It has been suggested that this article or section be merged into Alcohol intoxication. (Discuss)

Acute alcohol intoxication can result from a high level of alcohol in the bloodstream, accompanied by extreme drunkenness. The term acute alcohol intoxication is used by healthcare providers, often in emergencies. Toxicologists also speak of alcohol intoxication to discriminate from other toxins researched in the field.

[edit] Epidemiology

A drunken male on the ground, Pichilemu, Chile.

The condition is frequently found in either young people who are being exposed to commonly available alcoholic beverages like beer, wine, and distilled liquor for the first time, and don't know their limits, or by people suffering from alcoholism who ingest much more than they usually do.

[edit] Pathophysiology

Ethanol is metabolised to acetaldehyde by ethanol dehydrogenase, which is found in many tissues, including the gastric mucosa. Acetaldehyde is metabolised to acetate by acetaldehyde dehydrogenase, which is predominantly found in liver mitochondria. However, it takes roughly 90 minutes for a healthy liver to metabolize a single ounce, approximately one hour per standard unit.

Ethanol's acute effects are largely due to its nature as a CNS depressant, and are dependent on blood alcohol concentrations:

• 20–99 mg/dL - Impaired co-ordination and euphoria
• 100-199 mg/dL - Ataxia, poor judgement, labile mood
• 200-299 mg/dL - Marked ataxia, slurred speech, poor judgement, labile mood, nausea and vomiting
• 300-399 mg/dL - Stage 1 anaesthesia, memory lapse, labile mood
• 400+mg/dL - Respiratory failure, coma and death

As drinking increases, people become sleepy, or fall into a stupor. Ultimately, the respiratory system becomes depressed, and the person will stop breathing. This is a common cause of death on college campuses. The most important thing for friends who witness someone "passing out" from too much alcohol is to get them emergency medical treatment. Commonly, comatose patients will aspirate their vomit. CNS depression and impaired motor co-ordination along with poor judgement increases the likelihood of accidental injury occurring. ^[1]. It is estimated that about half of alcohol related deaths are due to accidents (32%) or intentional injury (13.7%)^[2].

In addition to respiratory failure and accidents caused by effects on the central nervous system, alcohol causes significant metabolic derangements. Hypoglycaemia occurs due to ethanol's inhibition of gluconeogenesis, especially in children, and may cause lactic acidosis, ketoacidosis and acute renal failure. Metabolic acidosis is compounded by respiratory failure. Patients may also present with hypothermia.

[edit] Avoidance of intoxication

Alcohol is metabolized by a normal liver at that rate of about one ounce (one "highball", a normal beer, a regular sized glass of wine) every 90 minutes. An "abnormal" liver, one with hepatitis, cirrhosis, gall bladder disease, cancer, etc, will have a slower rate of metabolism. One can delay the absorption of alcohol by drinking water and ingesting food, but it prolongs the un-metabolized alcohol in the body.

[edit] Diagnosis

In determining if someone is intoxicated it is necessary to observe their behavior while the subject is sober to establish a baseline; ruling out a preexisting condition such as hypoglycemia, narcotic usage, mental health issues, etc. . However several well known criteria can be used to establish a probable diagnosis. For a physician in the acute treatment setting, acute alcohol intoxication can mimic other acute neurological disorders, or is frequently combined with other recreational drugs which complicate diagnosis and treatment. Definitive diagnosis relies on a blood test for alcohol, usually performed as part of a toxicology screen. Many patients are uninhibited and therefore disclose information which simplifies the diagnosis especially when legal consequences are not likely (e.g. a law enforcement official is not present).

[edit] Treatment

Emergency treatment for acute alcohol intoxication is aimed at stabilising the patient, maintaining a patent airway and respiration, and waiting for alcohol to be metabolised:^[3]

• protecting the vital signs by monitoring ABCs, or Airway, Breathing, and Circulation, ie. if the person is thought to be at risk for severe respiratory depression, they may have an Endotracheal tube placed to protect the airway and assist with breathing.
• protecting the airway by aspirating stomach contents that may lead to aspiration pneumonia,
• Hypoglycaemia is treated with 50ml 50% dextrose solution and saline flush as ethanol induced hypoglycaemia is unresponsive to glucagon,
• administering the vitamin thiamine to prevent the development of Wernicke-Korsakoff syndrome which may cause a seizure(This is more usually a treatment for chronic alcoholism, but in the acute context is usually co-administered to ensure maximal benefit),
• Urea and electrolytes should be checked to guide fluid replacement
• Haemodialysis is indicated if the blood concentration is dangerously high (>400 mg%), and especially if there is metabolic acidosis

Additional medication may be indicated for treatment of nausea, tremor, and anxiety.

[edit] Prognosis

A normal liver will detoxify the blood of alcohol over time, and the time depends on the initial level and the patient's overall physical condition. The abnormal liver will take longer, as long as the alcohol doesn't cause liver failure. ^[4]

People who have been drinking heavily for several days or weeks may have withdrawal symptoms after the acute intoxication has subsided. ^[5]

[edit] References

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