ALCOHOL INTOXICATION

ALCOHOL INTOXICATIONIntroductionclinically harmful conditioningestion of a large amount of alcoholEthanol (CH3CH2OH) is a water-soluble compound thatrapidly crosses cell membranesabsorption occurs mainly in the proximal intestinal tractStomach (70%) , in the duodenum (25%), only a small percentage occurs in the remaining intestinal tractsGastric alcohol dehydrogenase (ADH) is responsible for 10% of alcohol metabolismremaining 90% metabolized in acetaldehyde along 3 liver enzymatic pathways in different percentages: >liver ADH (90%), >microsomal ethanol oxidizing system (MEOS; 810%) >catalase (02%)Clinical featuresThe Diagnostic and StatisticalManual ofMental Disorders IV edition criteria for acute alcohol intoxication include:(a) recent alcohol ingestion(b) clinically significant maladaptive behavioral or psychological changes developing during or shortly after alcohol ingestion and including inappropriate sexual or aggressive behavior, unstable mood, impaired judgment, and impaired social or occupational functioning(c) one or more of the following signs that develop during orshortly after alcohol use: (i) slurred speech (ii) lack of coordination; (iii) unsteady gait(iv) nystagmus(v) impairment of attention or memory(vi) stupor or coma(vii) symptoms that are not due to a general medical conditionFactors can influence the extent of acute alcohol intoxicationthe amount of alcohol ingestedIndividual body weight tolerance to alcohol the percentage of alcohol in the beverage the period of alcohol ingestionSymptoms related to blood alcohol concentration (BAC)BAC higher than 300 mg/dl (65.1 mmol/l), there is an increased risk of respiratory depression and arrest.It can be fatal if the BAC higher than 500 mg/dl (108.5 mmol/l)

SymptomsBACImpairment in some tasks requiring skillIncrease in talkativenessRelaxationBAC100 mg/dl (21.7 mmol/l)AmnesiaDiplopiaDysarthriaHypothermiaNauseaVomitingBAC>200 mg/dl(43.4 mmol/l)Respiratory depressionComaDeathBAC >400 mg/dl(86.8 mmol/l)DiagnosisHistory taking QuantityTypeTime of symptomsEventual injuriesPhysical ExaminationVital signsHyrationAlcoholism related signs (capillary prominence, spider naevi, talengiectasias, palmar erythema, and muscular atrophy)Cardiac examinationChest examinationAbdominal examinationNeurological examinationLaboratory analysis (to determine BAC)Breath analysisSaliva dipstickUrine analysisBlood chemisrty analysis

Main clinical conditionDetailed clinical conditionsOther substance-related intoxicationAlcohol other than ethanolMethanolIsopropyl alcoholDrugs of abuse:CocaineOpiatesTetrahydrocannabinoilBarbituratesBenzodiazepineTricyclic antidepressantsDisulfiramCarbon monoxideMetabolic causesHepatic encephalopathyHypoglycemiaElectrolyte abnormalities:Hyper-/hypo natremiaHyper-/hypo calcemiaAlcoholic ketoacidosisDiabetic ketoacidosisNon-ketotic hyperosmolar comaUremiaHypertensive encephalopathyInfectious diseaseSepsisMeningitisEncephalitisNeurological causesAlcohol withdrawal syndromeWernikeKorsakoff syndromeCerebrovascular accidentsSeizure disordersTraumaIntracranial bleedingSubdural hematomaConcussion syndromesRespiratory causesHypoxiaRespiratory depressionOtherHypotensionHyper-/hypothermiaHyper-/hypothyroidismDehydrationTreatment..Patient stabilizationAirway assessmentObservation of respiratory functionPrevention of aspirationMechanical ventilation, if necessaryIntravenous accessIntravenous solution administration correctionof hypoglycemia and electrolyte imbalances(dextrose+magnesium+folate+thiamine+multivitamins)Anti-emetic drugsPatient sedation(if necessary)DroperidolHaloperidolPhysical restraints (not advised)Acceleration ofethanol eliminationMetadoxine (300900 mg i.v.)Acute alcohol intoxication or chronic alcohol abusePatients who abuse or who are dependent on alcohol may experience an alcohol withdrawal syndrome following detoxification (delirium tremens, seizure)The patient should be monitored for 72 h following a BAC of 0 mg/dlThank you!