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Acute Alcohol Intoxication

Acute alcohol intoxication refers to the development of severe and possibly life-threatening complications after ingestion of large amounts of alcohol. Symptoms range from changes in behavior to severe hypothermia, vomiting, altered consciousness, coma, and respiratory insufficiency that may be fatal. A detailed clinical assessment, together with a thorough laboratory workup, are essential steps in order to make the diagnosis and establish the severity of intoxication.


Presentation

As one of the most frequent substances of abuse, particularly in the Western world [1], alcohol (in the form of ethanol) exerts numerous harmful effects on the human body if present in high concentrations. Acute alcohol intoxication (or "binge drinking" which is defined as the consumption of more than four alcoholic beverages for women and more than five for men in a short period of time, is described as the main culprit) is responsible for a significant amount of accidents and emergency visits [1] [2] [3] [4]. Although alcohol intoxication is predominantly diagnosed in males, it is well-known that females require less amounts of alcohol in order to attain toxic concentrations [5]. The spectrum of signs and symptoms is diverse [1] [2] [3] [4]. Behavioral changes such as euphoria and aggressiveness, as well as slurred speech, are seen in milder intoxications [1] [6], which are estimated to occur at blood ethanol concentrations of 150-250 mg/ml [2]. Gait disturbance, cognitive dysfunction (memory impairment) nausea, vomiting, visual deficits (diplopia, mydriasis), and hypothermia are symptoms encountered in more pronounced intoxication, whereas altered consciousness, stupor, coma, and even death due to respiratory insufficiency are indicators of severe intoxication [1] [2] [6] [7] [8]. The life-threatening nature of acute alcohol intoxication stems from many complications that arise in the presence of large quantities of ethanol in the circulation (> 350mg/100ml) [2], including lactic acidosis, hypokalemia, hypoglycemia, thromboembolic events, and cardiac arrhythmias [1] [2].

