Ethanol toxicity

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Background

  • Rate of ETOH elimination is 15-30mg/dL/hr (depending on degree of chronic alcohol intake)

Clinical Features

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

Mellanby effect

  • Impairment is greater at a given blood alcohol concentration when the level is rising than when it is falling. [1]

Differential Diagnosis

Sedative/hypnotic toxicity

Diagnosis

Clinical diagnosis. No specific workup required, but the following may be considered based on clinical picture/gestalt:

  • Fingerstick glucose
  • Blood alcohol level (BAL)
    • Correlates poorly with degree of intoxication[2]

Management

  • 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 ambulate without assistance.

See Also

References

  1. ↑ Wang MQ, Nicholson ME, Mahoney BS, et al. Proprioceptive responses under rising and falling BACs: a test of the Mellanby effect. Percept Mot Skills. 1993 Aug;77(1):83-8.
  2. ↑ Olson KN, Smith SW, Kloss JS, et al. Relationship between blood alcohol concentration and observable symptoms of intoxication in patients presenting to an emergency department. Alcohol Alcohol. 2013 Jul-Aug;48(4):386-9. doi: 10.1093/alcalc/agt042.
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