Difference between revisions of "Ethanol toxicity"

(See Also)
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==Background==
 
==Background==
CAGE
+
*AMS that doesn't improve after few hrs is d/t 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)
  
C- can you cut down
+
==Clinical Features==
 
+
#Classic Features
A- anyone annoyed
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##Slurred speech
 
+
##Nystagmus
G- Guilty about drinking
+
##Ataxia
 
+
##N/V
E- Eye opener in am?
+
##Respiratory depression
 +
##Coma
 +
#Other Features (if malnourished)
 +
##Hypoglycemia
 +
##Ketoacidosis
 +
##Lactic acidosis
  
 
==Diagnosis==
 
==Diagnosis==
-    withdrawals sxs- dysphoria, insomnia, anxiety, irritable, nause, agitation, tachy, HTN- all same for all three classes of drugs but complications and tx different
+
#Blood sugar
 
+
#BAL
-    substance abuse tx- detox, abstinence, reduce withdrawal sxs, retain pt in tx
+
##Appropriate if AMS is due to unknown cause
 
+
##Not necessarily required in mild-mod intoxication or if no other abnormality suspected
-   ongoing tx needed to maintain tx
+
#Elevated osmolar gap
 
 
-    substitute long acting agent for abused drug and then taper- med should be oral, low potential for abuse/ overdose and low side effects
 
  
-    out pt  is mild to moderate
+
==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
  
-    inpt if DT's, psychotic, depressed
+
==Disposition==
 
+
*Most pts require observation only
-    behavioral interventions- contingency management, motivation, cognitive therapy
 
 
 
==ETOH Metabloism==
 
20-40 per hour
 
 
 
May D/C at <200 (Harbor)
 
  
 
==See Also==
 
==See Also==
[[Beer Potomania Syndrome]]
+
*[[ETOH Withdrawl]]
 
+
*[[Beer Potomania Syndrome]]
[[ETOH Withdrawl]]
 
  
 
==Source==
 
==Source==
PANI 9/09
+
*Tintinalli
  
 
[[Category:Tox]]
 
[[Category:Tox]]

Revision as of 06:18, 4 January 2012

Background

  • AMS that doesn't improve after few hrs is d/t 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

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

Source

  • Tintinalli