Alcohol Intoxication

Aka: Alcohol Intoxication, Drunkenness, Inebriation, Alcohol Poisoning, Alcohol Overdose, Ethanol Intoxication, Ethanol Poisoning

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II. Definitions

  1. Alcohol Intoxication
    1. Excessive ingestion (or Overdose) of Alcohols resulting in an acute brain syndrome
    2. Alcohol Intoxication, although typically due to Ethanol ingestion, may include toxic or parent Alcohols
    3. Toxic Alcohols in Methanol, Ethylene Glycol and Isopropyl Alcohol

III. Epidemiology

  1. Ethanol ingestion in children age < 6 years accounts for thousands of U.S. Poison Control contacts per year
    1. Most exposures (90%) are related to home products containing Ethanol (see below)

IV. Physiology

  1. See Ethanol

V. Sources

  1. Alcoholic Beverages (Ethanol): Standard Drink Equivalents (12 grams of Alcohol)
    1. Can of 4.5% Beer (12 ounces)
    2. Glass of 12.9% wine (5 ounces)
    3. Glass of 40% or 80-proof liquor (1.5 ounces)
  2. Other Ethanol sources (esp. Accidental Ingestion in children)
    1. Aftershave, Colognes and Perfumes
    2. Cosmetics
    3. Cough Syrup
    4. Glass Cleaner
    5. Hand Sanitizer
    6. Kombucha
    7. Mouthwash
    8. Vanilla Extract
  3. Toxic Alcohols
    1. See Methanol Poisoning
    2. See Ethylene Glycol Poisoning
    3. See Isopropyl Alcohol Poisoning

VI. Differential Diagnosis

  1. See Altered Level of Consciousness Causes
  2. Closed Head Injury (e.g. acute Subdural Hematoma)
  3. Meningitis or Encephalitis
  4. Wernicke's Encephalopathy
  5. Hepatic Encephalopathy
  6. Gastrointestinal Bleeding (Esophageal Varices, Peptic Ulcer Disease)
  7. Substance
    1. See Unknown Ingestion
    2. See Drugs of Abuse
    3. See Date Rape Drug

VII. Signs: Ethanol Intoxication

  1. See Methanol Poisoning
  2. See Ethylene Glycol Poisoning
  3. See Isopropyl Alcohol Poisoning
  4. Slurred Speech
  5. Impaired Judgement and risky behavior
  6. Disorientation
  7. Ataxia
  8. Nystagmus
  9. Bradycardia
  10. Hypothermia
  11. Diuresis (may result in Hypovolemia and Hypotension)
  12. Respiratory Depression
  13. Lethargy to Coma
  14. Hypoglycemia
    1. Seen in younger children, and when Alcohol is combined with Sulfonylureas

VIII. Evaluation: General

  1. See Unknown Ingestion
  2. See Alcoholism
  3. See Alcohol Withdrawal
  4. Careful examination for signs of Trauma, infection
  5. Alcohol level is not needed in routine cases of Alcohol Intoxication
    1. Use Clinical Sobriety and decision making capacity to determine observation and disposition
    2. Obtain Blood Alcohol Level when cause of altered status is unclear
      1. See Altered Level of Consciousness and Unknown Ingestion
      2. Evaluate other causes (e.g. Methanol, Ethylene Glycol) when Blood Alcohol is too low to explain status
      3. Consider Head CT (esp. if external signs of Trauma)
  6. Evaluate for risk of Alcohol Withdrawal
    1. Daily Alcohol use?
    2. Last Alcohol intake?
    3. Prior Alcohol Withdrawal, Delirium Tremens, Seizures, hospitalizations?
  7. Markers of Critical Illness in an intoxicated patient
    1. Hypoglycemia
    2. Abnormal Vital Signs
    3. Need for Chemical Restraint
    4. Klein (2017) Ann Emerg Med +PMID:28833504 [PubMed]

