Ethanol toxicity

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  • 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


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]


  • 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


  • Can be discharged once patient at baseline mental status, able to tolerate PO and ambulate without assistance.

See Also


  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.