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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.[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]
  • The most common cause of injury was a fall. The results of this study confirm the heavy use of alcohol by some young children.[ncbi.nlm.nih.gov]
  • The groups also differed in injury related characteristics, with intoxicated patients more frequently sustaining falls or violence-related injuries. The intoxicated group was assessed with a lower GCS score and had a higher hospital admission rate.[ncbi.nlm.nih.gov]
  • This corresponds to a blood alcohol concentration fall of about 20 mg/dL per hour.[emedicinehealth.com]
Hypothermia
  • 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]
  • February 27, 2014 at 3:41 pm Jake Anderson (credit: CBS) MINNEAPOLIS (WCCO) – The 19-year-old University of Minnesota student found dead near the Stone Arch Bridge in December died of hypothermia with acute alcohol intoxication contributing, officials[minnesota.cbslocal.com]
  • 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]
  • Alcohol lowers your body temperature, which could lead to hypothermia. A cold shower could make them colder than they already are. Never let them drink any more alcohol. The amount of alcohol in their bloodstream could become dangerously high.[drinkaware.co.uk]
Impaired Balance
  • As intoxication becomes more severe, patients will exhibit an unsteady gait and impaired balance.[emsworld.com]
Vomiting
  • 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]
  • This is important in preventing aspiration should the person vomit. Stay with the person until medical help arrives.[mtholyoke.edu]
Nausea
  • 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]
  • […] increases its use associated with the common reward pathway Norepinephrine - associated with the "party" effects Opioids - possibly related to analgesic and euphoric effects Serotonin - possibly linked with pleasure effects definitely linked with associated nausea[prezi.com]
  • Table 7: Clinical Institute Withdrawal Assessment Scale Criteria Rating Nauseau and vomiting 0 No nausea or vomiting 1 Mild nausea with no vomiting 7 Constant nausea and frequent vomiting Tremors 0 No tremor 1 Tremors not visible but can be felt fingertip[emsreference.com]
  • In some cases, medication is used to relieve nausea or vomiting.[theravive.com]
  • The patient may experience nausea, vomiting, and diuresis. Depression of the gag reflex from alcohol leads to the risk for aspiration of stomach contents.[medical-dictionary.thefreedictionary.com]
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]
  • Immediate correction of clinical volume depletion and hypotension with isotonic crystalloid infusion (saline).[clinicaladvisor.com]
Tachycardia
  • Take the patient’s blood pressure to ascertain if there are any orthostatic changes, hypotension , or tachycardia .[medical-dictionary.thefreedictionary.com]
  • […] episodes Acute alcohol intoxication is found in approximately 70% of trauma patients Association with outcomes is controversial Describe what you see Signs & Symptoms of alcohol intoxication Wide range of psychiatric presentations Flushing, diaphoresis, tachycardia[prezi.com]
  • Vital signs include a normal to elevated blood pressure , tachycardia, and normal to fast respiratory rate.[emsreference.com]
  • Without this enzyme, ingestion of ethanol results in facial flushing, occasionally with nausea and tachycardia, in a syndrome colloquially known as the "Asian flush.” Nystagmus. Miosis.[clinicaladvisor.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]
Flushing
  • […] of impaired driving episodes Acute alcohol intoxication is found in approximately 70% of trauma patients Association with outcomes is controversial Describe what you see Signs & Symptoms of alcohol intoxication Wide range of psychiatric presentations Flushing[prezi.com]
  • 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]
  • Without this enzyme, ingestion of ethanol results in facial flushing, occasionally with nausea and tachycardia, in a syndrome colloquially known as the "Asian flush.” Nystagmus. Miosis.[clinicaladvisor.com]
  • […] 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]
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]
  • Acute visual changes such as photophobia or blurred vision may suggest methanol toxicity. Acute kidney injury, symptomatic hypocalcemia may suggest ethylene glycol toxicity.[clinicaladvisor.com]
Diplopia
  • 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]
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]
  • 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]
  • Call 911 if the person has these symptoms of alcohol poisoning: Mental confusion or unconsciousness Repeated vomiting Seizures Slow or irregular breathing Low body temperature Pale, clammy, or bluish skin 1.[webmd.com]
Slurred Speech
  • 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]
  • A set of clinical signs—disturbed consciousness and memory, slurred speech, imbalance, aggressiveness or euphoria—may be an indicator of AAI.[academic.oup.com]
  • One (or more) of the following signs, developing during, or shortly after, alcohol use: (1) slurred speech (2) incoordination (3) unsteady gait (4) nystagmus (5) impairment in attention or memory (6) stupor or coma D.[hams.cc]
  • 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]
Stupor
  • 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]
  • Persoanele respective prezinta cel putin unul dintre urmatoarele : vorbire neclara (caracteristic ebrioasa), incoordonare, mers instabil, nistagmus, tulburare a memoriei, stupor si fata congestionata.[emedonline.ro]
  • One (or more) of the following signs, developing during, or shortly after, alcohol use: (1) slurred speech (2) incoordination (3) unsteady gait (4) nystagmus (5) impairment in attention or memory (6) stupor or coma D.[hams.cc]
Ataxia
  • […] approximately 70% of trauma patients Association with outcomes is controversial Describe what you see Signs & Symptoms of alcohol intoxication Wide range of psychiatric presentations Flushing, diaphoresis, tachycardia Mydriasis Nystagmus Dysarthria Ataxia[prezi.com]
  • 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]
  • 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]
  • In mild to moderate intoxication, mild incoordination, euphoria, ataxia, nystagmus, disinhibition and impaired judgment may result.[clinicaladvisor.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]
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]
  • "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].