Falling
  • These factors probably contribute to the increased risk of falling when intoxicated with alcohol. KEYWORDS: Ethanol; adaptation; balance; postural control; vision[ncbi.nlm.nih.gov]
  • Among women, the factors associated with a BAC 0.08 g/dl were younger age, being American Indian/Alaska Native, and using a firearm, hanging/suffocation or falling as method of death.[ncbi.nlm.nih.gov]
  • Make sure the person will not fall or get hurt. Place the person on their side in case they throw up (vomit). DO NOT make the person throw up unless told to do so by a health care professional or Poison Control.[medlineplus.gov]
  • Vestibular disturbances may cause them to believe that the floor is moving, the walls are falling, or the room is rotating. As the delirium progresses, resting tremor of the hand develops, sometimes extending to the head and trunk.[merckmanuals.com]
Hypothermia
  • Symptoms range from changes in behavior to severe hypothermia, vomiting, altered consciousness, coma, and respiratory insufficiency that may be fatal.[symptoma.com]
  • Coma, vomiting and hypothermia are the commonest symptoms in young teenagers intoxicated by alcohol. The biochemical disturbances in children 11-16 years of age with alcohol intoxication resemble those of adults.[ncbi.nlm.nih.gov]
  • Children are more prone to develop complications such as hypothermia, acidosis, electrolyte disturbance and trauma. Hypoglycaemia develops in 24-50% of cases, more frequently in infants and after starvation.[ncbi.nlm.nih.gov]
  • Ensure that the patient maintains a normal body temperature; initiate body warming procedures for hypothermia. Electrolyte replacement, especially magnesium and potassium, may be necessary.[medical-dictionary.thefreedictionary.com]
  • Signs and symptoms of alcohol poisoning The signs and symptoms of alcohol poisoning include: confusion severely slurred speech loss of co-ordination vomiting irregular or slow breathing hypothermia (pale or blue-tinged skin caused by low body temperature[nhs.uk]
Impaired Balance
  • As intoxication becomes more severe, patients will exhibit an unsteady gait and impaired balance.[emsworld.com]
Vomiting
  • Symptoms range from changes in behavior to severe hypothermia, vomiting, altered consciousness, coma, and respiratory insufficiency that may be fatal.[symptoma.com]
  • Unconscious or semi-conscious Slowed or irregular breathing (eight or less breaths per minute) or lapses in breathing of more than 10 seconds Cold, clammy or pale/bluish skin Vomiting while “sleeping” or passed out, and not waking up after vomiting Appropriate[ramapo.edu]
  • Coma, vomiting and hypothermia are the commonest symptoms in young teenagers intoxicated by alcohol. The biochemical disturbances in children 11-16 years of age with alcohol intoxication resemble those of adults.[ncbi.nlm.nih.gov]
Nausea
  • Gait disturbance, cognitive dysfunction (memory impairment) nausea, vomiting, visual deficits (diplopia, mydriasis), and hypothermia are symptoms encountered in more pronounced intoxication, whereas altered consciousness, stupor, coma, and even death[symptoma.com]
  • If you were given medicine to prevent nausea, be sure to take it exactly as prescribed. Before you take any medicine, tell your doctor if: You have had a bad reaction to any medicines in the past.[myhealth.alberta.ca]
  • In some cases, medication is used to relieve nausea or vomiting.[theravive.com]
  • […] toilet more often as your body attempts to quickly pass the alcohol out of your body in your urine you'll be dehydrated in the morning, and probably have a severe headache the excess alcohol in your system may upset your digestive system, leading to nausea[nhs.uk]
Hypotension
  • Take the patient’s blood pressure to ascertain if there are any orthostatic changes, hypotension, or tachycardia.[medical-dictionary.thefreedictionary.com]
  • Intoxicated patients were more likely to be hypotensive on admission (p 0.01) despite a lower liver injury grade and no significant difference in ISS.[ncbi.nlm.nih.gov]
  • Patient evolved in the post-anesthetic care unit with hypotension, hypoxemia and mental confusion, which were reverted with intravenous hydration and elevation of lower limbs.[scielo.br]
  • Treatment Supportive measures are often sufficient if the patient is not comatose and/or hypotensive. If hypotension is present along with coma, then initiation of hemodialysis has been recommended ( 4 , 126 – 128 ).[cjasn.asnjournals.org]
