Difference between revisions of "Ethanol toxicity"

(See Also)
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==Background==
 
==Background==
*AMS that doesn't improve after few hrs is due to alternative cause until proven otherwise
+
*Rate of ETOH elimination is 15-30mg/dL/hr (depending on degree of chronic alcohol intake)
*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==
 
==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==
''Most patients require observation only''
+
''Clinical diagnosis. No specific workup required, but the following may be considered based on clinical picture/gestalt:''
*Blood sugar
+
*Fingerstick glucose
*BAL
+
*Blood alcohol level (BAL)
**Appropriate if AMS is due to unknown cause
+
**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>
**Not necessarily required in mild-mod intoxication or if no other abnormality suspected
 
*Elevated osmolar gap
 
  
==Treatment==
+
==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, and road test successful
+
*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]]
*[[Alcohol Withdrawal]]
 
 
*[[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

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.