IX. Evaluation: Children with Alcohol Poisoning

  1. See Unknown Ingestion
  2. Signs
    1. Nausea or Vomiting
    2. Altered Level of Consciousness (e.g. stupor, coma)
    3. Ataxia
    4. Hypoglycemia (young children)
    5. Hypothermia (young children)
  3. Toxic dose of Ethanol
    1. Young children: 0.4 ml/kg
    2. Peak serum level >50 mg/dl
  4. Obtain broad-based toxicology evaluations
    1. Bedside Glucose (Hypoglycemia is common)
    2. Venous Blood Gas
    3. Basic metabolic panel
      1. Evaluate for Metabolic Acidosis with Anion Gap (Toxic Alcohols)
    4. Blood Alcohol Level
    5. Acetaminophen level
    6. Salicylate level
    7. Urine Drug Screen
    8. Serum Osmolality
      1. Calculate Osmolal Gap (Toxic Alcohols)
    9. Urinalysis
      1. Calcium oxalate crystals may be seen in Ethylene Glycol Poisoning

X. Course

  1. Blood Alcohol decreases 0.02 g/dl/h in non-Alcoholics
  2. Blood Alcohol decreases 0.03 g/dl/h in Alcoholics and in children

XI. Management: Acute or chronic Alcohol Intoxication in chronic Alcoholism

  1. See Alcohol Withdrawal for labs, supplementation (e.g. Thiamine, Folate, MVI)
  2. See Alcoholic Ketoacidosis
  3. Prevent Alcohol Withdrawal
    1. Admit to Alcohol Detoxification
      1. Indicated if patient is interested in sobriety and Alcohol Abuse treatment
    2. Alcohol Withdrawal management if signs present
      1. Re-evaluate closely (every 1-2 hours)
      2. Early Benzodiazepines
    3. Early discharge when patient is Clinically Sober (not based on Alcohol level)
      1. See Clinical Sobriety
  4. Manage acute exacerbations of
    1. Wernicke's Encephalopathy
    2. Alcoholic Hepatitis or Cirrhosis
    3. Acute Pancreatitis
    4. Upper Gastrointestinal Bleeding (Esophageal Varices, Peptic Ulcer Disease)
    5. Malnutrition

XII. Management: Acute Alcohol Intoxication in non-Alcoholic adults

  1. See Altered Level of Consciousness
  2. Obtain Alcohol level to help confirm Alcohol as cause of altered status
  3. Supportive care
    1. Manage airway as needed (aspiration risk)
    2. Fluid Resuscitation as needed

XIII. Management: Children (Acute Poisoning)

  1. See Alcohol Poisoning
  2. Hypoglycemia (due to impaired Gluconeogenesis)
    1. Monitor Serum Glucose every 1-2 hours after ingestion until Blood Alcohol Level 0 for at least 1-2 hours
  3. Altered Level of Consciousness with CNS depression
    1. Exaggerated response to a given Blood Alcohol Level when compared with adults
  4. Respiratory depression
  5. References
    1. Claudius and Levine in Herbert (2012) EM:RAP 12(5): 6

XIV. Complications

  1. Fatal motor vehicle crashes
  2. Behavior problems affecting school, work and home
  3. Gateway to other Substance Abuse
  4. Risky sexual behavior

XV. References

  1. Mason and Armenian in Herbert (2018) EM:Rap 18(3): 18
  2. Rodriguez (2022) Crit Dec Emerg Med 36(4): 26-31

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Related Studies

Ontology: Alcoholic Intoxication (C0001969)