Tachycardia
  • Take the patient’s blood pressure to ascertain if there are any orthostatic changes, hypotension, or tachycardia.[medical-dictionary.thefreedictionary.com]
  • […] administered to patient (40mL) was higher than that found in the literature, which may be related to intraoperative hypertension and complications detected at PACU, especially neurological ones associated to alcohol intoxication, similar to inebriation, tachycardia[scielo.br]
  • Tachycardia may be present and blood pressure can be slightly elevated. Symptoms usually begin within about 6 h of cessation.[merckmanuals.com]
  • This vasodilation, as well as fluid loss secondary to vomiting and urination, can result in hypotension and a compensatory tachycardia. In children, ethanol ingestion can lead to hypoglycemia and hypoglycemic seizures.[emsworld.com]
Flushing
  • Alcohol intoxication is manifested by such signs as facial flushing, slurred speech, unsteady gait, euphoria, increased activity, volubility, disorderly conduct, slowed reactions, impaired judgement and motor incoordination, insensibility, or stupefaction[who.int]
  • […] could: insert a tube into their windpipe to help them breathe. put them on a drip to top up their body’s water, blood sugar and vitamin levels. fit a catheter – a tube that allows them to empty their bladder straight into a bag. pump the stomach by flushing[drinkaware.co.uk]
  • (40mL) was higher than that found in the literature, which may be related to intraoperative hypertension and complications detected at PACU, especially neurological ones associated to alcohol intoxication, similar to inebriation, tachycardia, facial flushing[scielo.br]
  • The warm, flushed skin common to ethanol toxicity is the result of peripheral vasodilation and may also lead to symptoms such as a feeling of warmth described by the patient.[emsworld.com]
Diplopia
  • Gait disturbance, cognitive dysfunction (memory impairment) nausea, vomiting, visual deficits (diplopia, mydriasis), and hypothermia are symptoms encountered in more pronounced intoxication, whereas altered consciousness, stupor, coma, and even death[symptoma.com]
  • Wernicke's syndrome occurs acutely and patients present with confusion, visual impairment (diplopia) and ataxia. Korsakoff's syndrome occurs more chronically and is characterised by memory deficits and confabulation.[patient.info]
Blurred Vision
  • vision Slurred speech Pain is dulled Stupor Cannot stand or walk Vomiting Unconsciousness is possible Decreased response to stimuli Apathetic Coma Unconscious Low body temperature Possible death Shallow breathing Slow pulse Death Death as a result of[casapalmera.com]
  • Visual disturbances, including decreased visual acuity, photophobia, and blurred vision, and abdominal pain are the most common symptoms of methanol intoxication ( 7 , 64 ), one or both being found in 37 to 72% of patients ( 7 , 64 ).[cjasn.asnjournals.org]
Aggressive Behavior
  • We predicted that 5-HT augmentation would be associated with lower aggressive behavior overall, and also reduce the aggression facilitating effects of acute alcohol intoxication.[ncbi.nlm.nih.gov]
  • Abstract This study investigated the relationships between provocation, acute alcohol intoxication, impaired frontal-lobe function, and aggressive behavior.[ncbi.nlm.nih.gov]
  • Aggressive behavior was operationalized as the shock intensities administered to the fictitious opponent under conditions of low and high provocation. Of all the variables, provocation was the strongest elicitor of aggression.[history.as.uky.edu]
  • ., inappropriate sexual or aggressive behavior, mood lability, impaired judgment, impaired social or occupational functioning) that developed during, or shortly after, alcohol ingestion. C.[hams.cc]
Emotional Lability
  • Introduction One of the most commonly abused substances Particularly dangerous when combined with stimulants (caffeine, cocaine) Presentation Symptoms (in order of increasing EtOH plasma level) disinhibition emotional lability slurred speech gait disturbances[step2.medbullets.com]
Visual Hallucination
  • They may also develop seizures and auditory and visual hallucinations.[patient.info]
Confusion
  • Alcohol, Vitamin B1 – Thiamine Deficiency and Brain Damage Acute alcohol intoxication will typically produce unsteadiness, slurring of speech and mild confusion.[stewartnutrition.co.uk]
