I.

OBJECTIVES
 To acquire more knowledge regarding alcohol intoxication, its definition, stages, causes, signs and
symptoms, risk factors, complications, preventions, incidence as well as the prognosis.
 To know the profile information, history of past and present illnesses and the Maslow’s Hierarchy of
needs of the client.
 To appraise the physical features of the client.
 To review the anatomy and physiology of the central nervous system.
 To illustrate the pathophysiology o
 To identify the ideal and actual nursing, medical, surgical, and pharmacological management and
diagnostic examinations.
 To use the nursing care plan as framework of care.
 To impart appropriate health teachings to the client and significant others.
 To be updated with the latest treatment and management of alcohol intoxication.

II. INTRODUCTION
Alcohol intoxication, also known as drunkenness or alcohol poisoning, is the negative behavior and physical
effects due to the recent drinking of ethanol (alcohol). Symptoms at lower doses may include mild sedation and
poor coordination. At higher doses, there may be slurred speech, trouble walking, and vomiting. Extreme doses
may result in a decreased effort to breathe (respiratory depression), coma, or death. Complications may include
seizures, aspiration pneumonia, injuries including suicide, and low blood sugar.
Stages
 Euphoria: difficulty concentrating, talkative, lowered inhibitions, brighter color in the face, fine motor skills
are lacking
 Excitement: senses are dulled, poor coordination, drowsy, beginnings of erratic behavior, slow reaction
time, impaired judgment
 Confusion: exaggerated emotions, difficulty walking, blurred vision, slurred speech, pain is dulled
 Stupor: cannot stand or walk, vomiting, unconsciousness is possible, decreased response to stimuli,
apathetic
 Coma: unconscious, low body temperature, possible death, shallow breathing, slow pulse
 Death: death as a result of respiratory arrest

Causes
Alcohol is a generic term for ethanol, which is a alcohol produced by the fermentation of many foodstuffs -
most commonly barley, hops, and grapes. Other types of alcohol commonly available such as methanol
(common in glass cleaners), isopropyl alcohol (rubbing alcohol), and ethylene glycol (automobile antifreeze
solution) are highly poisonous when swallowed, even in small quantities.
Ethanol produces intoxication because of its depressive effects on various areas of the brain causing the
following physical and mental impairments in a progressive order as the persons alcohol level increases (the
person becomes more and more intoxicated).

Signs and Symptoms

 severe confusion, unpredictable or violent behavior and stupor
 sudden lapses into and out of unconsciousness or semi-consciousness (with later alcoholic amnesia)
 vomiting while unconscious or semi-conscious
 seizures
 respiratory depression (fewer than eight breaths a minute)
 pale, bluish, cold and clammy skin due to insufficient oxygen

Risk Factors
 age: young adults are more likely to drink excessively, leading to an alcohol overdose.
 gender: men are more likely than women to drink heavily, resulting in a greater risk for an alcohol overdose.
 body size: someone with a smaller body may experience the effects of alcohol more rapidly than someone
with a larger body. In fact, the smaller-bodied person may experience an alcohol overdose after drinking the
same amount that a larger-bodied person can consume safely.
 tolerance: having a high tolerance for alcohol or drinking quickly (for example, by playing drinking games)
can put at increased risk for an alcohol overdose.
 binge drinking: people who binge drink (drink more than five drinks in an hour) are also at risk for alcohol
overdose.
 drug use: if a person combines alcohol and drugs, he/she may not feel the effects of the alcohol. This may
cause her/him to drink more, increasing the risk for an alcohol overdose.
 other health conditions: if a person has other health conditions, such as diabetes, he/she may be at greater
risk for having an alcohol overdose.

Complications
 seizures
 aspiration pneumonia
 injuries including suicide
 hyponatremia
 pancreatitis
 dysrhythmia

Preventions
Alcohol intoxication can be avoided by drinking alcohol moderately or not at all. Strategies that may help avoid
alcohol intoxication include alternating alcoholic drinks with non-alcoholic drinks (ideally water), counting
drinks carefully, choosing beverages with lower alcohol content and eating a solid meal before drinking alcohol.

