L. Metabolic acidosis affected 94% of patients while their median pH level reached 7.21. The laboratory analysis revealed increased lactate levels higher than 3.0 mmol/L in 95% of cases whose median lactate reading was 4.3 mmol/L.
The median potassium level was 2.7 mmol/L, with hypokalemia observed in 75% of cases. Out of nine patients whose triglyceride levels were measured, 89% showed temporary pseudohypertriglyceridemia with median results of 19.5 mmol/L. Elevated free fatty acid (FFA) to 3-hydroxybutyrate (3-OHB) ratios were detected in 75% of these patients. The urine organic acid analysis of 17 patients showed glyceroluria as a universal finding, while most revealed elevated lactate and ketonuria results. Subsequent urine tests during recovery confirmed the absence of glycerol.
Functional enzyme studies carried out in three patients confirmed normal fructose-1,6-bisphosphatase (FBPase) activity. Genetic testing of 14 patients using targeted gene panels and whole exome/genome sequencing methods failed to identify any inherited metabolic disease mutations. Medical staff formally advised patients to avoid consuming slush ice beverages post-hospitalization. Most patients (95%) did not experience recurrent symptoms, while only one child exhibited symptoms after exposure but received prompt intervention for recovery.
Medical investigations identified patients who showed laboratory signs associated with genetic diseases such as FBPase deficiency together with glycerol kinase (GK) deficiency. Glyceroluria develops as a signature symptom of IMDs, yet it also occurs when patients consume certain medications or food products containing glycerol. The sugar-free label commonly found on slush ice drinks is deceptive because these beverages contain glycerol (E422) as a texture stabilizer. Safety regulations exist for glycerol use, but researchers have confirmed incidents of toxicity, primarily when patients consume high amounts of this substance.
These research participants developed acute neurological deterioration while presenting with severe hypoglycemia in addition to metabolic acidosis soon after they had ingested glycerol-containing slush ice beverages. Laboratory investigations showed pseudohypertriglyceridemia and elevated FFA:3-OHB ratios along with glyceroluria, which acted as diagnostic indicators. The medical team initially worried about a metabolic disorder, but all enzymatic tests, along with genetic examinations, proved negative.
Scientific findings demonstrate that children may develop acute health problems after consuming slush ice drinks containing glycerol. Small amounts of glycerol are usually safe, but large doses can affect how the body processes things. Healthcare services, public monitoring bodies, and community members need to grasp these safety risks to prevent harmful occurrences.
References: Brothwell SL, Fitzsimons PE, Gerrard A, et al. Glycerol intoxication syndrome in young children, following the consumption of slush ice drinks. Arch Dis Child. Published online March 11, 2025. doi:10.1136/archdischild-2024-328109
