Ethanol toxicity


  • 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


  • 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


  • 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


  • Most pts require observation only
  • Can be discharged once patient at baseline mental status, able to tolerate PO, and road test successful

See Also