Acute alcohol intoxication

Acute alcohol intoxication can result from a high level of alcohol in the bloodstream leading to drunkenness. The term acute alcohol intoxication is used by healthcare providers, often in emergencies. Toxicologists also speak of alcohol intoxication to discriminate from other toxins researched in the field.

Epidemiology

The condition is frequently found in either young people who are being exposed to commonly available alcoholic beverages like beer, wine, and distilled liquor for the first time, and don't know their limits, or by people suffering from alcoholism who ingest much more than they usually do.

Pathophysiology

The body sees the alcohol as a toxin, and the liver begins to metabolize (deactivate) it. However, it takes roughly 90 minutes for a healthy liver to metabolize a single ounce, so when more than a drink an hour is ingested, other body systems begin to have side effects.

Alcohol is considered a "mood potentiator", meaning it will enhance the prevalent mood the person already has. This means if ones mood is sadness, it will worsen. If happy, it will typically increase. Some of these effects are often thought to be desirable, but in increasing doses, can be increasingly problematic.

For example, as the level of alcohol increases in the bloodstream, judgement becomes impaired. This isn't only the ability to choose right from wrong, but also the ability to interpret what the 5 senses are "reporting". This is very dangerous when interfacing with the world to perform tasks of motor dexterity, like using kitchen blenders or food processors, or driving automobiles. As drinking increases, people become sleepy, or fall into a stupor. Ultimately, the respiratory system becomes depressed, and the person will stop breathing. This is a common cause of death on college campuses. The most important thing for friends who witness someone "passing out" from too much alcohol is to get them emergency medical treatment. [McArdle, P (2004). Substance abuse by children and young people. Arch. Dis. Child. 89: 701-704]

Avoidance of Intoxication

Alcohol is metabolized by the normal liver at that rate of about one ounce (one "highball", a normal beer, a regular sized glass of wine) every 90 minutes. The "abnormal" liver, one with hepatitis, cirrhosis, gall bladder disease, cancer, etc, will have a slower rate of metabolism. One can delay the absorption of alcohol by drinking and ingesting food, but it prolongs the un-metabolized alcohol in the body.

Diagnosis

Determining if someone is intoxicated is pretty easy when the person is still drinking at a party and had been observed being sober. For a physician in the acute treatment setting, acute alcohol intoxication can mimic other acute neurologic disorders, or is frequently combined with other recreational drugs which complicate diagnosis and treatment. Definitive diagnosis relies on a blood test for alcohol, usually performed as part of a toxicology screen.

Treatment

Emergency treatment for acute alcohol intoxication may include: [Devi, G., Castro, V. J., Huitink, J., Buitelaar, D., Kosten, T., O'Connor, P. (2003). Management of Drug and Alcohol Withdrawal. NEJM 349: 405-407]
* protecting the vital signs by monitoring ABCs, or Airway, Breathing, and Circulation,ie. if the person is thought to be at risk for severe respiratory depression, they may have a tube placed to protect the airway and assist with breathing.
* protecting the airway from aspirating stomach contents that may lead to aspiration pneumonia,
* administering dextrose intravenously to bring up blood sugar and prevent seizures,
* administering the vitamin thiamine to prevent the development of Wernicke-Korsakoff syndrome which may cause a seizure(This is more usually a treatment for chronic alcoholism, but in the acute context is usually co-administered to ensure maximal benefit),
* correcting electrolytes imbalance to improve the body's functioning, if warranted according to blood chemistry tests, or
* kidney dialysis if the blood concentration is dangerously high (>400 mg%).

Additional medicine may be indicated for treatment of nausea, tremor, and anxiety.

Medications exist that reduce the desire to drink, usually by making one very ill if alcohol is ingested. [Drug Therapy for Alcohol Dependence, Swift RM, N Engl J Med 340:1482, May 13, 1999 Review Article]

Prognosis

The normal liver will detoxify the blood of alcohol over time, and the time depends on the initial level and the patient's overall physical condition. The abnormal liver will take longer, as long as the alcohol doesn't cause liver failure. [Management of alcoholic hepatitis, Drug and Therapeutics Bulletin 2003;41:49-52; doi:10.1136/dtb.2003.41749] Unfortunately, acute alcoholic intoxication is often considered a rite of passage. [http://www.usatoday.com/news/nation/2007-08-21-campus-safety_N.htm]

People who have been drinking for several days or weeks will have further problems after the acute intoxication has subsided, including delirium tremens, a serious condition that can be fatal. [DeBellis, R., Smith, B. S., Choi, S., Malloy, M. (2005). Management of Delirium Tremens. J Intensive Care Med 20: 164-173]

References