Definition (MSH) An acute brain syndrome which results from the excessive ingestion of ETHANOL or ALCOHOLIC BEVERAGES.
Concepts Mental or Behavioral Dysfunction (T048)
MSH D000435
SnomedCT 191880005, 231465008, 154916003, 268767001, 231464007, 25702006
DSM4 303.00
English Intoxication, Alcoholic, Drunkenness, INTOX ALCOHOLIC, ALCOHOLIC INTOX, alcohol intoxication (diagnosis), alcohol intoxication, Drunkennesses, Alcoholic Intoxication [Disease/Finding], acute alcohol intoxication, alcoholic intoxication, drunks, Abuse;alcohol;acute, drunk, inebriation, heavy drinker, intoxication alcohol, Intoxication - alcohol, Inebriety NOS (disorder), Drunkenness NOS (disorder), Alcohol intoxication, Drunk, Alcohol intoxication (disorder), drunkenness, inebriety, intoxication; alcohol, alcohol; intoxication, Alcoholic Intoxication, Intoxication (Alcohol), Alcohol Intoxication, Drunkenness NOS, Inebriety NOS, Addiction;alcohol;acute
Dutch alcoholintoxicatie, dronkenschap, alcohol; intoxicatie, intoxicatie; alcohol, Alcoholintoxicatie, Alcoholvergiftiging, Dronkenschap, Intoxicatie, alcohol-
French Intoxication par l'alcool, Ébriété, Intoxication alcoolique, Ivresse
Italian Intossicazione da alcool, Ubriachezza, Intossicazione alcolica
Portuguese Intoxicação alcoólica, Embriaguez, Intoxicação Alcoólica, Intoxicação por Álcool
Spanish Intoxicación alcohólica, Borrachera, Intoxicación por Alcohol, borrachera, SAI (trastorno), ebriedad, SAI (trastorno), ebriedad, SAI, borrachera, SAI, Envenenamiento Alcohólico, Envenenamiento por Alcohol, embriaguez, intoxicación alcohólica (trastorno), intoxicación alcohólica, intoxicación etílica, Embriaguez, Intoxicación Alcohólica
Japanese アルコール中毒, 酩酊, ﾒｲﾃｲ, ｱﾙｺｰﾙﾁｭｳﾄﾞｸ, アルコール中毒-急性, 中毒-アルコール-急性, アルコール酩酊, 急性アルコール中毒, 酩酊-アルコール
Swedish Alkoholförgiftning
Finnish Alkoholimyrkytys
Russian INTOKSIKATSIIA ALKOGOL'NAIA, ALKOGOL'NAIA INTOKSIKATSIIA, АЛКОГОЛЬНАЯ ИНТОКСИКАЦИЯ, ИНТОКСИКАЦИЯ АЛКОГОЛЬНАЯ
Czech Intoxikace alkoholem, Opilost, alkohol - otrava, alkoholová intoxikace, otrava alkoholem, opilost
Croatian ALKOHOLNA INTOKSIKACIJA
Polish Zatrucie alkoholem
Hungarian Ittasság, Alkohol intoxicatio
Norwegian Alkoholintoksikasjon, Alkoholforgiftning
German Alkoholvergiftung, Intoxikation, Alkohol-, Alkoholintoxikation, Alkoholrausch, Trunkenheit
Derived from the NIH UMLS (Unified Medical Language System)

Ontology: Alcohol poisoning (C0392620)

Concepts Injury or Poisoning (T037)
SnomedCT 82782008
Italian Avvelenamento da alcool
Japanese アルコール中毒, ｱﾙｺｰﾙﾁｭｳﾄﾞｸ
English Alcohol poisoning, poisoning by ethyl alcohol (diagnosis), poisoning by alcohol, poisoning by alcohol (diagnosis), poisoning by ethyl alcohol, poison alcohol, poisoning alcohol, alcohol poison, overdose alcohol, alcohol poisonings, poisoning ethanol, alcohol poisoning, ethanol poisoning, alcohol overdoses, alcohol overdose, Ethanol poisoning, Ethyl alcohol poisoning, ethylism, poisoning; alcohol, alcohol; poisoning
Czech Otrava alkoholem
Hungarian Alkoholmérgezés
Dutch alcohol; vergiftiging, vergiftiging; alcohol, alcoholvergiftiging
Spanish intoxicación por alcohol etílico, intoxicación por etanol, Intoxicación etílica
Portuguese Intoxicação alcoólica
French Intoxication alcoolique
German Alkoholvergiftung
Derived from the NIH UMLS (Unified Medical Language System)

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