In Reply.—We appreciate the opportunity to respond to Dr Silverman's concerns. The primary conclusion of our study was that because the history of ingestion is unreliable in children, using maximum possible ingested dose of ethanol per kilogram of body weight as suggested by Dr Silverman cannot be a reliable predictor of toxicity. The children in our study who had blood ethanol concentrations measured had levels far below those predicted, and children who did not have levels measured remained asymptomatic despite having predicted levels in the extremely toxic range. Our study therefore concluded that symptoms, and not histories, should guide poison centers and clinicians in determining which children should go to a health care facility.
The concept of "lethal dose" requires clarification. No amount of ethanol ingested by a child should be a lethal dose if aggressive supportive therapy is administered in a timely manner. Our study tried instead to