Acute Alcohol

Discuss the epidemiology of alcohol misuse Review clinical examination findings of ethanol toxicity Discuss treatment of patient with ethanol toxicity.
1 This month continuing education article focuses on acute ethanol poisoning in the nonalcoholic patient.
Ethanol intoxication is typical in patients who seek care in emergency departments, but it not always their main cause.
A late-’80s study found that based upon the location of the ED, 15%-40% of presenting individuals had detectable degrees of ethanol in their blood.
Acute alcohol intake may result in a reduced cardiac output in nonalcoholic individuals with preexisting cardiac disease.
The warm, flushed skin typical to ethanol toxicity is the result of peripheral vasodilation and also can lead to symptoms like a feeling of heat described by the patient.

As intoxication becomes more serious, patients will show an unsteady gait and impaired equilibrium. Advancing nerve system melancholy will result in the patient getting increasingly more lethargic, and he can have trouble sitting upright without assistance. Figure 1 shows the clinical examination findings correlated with ethanol intoxication, although it should be noted there is an undesirable correlation between BAC and clinical examination findings in patients with alcohol habituation. Respiratory depression and subsequent death might occur in the nonhabituated patient at concentrations of 0.4-0.5 g/dL, but it is not uncommon for a chronic alcoholic to appear minimally intoxicated with a BAC as high as 0.4 g/dL.8 Another factor that can affect a patient’s clinical examination is whether or not the patient is presenting with an increase or decreasing BAC.

It’s a known occurrence, termed the Mellanby impact, that the clinical symptoms of ethanol intoxication are more important when BAC is rising. Treatment of the patient with ethanol toxicity is mainly supportive in nature, as there’s no antidote currently available in the US. An antiemetic such as ondansetron or prochlorperazine can be administered in intoxicated patients who are nauseous and/or vomiting. A patient may be rolled onto their side and put into the restoration position so as to clear the airway and keep it cleared. If a patient can’t protect their airway or if breathing is insufficient, perform endotracheal intubation and bag mask ventilation as required. A 2009 study looked over 73 individuals who presented to the ED with reduced awareness as a consequence of drug or alcohol intoxication. Rather, a decreased degree of awareness is merely one data point to contemplate when identifying an airway and ventilation management plan to get the patient. Patients with ethanol patients may be uncooperative, combative and even violent.

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