  • For example, call if: You feel confused and are seeing things that are not there. You are thinking about killing yourself or hurting others. You have a seizure. You vomit blood or what looks like coffee grounds.[myhealth.alberta.ca]
  • Confusion, slurred speech. Internal (stomach and intestinal) bleeding. Slowed breathing . Stupor (decreased level of alertness), even coma. Unsteady walking . Vomiting , sometimes bloody.[medlineplus.gov]
Slurred Speech
  • Behavioral changes such as euphoria and aggressiveness, as well as slurred speech, are seen in milder intoxications, which are estimated to occur at blood ethanol concentrations of 150-250 mg/ml.[symptoma.com]
  • Introduction One of the most commonly abused substances Particularly dangerous when combined with stimulants (caffeine, cocaine) Presentation Symptoms (in order of increasing EtOH plasma level) disinhibition emotional lability slurred speech gait disturbances[step2.medbullets.com]
  • Confusion, slurred speech. Internal (stomach and intestinal) bleeding. Slowed breathing . Stupor (decreased level of alertness), even coma. Unsteady walking . Vomiting , sometimes bloody.[medlineplus.gov]
  • A set of clinical signs—disturbed consciousness and memory, slurred speech, imbalance, aggressiveness or euphoria—may be an indicator of AAI.[academic.oup.com]
Stupor
  • Gait disturbance, cognitive dysfunction (memory impairment) nausea, vomiting, visual deficits (diplopia, mydriasis), and hypothermia are symptoms encountered in more pronounced intoxication, whereas altered consciousness, stupor, coma, and even death[symptoma.com]
  • Symptoms of alcohol poisoning: Unable to stand or walk, or can only do so with difficulty Only vaguely aware of their surroundings Difficulty breathing Passed out or in a stupor Feverish or chilled Difficulty speaking or identifying oneself to others;[mcwell.nd.edu]
  • Symptoms of alcohol poisoning: Unable to stand or walk, or can only do so with difficult Only vaguely aware of his surroundings Difficulty breathing Passed out or in a stupor Feverish or chilled Difficulty speaking or identifying oneself to others; obnoxious[ramapo.edu]
  • MSG biblegateway Pro 23:21 Drunks and gluttons will end up on skid row, in a stupor and dressed in rags.[web.archive.org]
Ataxia
  • The patient with acute ethanol poisoning may present with symptoms ranging from slurred speech, ataxia and incoordination to coma, potentially resulting in respiratory depression and death.[ncbi.nlm.nih.gov]
  • Alcohol intoxication is associated with central nervous system depression including unresponsiveness, hypothermia, and loss of gross motor control (ataxia, slurred speech). Gastrointestinal/genitourinary.[medical-dictionary.thefreedictionary.com]
  • Wernicke's syndrome occurs acutely and patients present with confusion, visual impairment (diplopia) and ataxia. Korsakoff's syndrome occurs more chronically and is characterised by memory deficits and confabulation.[patient.info]
  • The National Institute on Alcohol Abuse and Alcoholism (NIAAA) defines the term " binge drinking " as a pattern of drinking that brings a person's blood alcohol concentration (BAC) to 0.08 g/dL or above. [19] 200–299 mg/dL: Marked ataxia, slurred speech[en.wikipedia.org]
  • […] levels that would serious affect alcohol naive patients females tend to have less tolerance than males typical 50-100 mg/dL: relaxation, sedation, prolonged reaction time,euphoria 100-200 mg/dL: impaired motor function and coordination, dysarthria, ataxia[lifeinthefastlane.com]
Altered Mental Status
  • Debra Posted Tue 28th of October, 2014 16:35:08 PM When patient's present to the Emergency Room intoxicated with altered mental status or ALOC, they may receive services to rule out other possible conditions, e.g.[supercoder.com]
  • Serum ethanol levels may be ordered in suspected alcohol ingestion as well altered mental status of unknown etiology, coma, psychiatric emergencies, traumatic emergencies, and history of other ingestions (eg, toxic alcohol, salicylates).[emedicine.medscape.com]
  • "Traumatic brain injury and other things cause altered mental status."[ems1.com]
  • All patients with altered mental status should have a blood glucose determined and dextrose administered if they are found to be hypoglycemic.[emsworld.com]

