Ethanol toxicity

Background

• AMS that doesn't improve after few hrs is due to alternative cause until proven otherwise
• Blood Alcohol Level
  • Correlates poorly with degree of intoxication
  • Rate of ETOH elimination is 15-30mg/dL/hr (depending on degree of chronic alcoholism)

Clinical Features

• Classic Features
  • Slurred speech
  • Nystagmus
  • Ataxia
  • N/V
  • Respiratory depression
  • Coma
• Other Features (if malnourished)
  • Hypoglycemia
  • Ketoacidosis
  • Lactic acidosis
  • Epigastric pain (pancreatitis)

Differential Diagnosis

Sedative/hypnotic toxicity

• Absinthe
• Barbiturates
• Benzodiazepines
  • Flunitrazepam (Rohypnol)
• Chloral hydrate
• Gamma hydroxybutyrate (GHB)
• Baclofen toxicity
• Opioids
  • Lomotil toxicity
  • Loperamide toxicity
• Toxic alcohols
  • Ethanol
  • Ethylene glycol
  • Isopropyl alcohol
  • Methanol
• Xylazine toxicity

Diagnosis

Most patients require observation only

• Blood sugar
• BAL
  • Appropriate if AMS is due to unknown cause
  • Not necessarily required in mild-mod intoxication or if no other abnormality suspected
• Elevated osmolar gap

Treatment

• GI decontamination
  • Activated charcoal ineffective (ETOH is too rapidly absorbed)
• Hypoglycemia
  • Give glucose immediately (do not have to wait to give thiamine first)
• "Banana Bag"
  • IV form is not justified
  • Likelihood of vitamin deficiency (except for thiamine) is low
  • IVF does not hasten ETOH elimination

Disposition

• Can be discharged once patient at baseline mental status, able to tolerate PO, and road test successful

See Also

• Sedative/Hypnotic
• Alcohol Withdrawal
• Beer Potomania Syndrome