Ethanol toxicity: Difference between revisions
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==Background== | ==Background== | ||
*Rate of ETOH elimination is 15-30mg/dL/hr (depending on degree of chronic alcohol intake) | |||
==Clinical Features== | ==Clinical Features== | ||
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**Ataxia | **Ataxia | ||
**N/V | **N/V | ||
**Alcohol odor on breath | |||
**Respiratory depression | **Respiratory depression | ||
**Coma | **Coma | ||
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**Lactic acidosis | **Lactic acidosis | ||
**Epigastric pain (pancreatitis) | **Epigastric pain (pancreatitis) | ||
===Mellanby effect=== | |||
*Impairment is greater at a given blood alcohol concentration when the level is rising than when it is falling. <ref>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.</ref> | |||
==Differential Diagnosis== | ==Differential Diagnosis== | ||
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==Diagnosis== | ==Diagnosis== | ||
'' | ''Clinical diagnosis. No specific workup required, but the following may be considered based on clinical picture/gestalt:'' | ||
* | *Fingerstick glucose | ||
*BAL | *Blood alcohol level (BAL) | ||
** | **Correlates poorly with degree of intoxication<ref>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.</ref> | ||
== | ==Management== | ||
*GI decontamination | *GI decontamination | ||
**Activated charcoal ineffective (ETOH is too rapidly absorbed) | **Activated charcoal ineffective (ETOH is too rapidly absorbed) | ||
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==Disposition== | ==Disposition== | ||
*Can be discharged once patient at baseline mental status, able to tolerate PO | *Can be discharged once patient at baseline mental status, able to tolerate PO and ambulate without assistance. | ||
==See Also== | ==See Also== | ||
*[[Alcohol Withdrawal]] | |||
*[[Alcoholic ketoacidosis]] | |||
*[[Sedative/Hypnotic]] | *[[Sedative/Hypnotic]] | ||
*[[Beer Potomania Syndrome]] | *[[Beer Potomania Syndrome]] | ||
*[[Altered mental status]] | *[[Altered mental status]] | ||
==References== | ==References== | ||
<References/> | |||
[[Category:Tox]] | [[Category:Tox]] | ||
Revision as of 06:40, 17 July 2015
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
- Absinthe
- Barbiturates
- Benzodiazepines
- Chloral hydrate
- Gamma hydroxybutyrate (GHB)
- Baclofen toxicity
- Opioids
- Toxic alcohols
- Xylazine 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
- Alcohol Withdrawal
- Alcoholic ketoacidosis
- Sedative/Hypnotic
- Beer Potomania Syndrome
- Altered mental status
References
- ↑ 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.
- ↑ 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.