Workup

Because of the devastating role of alcohol in the overall mortality rates (1 in 10 deaths were attributed to alcohol abuse according to certain reports, with half of the cases being due to acute alcohol intoxication after binge drinking) [3] [4], the importance of recognizing signs and symptoms early on is pivotal for making an early diagnosis and initiating appropriate treatment. One of the first and most important steps in the workup is a thoroughly obtained patient history (which often includes a heterogeneous anamnesis from the patient's friends or family) that will identify excessive alcohol consumption (the amount of alcohol ingested, what kind of alcoholic beverages were consumed and the timeframe) and lead to a presumptive diagnosis. After a thorough physical examination and assessment of vital signs (blood pressure, temperature, heart rate, etc.), laboratory studies should be immediately employed, comprised of a complete blood count (CBC), serum electrolytes, glucose levels, arterial blood gas (ABG) analysis, and urinalysis (including urine output) [2]. Some studies have confirmed elevated liver transaminase levels (alanine and aspartate aminotransferase, or ALT And AST, respectively) and an abnormal ratio, thus their inclusion in the laboratory panel is recommended in the case of acute alcohol intoxication [5].

Calcium Decreased
  • The serum concentration of ionized calcium decreased from 1.20 /- 0.01 to 1.16 /- 0.01 mmol per liter, reaching a nadir 8 to 12 hours after alcohol administration was begun (P less than 0.001).[ncbi.nlm.nih.gov]
  • In a manner consistent with the developing hypoparathyroidism, the serum levels of ionized and total calcium decreased and the urinary excretion of calcium increased.[nejm.org]

Treatment

  • Abstract This randomized, open-label study evaluated the efficacy of 300 mg metadoxine (given intravenously) added to standard treatment compared with standard treatment alone in managing the physical and psychological signs of acute alcohol intoxication[ncbi.nlm.nih.gov]
  • Patients were clinically and biochemically evaluated at 0.5, 1, 2, 3, 6, 9, and 12 hr after treatment.[ncbi.nlm.nih.gov]
  • Intervention condition is a manual-based brief motivational intervention with a telephone booster after 6 weeks and a manual-guided intervention for caregivers which will be compared to treatment as usual.[ncbi.nlm.nih.gov]
  • Because alcohol poisoning can be fatal, emergency treatment is urgently needed.[answers.yahoo.com]
  • Treatment is conservative but severely intoxicated children may require dialysis.[ncbi.nlm.nih.gov]

Prognosis

  • […] is concern withdrawal long-acting benzodiazepines with taper addiction disulfiram inhibits acetaldehyde dehydrogenase aversive conditioning naltrexone decreases desire to drink gabapentin topiramate also an anti-seizure and anti-migraine medication Prognosis[step2.medbullets.com]
  • […] are well known. 1 There are a few case reports of alcohol-induced hypoglycemia in young children 2 and also case reports of withdrawal symptoms in infants of alcoholic mothers. 3 Yet there is very little in the literature on the course, treatment, and prognosis[pediatrics.aappublications.org]
  • Prognosis [ edit ] A normal liver detoxifies the blood of alcohol over a period of time that depends on the initial level and the patient's overall physical condition.[en.wikipedia.org]
  • Table 8 summarizes salient epidemiologic aspects, key clinical and laboratory findings listed in the order of their usefulness for diagnosis, and important indicators of a poor prognosis.[cjasn.asnjournals.org]

Etiology

  • Answer: For first part you need to follow the ICD guideline of reporting etiology followed by symptom. Report first the alcohol poisoning or toxic effect of alcohol or alcohol abuse and then report AMS or ALOC. See links below: Thanks !![supercoder.com]
  • Serum ethanol levels may be ordered in suspected alcohol ingestion as well altered mental status of unknown etiology, coma, psychiatric emergencies, traumatic emergencies, and history of other ingestions (eg, toxic alcohol, salicylates).[emedicine.medscape.com]

Epidemiology

  • The primary aims of this epidemiological study were to assess the prevalence and factors associated with acute alcohol intoxication among 57 813 suicide decedents in 16 states.[ncbi.nlm.nih.gov]
  • See: Statistics from Altmetric.com ACCIDENT & EMERGENCY MEDICINE EPIDEMIOLOGY Strengths and limitations of this study Data were collected by the treating clinician at the time of the admission decision thus obtaining the most accurate data on the influence[bmjopen.bmj.com]
  • Isopropanol Epidemiology Isopropanol is used in various industrial products, as a cleaning agent, deicer, and in rubbing alcohol.[cjasn.asnjournals.org]
  • He has since completed further training in emergency medicine, clinical toxicology, clinical epidemiology and health professional education.[lifeinthefastlane.com]
  • Grant BF, Goldstein RB, Saha T, et al : Epidemiology of DSM-5 alcohol use disorder results from the National Epidemiologic Survey on Alcohol and Related Conditions III. JAMA Psychiatry 72 (8):757–766, 2015. doi: 10.1001/jamapsychiatry.2015.0584.[merckmanuals.com]
Sex distribution
Age distribution

