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Acute alcohol intoxicationFrom Wikipedia, the free encyclopedia
Acute alcohol intoxication can result from a high level of alcohol in the bloodstream, accompanied by extreme drunkenness. The term acute alcohol intoxication is used by healthcare providers, often in emergencies. Toxicologists also speak of alcohol intoxication to discriminate from other toxins researched in the field. EpidemiologyThe condition is frequently found in either young people who are being exposed to commonly available alcoholic beverages like beer, wine, and distilled liquor for the first time, and don't know their limits, or by people suffering from alcoholism who ingest much more than they usually do. PathophysiologyEthanol is metabolised to acetaldehyde by alcohol dehydrogenase (ADH), which is found in many tissues, including the gastric mucosa. Acetaldehyde is metabolised to acetate by acetaldehyde dehydrogenase (ALDH), which is predominantly found in liver mitochondria. Acetate is used by the muscle cells to produce Acetyl-CoA using the enzyme acetyl-CoA synthetase, and the Acetyl-CoA is then used in the Citric Acid Cycle[1]. It takes roughly 90 minutes for a healthy liver to metabolize a single ounce, approximately one hour per standard unit. Ethanol's acute effects are largely due to its nature as a CNS depressant, and are dependent on blood alcohol concentrations:
As drinking increases, people become sleepy, or fall into a stupor. Ultimately, the respiratory system becomes depressed, and the person will stop breathing. This is a common cause of death on college campuses. The most important thing for friends who witness someone "passing out" from too much alcohol is to get them emergency medical treatment. Commonly, comatose patients aspirate their vomit (resulting in vomitus in the lungs, which may cause "drowning" and later pneumonia if survived). CNS depression and impaired motor co-ordination along with poor judgement increases the likelihood of accidental injury occurring.[2]. It is estimated that about half of alcohol related deaths are due to accidents (32%) or intentional injury (13.7%)[3]. In addition to respiratory failure and accidents caused by effects on the central nervous system, alcohol causes significant metabolic derangements. Hypoglycaemia occurs due to ethanol's inhibition of gluconeogenesis, especially in children, and may cause lactic acidosis, ketoacidosis and acute renal failure. Metabolic acidosis is compounded by respiratory failure. Patients may also present with hypothermia. Avoidance of intoxicationAlcohol is metabolized by a normal liver at that rate of about one ounce (one "highball", a normal beer, a regular sized glass of wine) every 90 minutes.[citation needed] An "abnormal" liver, one with hepatitis, cirrhosis, gall bladder disease, cancer, etc, will have a slower rate of metabolism. One can delay the absorption of alcohol by drinking water and ingesting food, but it prolongs the un-metabolized alcohol in the body.[citation needed] DiagnosisIn determining if someone is intoxicated it is necessary to observe their behavior while the subject is sober to establish a baseline, ruling out a preexisting condition such as hypoglycemia, usage of narcotics besides alcohol, mental health issues, etc. Several well known criteria can be used to establish a probable diagnosis. For a physician in the acute treatment setting, acute alcohol intoxication can mimic other acute neurological disorders, or is frequently combined with other recreational drugs that complicate diagnosis and treatment. Definitive diagnosis relies on a blood test for alcohol, usually performed as part of a toxicology screen. Many patients are uninhibited, especially when legal consequences are unlikely (e.g., no police are present), so they disclose information that simplifies the diagnosis. Signs and symptomsThe signs and symptoms of alcohol poisoning include:
TreatmentEmergency treatment for acute alcohol intoxication strives to stabilize the patient and maintain a patent airway and respiration, while waiting for the alcohol to metabolize:[5] Also:
Additional medication may be indicated for treatment of nausea, tremor, and anxiety. PrognosisA normal liver detoxifies the blood of alcohol over a time that depends on the initial level and the patient's overall physical condition. An abnormal liver takes longer but still succeeds, as long as the alcohol doesn't cause liver failure.[6] People who have been drinking heavily for several days or weeks may have withdrawal symptoms after the acute intoxication has subsided.[7] References
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