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Alcohol Intoxication

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Alcohol Intoxication, Drunkenness, Inebriation, Alcohol Poisoning, Alcohol Overdose, Alcoholic Ketoacidosis

  • See Also
  1. Alcohol Toxicity
  2. Alcohol Withdrawal
  3. Alcohol Detoxification
  4. Alcohol Detoxification in Ambulatory Setting
  5. Chemical Dependency
  • 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
  • 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]
  • Course
  1. Blood Alcohol decreases 0.02 g/dl/h in non-Alcoholics
  2. Blood Alcohol decreases 0.03 g/dl/h in Alcoholics
  • 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
  • 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
  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
  • References
  1. Mason and Armenian in Herbert (2018) EM:Rap 18(3): 18