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ACUTE ALCOHOL

INTOXICATION
Consider acute alcohol intoxication in any patient presenting with:
-coma
-syncope
-any inappropriate behavior
-any neurological abnormality
-trauma
-traffic accident
-hypothermia
Inappropriate Behavior; in coordination, confusion, slurred speech, aggressive,
inappropriately sensitive behavior etc
Neurological Abnormality; e.g. ataxia, nystagmus, divergent bulbae etc.
Reliable history gives more helpful information in contrast to physical examination which
is less sensitive and specific.

MANAGEMENT
Assess vital functions
-Airway
-Breathing
-Circulation
Assess level of consciousness
Assess and treat for complications of alcohol

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CIRCULATION

Palpate carotid artery pulsations


Absent pulse
Observe ECG rhythm
Prepare for cardiopulmonary resuscitation

Weak pulse
Measure blood pressure
If systolic <90mmHg
- Give saline 0.9% 500ml by rapid I/V infusion; repeat as needed

- If refractory to saline give nor epinephrine continuous I/V infusion, start


with 0.5-1 g/min

Evaluate for bleeding; aspirate stomach fluid via nasogastric cannula and consider
endoscopy

(Chronic alcoholics may have esophageal varices, peptic ulcer or congestive


gastropathy. Also,
Mucosal tears may occur after bouts of vomiting in alcohol overdose-Mallory
Weiss Syndrome.)

ASSESS LEVEL OF CONSCIOUSNESS

Speak to the patient in a loud voice


If no adequate response, apply a painful stimulus
Put the patient in lateral decubitus position while not intubated
Intubate trachea if tracheal reflexes are not adequate to prevent aspiration
Give Oxygen, initially @2-4L/min
Thiamine 100mg I/V
Measure blood glucose level by bedside test
I/V glucose 500ml of 10% or 100ml of 30%
Search for head trauma
Frequently assess pupils
Consider additional toxin ingestion
Consider cerebral computed tomography

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COMPLICATIONS AND PROBLEMS OF ACUTE ALCOHOL


INTOXICATION

AVOID BENZODIAZEPINES as they are potent respiratory depressants in


combination with alcohol

Aggressive patients
-try to listen, talk
-Haloperidol 10mg PO,I/V,I/M,S/C
-physical restraints are only a last resort

Co ingested poisons esp. cocaine, benzodiazepines and antidepressants


Hypoglycemia
Hypothermia
Rhabdomyolysis
Occult head injury
Wernickes encephalopathy
Hyponatremia

LABORATORY INVESTIGATIONS
BLOOD TESTS
Peripheral Blood Cell Count
-initially concentration of Hemoglobin and RBCs will be unchanged
-with bleeding, plasma and blood cells are lost
-ultimately leads to decrease in Hemoglobin and RBC concentration
Blood Ethanol levels
-poorly correlate with intoxication due to tolerance
Osmolal Gap
Anion Gap
Potassium levels
Arterial Blood Gas Analysis

BREATH TESTS
Roadside breath test
Calibrated breathalyzer

URINE
VITREOUS HUMOUR
Only taken postmortem and is most useful when blood not available or unsuitable for
analysis

AUTOPSY FINDINGS IN CHRONIC


ALCOHOLISM
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Chronic alcoholism refers to a steady, regular abuse of a drink.


On autopsy,

GENERAL FEATURES
-Signs of general neglect and malnutrition or obese and even edematous due
to chronic heart failure

INTERNAL FEATURES
-LIVER DAMAGE
In early stages, there will be fatty change and enlargement with increase in
weight up to 2000g.
Surface will be pale and greasy.
Patchy yellowish area may be visible within normal hepatic
parenchyma.
If abuse continues, fatty change may give way to fibrosis.
Cirrhosis of liver with nodules of 5-10 cm in diameter.
In late stage, liver becomes smaller and contracts to a hard, grayish yellow
block of only 800-1200g.

-CARDIAC DAMAGE
Heart is enlarged and shows patchy fibrosis with mixed cellular infiltrate,
hypertrophy of muscle fibers, patchy necrosis, hyalinization, edema and vacuolization,
nuclear enlargement and polymorphism.
Specific myocardium damage cause by cobalt added to commercial beers.
-SPLEEN
May be enlarged and firm, portal varices may be present at the gastroesophageal junction
-OTHER FINDINGS
Systemic fat embolism
Micro infarcts in brain and myocardium

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