Ketonuria
  • Urinalysis and urine toxicology for the presence of opiates and cocaine metabolites, ketonuria or evidence of infection.[clinicaladvisor.com]
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

  • 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]
  • In patients presenting an acute alcohol intoxication, alcohol-related disorders should be detected so that the patient can be directed to an alcohol treatment unit, where a personalized, specific treatment can be established.[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]
  • Thunström M (1988) The alcohol intoxicated child and its prognosis. Acta Paediatr Scand 77: 3–9 Google Scholar 67. Wallgren H, Barry H (1970) Actions of alcohol, vol 1 (Biochemical, physiological and psychological aspects).[link.springer.com]

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]
  • It is still important to consider alternative etiologies of metabolic acidosis such as lactic acidosis from profound volume depletion, sepsis, or bowel ischemia, and in diabetic patients, diabetic ketoacidosis (DKA).[clinicaladvisor.com]
  • Prenatal alcohol exposure and family history of alcoholism in the etiology of adolescent alcohol problems. J Stud Alcohol . 1998 Sep. 59(5):533-43. [Medline] . Bates BA, Shannon MW, Woolf AD.[emedicine.medscape.com]
  • […] alcohol, methanol, and ethlyene glycol Sedative-hypnotics Benzodiazepines, barbiturates, and gamma-hydroxybutyrate (GHB) Diabetic Ketoacidosis Central Nervous System Disorders Infection Encephalitis and meningitis Stroke Hemorrhage Seizure or other etiology[emsreference.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]
  • […] performed a systematic review of the literature in German and English using the terms alcohol intoxication, alcohol withdrawal delirium, alcoholism, binge drinking and emergency department as well as the related data concerning therapy, complications, epidemiology[infona.pl]
  • 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]
  • Toxikon Consortium Introduction Examine the medical science of acute alcohol intoxication Use general medical school curriculum as a guide Learn more about alcohol than what you "learned"in college Gross Anatomy Biochemistry Physiology Brain & Behavior Epidemiology[prezi.com]
  • View Article PubMed Google Scholar Stolle M, Sack PM, Thomasius R: Binge Drinking in Childhood and Adolescence Epidemiology, Consequences, and Interventions.[bmcemergmed.biomedcentral.com]
Sex distribution
Age distribution

Pathophysiology

  • The impact of chronic and acute alcoholism on perioperative morbidity and mortality and especially on anaesthetic risk are important, due to pharmacological interactions, pathophysiological changes and direct pharmacological interactivities between alcohol[thieme-connect.com]
  • 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 Alcohol is a central nervous system depressant, stimulating gamma-aminobutyric acid (GABA) receptors and acting as a blocker, or antagonist, of N-methyl-D-aspartate (NMDA) receptors.[emsreference.com]
  • 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]
  • Pathophysiology One serving of alcohol (one 12-oz can of beer, one 6-oz glass of wine, or 1.5 oz of distilled liquor) contains 10 to 15 g of ethanol.[merckmanuals.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. 62 children (31 boys), mean age 14.5 years, presented with alcohol intoxication proved by BALs[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]
  • 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 violent suicides[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