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

1. Classic Features
   1. Slurred speech
   2. Nystagmus
   3. Ataxia
   4. N/V
   5. Respiratory depression
   6. Coma
2. Other Features (if malnourished)
   1. Hypoglycemia
   2. Ketoacidosis
   3. Lactic acidosis
   4. Epigastric pain (pancreatitis)

Diagnosis

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

Treatment

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

Disposition

• Most pts require observation only

See Also

• Toxidromes
• Alcohol Withdrawal
• Beer Potomania Syndrome

Source

• Tintinalli