- Rate of ETOH elimination is 15-30mg/dL/hr (depending on degree of chronic alcohol intake)
- Classic Features
- Slurred speech
- Alcohol odor on breath
- Respiratory depression
- Other Features (if malnourished)
- Lactic acidosis
- Epigastric pain (pancreatitis)
- Impairment is greater at a given blood alcohol concentration when the level is rising than when it is falling. 
- Chloral hydrate
- Gamma hydroxybutyrate (GHB)
- Baclofen toxicity
- Toxic alcohols
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
- GI decontamination
- Activated charcoal ineffective (ETOH is too rapidly absorbed)
- 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
- Can be discharged once patient at baseline mental status, able to tolerate PO and ambulate without assistance.
- Alcohol Withdrawal
- Alcoholic ketoacidosis
- Beer Potomania Syndrome
- Altered mental status
- 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.