III. Evaluation

  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]

IV. Course

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

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

  1. See Alcohol Withdrawal for labs, supplementation (e.g. Thiamine, Folate, MVI)
  2. 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
  3. 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
  4. Manage Alcoholic Ketoacidosis
    1. Similar to Starvation Ketosis
    2. Most common cause of Metabolic Acidosis with Anion Gap in Alcoholics (poor nutrition)
      1. However, exclude toxic Alcohol ingestion (e.g. Ethylene Glycol Poisoning)
    3. As with Diabetic Ketoacidosis, Serum Beta Hydroxybutyrate is increased
      1. Urine Ketones are unreliable for detection
    4. Administer IV fluids containing dextrose (e.g. D5LR)
      1. Give Thiamine 100 mg before dextrose
      2. Dextrose infusions stop Ketone formation, whereas simple crystalloid will not

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

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

VII. 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

VIII. References

  1. Mason and Armenian in Herbert (2018) EM:Rap 18(3): 18

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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, アルコールチュウドク, 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
Czech Intoxikace alkoholem, Opilost, alkohol - otrava, alkoholová intoxikace, otrava alkoholem, opilost
Polish Zatrucie alkoholem
Hungarian Ittasság, Alkohol intoxicatio
Norwegian Alkoholintoksikasjon, Alkoholforgiftning
German Alkoholvergiftung, Intoxikation, Alkohol-, Alkoholintoxikation, Alkoholrausch, Trunkenheit

Ontology: Alcoholic ketoacidosis (C0268039)

Concepts Disease or Syndrome (T047)
SnomedCT 55571001
English alcoholic ketoacidosis (diagnosis), alcoholic ketoacidosis, Alcohol induced ketoacidosis, Alcoholic ketoacidosis, Alcoholic ketoacidosis (disorder)
Spanish cetoacidosis alcohólica (trastorno), cetoacidosis alcohólica

Ontology: Alcohol poisoning (C0392620)

Concepts Injury or Poisoning (T037)
SnomedCT 82782008
Italian Avvelenamento da alcool
Japanese アルコール中毒, アルコールチュウドク
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