What We Know From Current Statistics
Alcohol (ethyl alcohol), also known as ethanol, is one of the most abused substances worldwide, and alcohol poisoning is one of its varying manifestations. Furthermore, alcohol is psychoactive and is known for its ability to induce dependence. Therefore, misuse of alcohol has detrimental effects neurologically and systemically on an individual’s body, and it impacts their sphere of life psycho-socially and economically, the effects of which are generally negative within households and countries on a wider scale.
The National Health Institute mentions that 5.3 percent of deaths globally are related to alcohol consumption, with men being more at risk. The World Health Organization informs that this percentage approximates to around 3 million lives lost around the world.
In the United States particularly, Levine (2021) explains that “more than half of all trauma patients are intoxicated with ethanol” upon accessing the trauma center. It is also a frequent substance ingested along with other substances in suicide attempts.
As a result, it is crucial to be able to identify the presentation of alcohol poisoning or ethanol poisoning in the acute setting.
Risk Factors
Increased risk for alcohol poisoning is related to factors linked to the individual and how alcohol is consumed.
Risks Related To The Individual:
- Body mass index
- General health
- Recent food ingestion
- Alcohol tolerance level
Risks Related To Alcohol:
- Amount of alcohol ingested
- Co-ingestion of other drugs
- Rate of alcohol consumption
Risk factors may also include a history of alcoholism, binge drinking, as well as mental health issues, including depression associated with suicidal ideation.
Etiology
The general cause of alcohol poisoning results from drinking too much alcohol in a short period; more specifically, binge drinking is considered the main factor, where large quantities of alcoholic beverages are consumed rapidly in less than three hours.
Clinical Presentation
Levine (2021) clarifies that identifying recent changes in the circumstances of the patient may reveal the reason for the presentation.
It is important to note that the serum concentration of ethanol along with the frequency at which the patient may ingest alcohol can influence presentation as patients with antecedents of chronic drinking may not manifest cerebellar dysfunction in comparison to new drinkers. Signs and symptoms will encompass slurred speech, disinhibition in behavior as well lack of coordination. Posteriorly, the patient may show signs of central nervous system depression. Thus, causes that may also present with depression of the central nervous system (CNS) must also be considered. Hidden injuries must be evaluated in the physical examination.
Especially in children and adolescents, the physician must also consider the hypoglycaemic effects of alcohol in the clinical presentation due to the risk of experiencing it after single use in comparison to adults.
Signs and Symptoms of Alcohol Intoxication:
- Slurred speech
- Behavioural disinhibition
- Dizziness
- Ataxia
- Drowsiness
- Coma
Differential Considerations
The following are a few causes that also present similarly to alcohol poisoning:
- Acute hypoglycemia
- Diabetic ketoacidosis
- Meningitis
- Other drug toxicities
- Benzodiazepine
- Barbiturates
- Lithium
- Opioids
- Sedatives
- Stroke
Investigations
As previously mentioned, other causes related to depression of the CNS must be considered in such a presentation. (See a list of differentials above)
However, despite various tests that correspond to alternative causes, an investigation that must be evaluated quickly is the serum glucose level. Other tests include and are not limited to:
- Serum ethanol level. Levine (2021) notes the toxic dose of ethanol is 5 mg/dl and in children 3mg/dl.
- Toxicology Screen
- Routine Complete Blood Count and Chemistry to include Bicarbonate, bearing in mind that as the patient progresses, values will also change as related to the anion gap calculation.
- Liver Function Tests
- Arterial Blood Gas
- Electrocardiogram
- Imaging studies are dependent on suspicion or discovery of traumatic injuries, for example, head trauma.
Management
Treating or managing alcohol poisoning is founded on supportive care, bearing in mind the risk of respiratory depression; the patient’s airway must be protected.
Glucose must be checked frequently when the clinical presentation is severe. It should be monitored ideally every two hours in such cases. The presence of hypoglycemia must be corrected using intravenous dextrose solution. Intravenous fluids may also serve a dual effect to correct dehydration caused by the diuretic effect of alcohol on the body. Any associated traumatic injuries must also be managed. It is important to note that 100 mg of thiamine may be intravenously or intramuscularly administrated if Wernicke’s encephalopathy is suspected.
Key Points
- Three million deaths globally are linked to alcohol use.
- Alcohol poisoning is related to drinking large quantities of alcohol over a short period of time. Binge drinking is a major cause of alcohol poisoning.
- The clinical presentation ranges from slurred speech to coma in severe presentation.
- Patients’ blood glucose must be monitored, and another diagnosis that may present with signs of central nervous system depression must be ruled out.
- Investigations related to evaluating for hypoglycemia, verifying ethanol toxicity, organ damage, assessing suspected or apparent trauma, and ruling out other possible causes of the clinical presentation.
- Treatment is generally supportive and includes correction of hypoglycemia, dehydration, and management of any traumatic injuries.
References and Further Reading
- National Institute on Alcohol Abuse and Alcoholism (2021) ‘Alcohol Facts and Statistics’ NIH. [Online] Available at: https://www.niaaa.nih.gov/publications/brochures-and-fact-sheets/alcohol-facts-and-statistics (Accessed 16th August, 2021)
- LaHood, A. J. and Kok, S.J. (2021) ‘Ethanol Toxicity’ NCBI. [Online] Available at: https://www.ncbi.nlm.nih.gov/books/NBK557381/ (Accessed 16th August, 2021)
- Levine M. (2016) ‘Alcohols,’ in Tintinalli, J.E. (ed.) Tintinalli’s Emergency Medicine. 8th Edition. McGraw-Hill Education pp 580-583
- Levine M. (2021) ‘Alcohol Toxicity’ in Medscape [Online] Available at: https://emedicine.medscape.com/article/812411-overview (Accessed 16th August, 2021)
- World Health Organization (2018) ‘Alcohol’ World Health Organization [Online] Available at: https://www.who.int/news-room/fact-sheets/detail/alcohol (Accessed 16th August, 2021)
- Wyatt, J.P., et al. (2012) Oxford Handbook of Emergency Medicine. 4th Edition. Oxford University Press pp 197-217