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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]
  • Do not leave an intoxicated person alone, as he or she is at risk of getting injured from falling or choking. Keep the person on the ground in a sitting or partially upright position rather than in a chair. Help a person who is vomiting.[niaaa.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.[nlm.nih.gov]
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]
  • 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]
  • 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]
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]
  • 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]
  • 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]
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]
  • Symptoms include nausea, vomiting, and abdominal pain.[medicalnewstoday.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]
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]
  • The tachycardia was attributed to dehydration from vomiting by the treating clinician. The patient's tachycardia settled down after the 20 mL/kg i.v. saline infusion.[ncbi.nlm.nih.gov]
  • Vital signs include a normal to elevated blood pressure, tachycardia, and normal to fast respiratory rate.[emsreference.com]
  • The physical examination may reveal fever, tachycardia, and tenderness in the RUQ or epigastric region, often with guarding or rebound. However, the absence of physical findings does not rule out the diagnosis of cholecystitis. (See Presentation.)[emedicine.medscape.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]
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]
  • A Alcohol flush reaction ‎ (1 C, 12 F) Drunken people in art ‎ (22 C, 152 F) D Drunk driving ‎ (5 C, 61 F) F Drunken females ‎ (6 F) H Hangover ‎ (2 C, 19 F) M Drunken males ‎ (36 F) File nella categoria "Drunken people" Questa categoria contiene 57 file[commons.wikimedia.org]
  • 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]
  • 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]
Diplopia
  • The second patient (male, 62 years old) developed diplopia, dysarthria and trunk ataxia after consuming 4-units of alcohol, and his symptoms were attributed to alcohol intoxication.[ncbi.nlm.nih.gov]
  • 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]
Aggressive Behavior
  • 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.[hamsnetwork.org]
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]
  • Confusion If a man consumes more than five drinks or a woman more than 4 drinks in an hour, they’ll enter the next stage of intoxication: confusion. This stage of intoxication is marked by emotional outbursts and a major loss of coordination.[healthline.com]
  • 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.[nlm.nih.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]
  • A set of clinical signs—disturbed consciousness and memory, slurred speech, imbalance, aggressiveness or euphoria—may be an indicator of AAI.[academic.oup.com]
  • Confusion, slurred speech. Internal (stomach and intestinal) bleeding. Slowed breathing. Stupor (decreased level of alertness), even coma. Unsteady walking. Vomiting, sometimes bloody.[nlm.nih.gov]
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 first patient (female, 50 years old) had dysarthria, nystagmus and trunk ataxia on admission. Her blood alcohol level was 2.3‰.[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]
  • 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. 200–299 mg/dL: Marked ataxia, slurred speech, poor[en.wikipedia.org]
  • In mild to moderate intoxication, mild incoordination, euphoria, ataxia, nystagmus, disinhibition and impaired judgment may result.[clinicaladvisor.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].

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

  • 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]

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]
  • Uncomplicated cholecystitis has an excellent prognosis; the development of complications such as perforation or gangrene renders the prognosis less favorable.[emedicine.medscape.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]
  • 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]
  • 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]
  • The present study aims to compare the etiology of the intoxicated patients brought at the emergency hospitals in two different Romanian towns, Bucharest and Timisoara, in an attempt to find the “pattern” of intoxications in big Romanian cities.[tmj.ro]

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]
  • 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 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]
  • Sleisenger and Fordtran's Gastrointestinal and Liver Disease: Pathophysiology/Diagnosis/Management. 10th ed. Philadelphia, PA: Elsevier Saunders; 2016:chap 65. Updated by: Michael M.[medlineplus.gov]
  • 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]
  • , 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: 2019-06-28 10:02