Difference between revisions of "Ethanol toxicity"

(Diagnosis)
Line 6: Line 6:
  
 
==Clinical Features==
 
==Clinical Features==
#Classic Features
+
*Classic Features
##Slurred speech
+
**Slurred speech
##Nystagmus
+
**Nystagmus
##Ataxia
+
**Ataxia
##N/V
+
**N/V
##Respiratory depression
+
**Respiratory depression
##Coma
+
**Coma
#Other Features (if malnourished)
+
*Other Features (if malnourished)
##Hypoglycemia
+
**Hypoglycemia
##Ketoacidosis
+
**Ketoacidosis
##Lactic acidosis
+
**Lactic acidosis
##Epigastric pain (pancreatitis)
+
**Epigastric pain (pancreatitis)
  
 
==Differential Diagnosis==
 
==Differential Diagnosis==
Line 23: Line 23:
  
 
==Diagnosis==
 
==Diagnosis==
#Blood sugar
+
*Blood sugar
#BAL
+
*BAL
#*Appropriate if AMS is due to unknown cause
+
**Appropriate if AMS is due to unknown cause
#*Not necessarily required in mild-mod intoxication or if no other abnormality suspected
+
**Not necessarily required in mild-mod intoxication or if no other abnormality suspected
#Elevated osmolar gap
+
*Elevated osmolar gap
  
 
==Treatment==
 
==Treatment==
#GI decontamination
+
*GI decontamination
##Activated charcoal ineffective (ETOH is too rapidly absorbed)
+
**Activated charcoal ineffective (ETOH is too rapidly absorbed)
#Hypoglycemia
+
*Hypoglycemia
##Give glucose immediately (do not have to wait to give thiamine first)
+
**Give glucose immediately (do not have to wait to give thiamine first)
#"Banana Bag"
+
*"Banana Bag"
##IV form is not justified
+
**IV form is not justified
##Likelihood of vitamin deficiency (except for thiamine) is low
+
**Likelihood of vitamin deficiency (except for thiamine) is low
##IVF does not hasten ETOH elimination
+
**IVF does not hasten ETOH elimination
  
 
==Disposition==
 
==Disposition==
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*[[Beer Potomania Syndrome]]
 
*[[Beer Potomania Syndrome]]
  
==Source==
+
==References==
*Tintinalli
 
  
 
[[Category:Tox]]
 
[[Category:Tox]]

Revision as of 12:57, 1 June 2015

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

  • 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

Diagnosis

  • 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

Treatment

  • 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

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

See Also

References