Updated: 2/11/2018

Acute Alcohol Intoxication

Topic
Review Topic
0
0
Snapshot
  • A 22-year-old male is brought in by police after being removed forcefully from a bar. According to the police report, the patient had fallen several times during an altercation with another bar patron. In the ED, he is agitated and cannot follow questions.
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
    • blackouts
    • coma
Evaluation
  • Blood alcohol level
Treatment
  • Pharmacologic
    • nutritional - in chronic alcoholics or if you suspect deficiency
      • thiamine
        • must give prior to glucose administration
      • folate
      • multivitamin
    • sedative-hypnotics with taper (for agitation)
      • e.g., clonidine or propranolol
      • haloperidol if severe aggression or psychosis
    • intubation - if airway loss 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, Prevention, and Complications
  • Complications
    • Mallory-Weiss syndrome
      • repeat wretching/vomiting causes bleeding of mucosa
      • best initial step: IV fluids
      • best next step: endoscopy for diagnosis, photocoagulation, rubber band ligation for treatment
      • ultimate refractory therapy: Blakemore catheter (usually the WRONG answer)
    • Boerhaave Syndrome - esophageal perforation (repeat vomiting)
      • best next step: gastrografin swallow followed by surgical repair (after ABC's) 
    • Wernicke-Korsakoff syndrome
      • best next step: thiamine, multivitamin, IV fluids followed by glucose (order matters)
    • may require mechanical ventilation
    • much greater risk of physical harm
      • e.g., homicides, suicide, car accidents, fires, etc.
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 if necessary
  • Administer (in order)
    • thiamine and Mg2+
    • multivitamin
    •  B12/folate
    • IV fluids + dextrose
  • Begin CIWA and benzodiazepine taper if signs of withdrawal
  • Do not administer medications that lower seizure threshhold (bupropion, haloperidol)
  • Begin psychotherapy (must occur with medications)
    • individual
    • group (AAA)
  • Begin medication immediately
    • disulfiram
    • naltrexone
    • acamprosate
    • gabapentin
    • topiramate
 
 

Please rate topic.

Average 5.0 of 1 Ratings

Thank you for rating! Please vote below and help us build the most advanced adaptive learning platform in medicine

The complexity of this topic is appropriate for?
How important is this topic for board examinations?
How important is this topic for clinical practice?
Topic COMMENTS (5)
Private Note