Pathophysiology

  • The role of glutamatergic neurotransmission in the pathophysiology of alcoholism . Annu Rev Med. 1998 ;49: 173 - 184 . Google Scholar Crossref Medline ISI Alcohol Withdrawal Syndrome Guidelines.[doi.org]
  • Pathophysiology Metabolic acidosis and visual problems, hallmarks of this disorder, are due to metabolites of methanol.[cjasn.asnjournals.org]
  • One study found that consumption of spirits was more likely than wine or beer to cause acute pancreatitis. [ 4 ] The pathophysiology of alcohol-related pancreatitis is not clearly understood.[patient.info]
  • Pathophysiology The ingestion of any of the alcohols can result in clinical inebriation, and the strength of any alcohol’s inebriating effects is directly proportional to its molecular weight.[emsworld.com]

Prevention

  • The study was part of a multicentre-funded injury prevention project based on the widely accepted Canadian Hospital Injury Reporting and Prevention Programme.[ncbi.nlm.nih.gov]
  • Suicide prevention strategies should address alcohol use as a risk factor. Alcohol problems prevention strategies should focus on suicide as a consequence of alcohol use, especially among AI/AN youth and young adults.[ncbi.nlm.nih.gov]
  • Acetaldehyde significantly decreased TER, but inhibition of alcohol dehydrogenase or application of a superoxide dismutase mimetic failed to prevent alcohol-induced decreases in TER.[ncbi.nlm.nih.gov]
  • CONCLUSIONS: In both men and women, alcohol intoxication was associated with violent methods of suicide and declined markedly with age, suggesting that addressing risks associated with acute alcohol use may be of the greatest aid in the prevention of[ncbi.nlm.nih.gov]
  • , and Complications Complications ED Management Inpatient Management Chronic Management Prevent further ethanol intake Prevent individual from harming self or others Sedate patient if agitated or aggressive Order urine toxicity screen Stabilize vitals[step2.medbullets.com]

References

Article

  1. Tõnisson M, Tillmann V, Kuudeberg A, Lepik D, Väli M. Acute alcohol intoxication characteristics in children. Alcohol and Alcoholism. 2013;48(4):390-395.
  2. Morgan MY. Acute alcohol toxicity and withdrawal in the emergency room and medical admissions unit. Clin Med (Lond). 2015;15(5):486-489.
  3. Kanny D, Brewer RD, Mesnick JB, Paulozzi LJ, Naimi TS, Lu H. Vital signs: alcohol poisoning deaths - United States, 2010-2012. MMWR Morb Mortal Wkly Rep. 2015;63(53):1238-1242.
  4. Stahre M, Roeber J, Kanny D, Brewer RD, Zhang X. Contribution of excessive alcohol consumption to deaths and years of potential life lost in the United States. Prev Chronic Dis 2014;11:130293.
  5. Binder C, Knibbe K, Kreissl A, et al. Does acute alcohol intoxication cause transaminase elevations in children and adolescents? Alcohol. 2016;51:57-62.
  6. Bitunjac K, Saraga M. Alcohol Intoxication in Pediatric Age: Ten-year Retrospective Study. Croat Med J. 2009;50(2):151-156.
  7. Lamminpää A. Alcohol intoxication in childhood and adolescence. Alcohol and Alcoholism. 1995 Jan;30(1):5-12.
  8. National Institute of Alcohol Abuse and Alcoholism. Alcohol overdose: the dangers of drinking too much. Bethesda, MD: National Institute of Alcohol Abuse and Alcoholism; 2013.

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Last updated: 2018-06-21 20:56