Alcohol Intoxication

1. Alcohol Intoxication
Ade Wijaya, MD – October 2018

2. Outline:
• Introduction
• Clinical presentation
• Diagnosis
• Differential diagnosis
• Management
• Acute Alcohol Intoxication or Chronic Alcohol Abuse?
• Summary

3. Introduction
• Ethanol (CH3CH2OH) is a watemembranes, resulting in ready
equilibration between intra- and extra-cellular concentrations.
• Mainly absorbed in the stomach (70%) and duodenum (25%)
• Gastric alcohol dehydrogenase (ADH) – 1st pass metabolism (10 %)
gender difference
• r-soluble compound that rapidly crosses cell
Marco CA, Kelen GD. Acute intoxication. Emerg Clin North Am 1990;8:731–48. L. Vonghia et al. / European Journal of Internal Medicine 19 (2008) 561–567 565
Frezza, Di Padova C, Pozzato G, Terepin M, Barona E, Lieber CS. High blood alcohol levels in women: role of decreased gastric alcohol dehydrogenase activity and first pass metabolism. N Engl J Med 1990;322:95–9

4. Clinical Presentation
Wallgren H. Actions of alcohol. Amsterdam: Elsevier; 1970

5. Diagnosis
• History
• Physical Exam: capillary prominence, spider naevi, talengiectasias,
palmar erythema, and muscular atrophy
• Blood alcohol concentration
• serum osmolality usually shows a hyperosmolality with an “osmolal
gap”
• Urine test
Vonghia L, Leggio L, Ferrulli A, Bertini M, Gasbarrini G, Addolorato G, Alcoholism Treatment Study Group. Acute alcohol intoxication. European Journal of Internal Medicine. 2008 Dec 1;19(8):561-7.

6. Differential Diagnosis
Yost DA. Acute care for alcohol intoxication. Be prepared to consider clinical dilemmas. Postgrad Med 2002; 112: 14–6, 21–2, 25–6.
Marco CA, Kelen GD. Acute intoxication. Emerg Clin North Am 1990;8:731–48.

7. Management
Marco CA, Kelen GD. Acute intoxication. Emerg Clin North Am 1990;8:731–48.

8. Acute Alcohol Intoxication or Chronic Alcohol Abuse?
• History
• AUDIT or AUDIT-C and/or the CAGE tests
• Patients who abuse or who are dependent on alcohol may experience
an alcohol withdrawal syndrome following detoxification. Such a
syndrome, in its severe form, may be life-threatening and present
with delirium tremens and seizures
Reinert DF, Allen JP. The alcohol use disorders identification test (AUDIT): a review of recent research. Alcohol Clin Exp Res 2002;26: 272–9.
Dawson DA, Grant BF, Stinson FS, Zhou Y. Effectiveness of the derived alcohol use disorders identification test (AUDIT-C) in screening for alcohol use disorders and risk drinking in the U.S. general population. Alcohol Clin Exp Res 2005;29:844–54.
Ewing JA. Detecting alcoholism. The CAGE questionnaire. JAMA 1984;252:1905–7.
Fiellin DA, O'Connor PG, Holmboe ES, Horzwitz RI. Risk of delirium tremens in patients with alcohol withdrawal syndrome. Subst Abuse 23: 83–94

9. Summary
• A Harmful condition that usually follows the ingestion of a large
amount of alcohol.
• Behavioral, cardiac, gastrointestinal, pulmonary, neurological, and
metabolic manifestations can occur.
• The management of an intoxicated patient occurs mainly in the
emergency department and is aimed at stabilizing the clinical
condition of the patient.
• Metadoxine is an effective pharmacological treatment for patients
affected by acute alcohol intoxication.