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.
As one of the most frequent substances of abuse, particularly in the Western world , 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    . 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 . The spectrum of signs and symptoms is diverse    . 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 . 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     . 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) , including lactic acidosis, hypokalemia, hypoglycemia, thromboembolic events, and cardiac arrhythmias  .
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)  , 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) . 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 .