Incidence
Alcohol intoxication’s incidence was tripled as compared to 2018. Case fatality rate was higher in women
(7.5% vs. 6.6%). Males who were self-employed or unemployed and females who were housekeepers or
students were at greatest risk. The age-specific prevalence rate was highest in 10-20 (6.25 per 100,000), and the
age-specific mortality rate was highest in 30-40 (2.13 per 100,000) age group.

Prognosis
After an episode of alcohol intoxication, it takes time to recover. The person will be hospitalized until their vital
signs return to normal. This may take days, up to weeks.
During the recovery period, a person may experience a depressed mood and appetite, discomfort, and memory
problems. Even after a person is released from hospital care, it can take up to a month for them to feel normal
again.
The good news is that it’s possible to survive alcohol intoxication if appropriate medical treatment is given
promptly.
III. PATIENT’S PROFILE

HOSPITAL #: 145715
NAME: Mr. Ethan
AGE: 35 years old
ADDRESS: Danglas,Abra
GENDER: Male
BIRTHDATE: January 09, 1956
BIRTHPLACE: Danglas, Abra
OCCUPATION: Carpenter
CIVIL STATUS: Married
RELIGION: Roman Catholic
NATIONALITY: Filipino
DATE AND TIME OF ADMISSION: September 24, 2019 at 5:30 AM
CHIEF COMPLAINT: Bruises and lacerated wounds on face, head and both arms and both feet, few
minutes PTA
ADMITTING PHYSICIAN: Rolex C. Gonzales, M.D.
ADMITTING DIAGNOSIS: Alcohol intoxication
WARD: Surgery Ward
DIET: NPO

IV. HISTORY OF PAST AND PRESENT ILLNESSES (09-24-29 at 2pm)

PAST HISTORY
Patient Ethan had experienced childhood illnesses but was not able to recall if he had completed his vaccines.
He began to take alcohol during his teenage years consuming 3-4 bottles of ginebra a day with his friends until
he was used to it. Through the years, he was frequently seen to have bruises every time he drinks but never been
hospitalized. Aside from this, he was also been aggressive in which he breaks bottles or punches door or table.
On September 24, 2019 at around 5 am, patient Ethan was driving a motorcycle while being drunk going to
their home when he run over two individuals who were jogging. He had bruises and lacerated wounds on face,
head and both arms and both feet. One of the individuals who had been hit got fracture on his right lower
extremity while the other one had bruises on faces and arms.
PRESENT HISTORY
He was rushed by the bystanders to APH at 5:30am and he was diagnosed with alcohol intoxication by Dr.
Rolex C. Gonzalex. He was forwarded to orthopedic ward for further care and management.
FAMILIAL HISTORY
He had history of hypertension on paternal side but no history of the disease said. His father died due to stroke
for he was also an alcoholic drinker which they thought that triggered his condition. Patient had no known
allergies to foods and drugs.
PSYCHOSOCIAL HISTORY
Patient Ethan was a high school graduate due to early parenthood wherein he still lives with his mother together
with his wife and son in one roof. He is a carpenter while his wife is a housekeeper. He likes fishing and fond of
eating high-carbs foods. His vices included were alcohol drinking (1 ½ bottles of ginebra when drinking alone)
and cigarette smoking (maximum of 1 pack mighty red a day).

V. MASLOW’S HIERARCHY OF NEEDS (09-24-19 at 2pm)

Physiologic Needs (PEARSON)
 Loves fishing before hospitalization
 With IFC connected to urine bag at 300cc level, yellowish in color and slightly turbid
 Not defecated within the shift
 With minimal activity
 Able to breathe in an atmospheric room temperature with oxygen saturation of 97%.
 Sleeps 9 hours at night and an hour of nap at daytime
 Sexually inactive due to his condition but sexually active before hospitalization
 NPO maintained
 With IVF of D5LRS1L x 30gtts/min hooked at the right metacarpal vein at full level, patent and infusing well
 Provided wrinkle-free bed and clean linens
Safety and Security
 Provided with safe and secured treatment and care rendered by the physicians, staff nurses and student
nurses.
 Observed 16 R’s in preparing and administering prescribed medications by the nurses on duty.
 Arranged things within easy reach and ensured a 24-hr watcher.
 Monitored and recorded vital signs.
Love and Belongingness
 He felt loved and cared by the presence of his mother and wife who took good care of him and looked after
his needs in the hospital.
Self-Esteem
 Manifested low self-esteem during hospitalization due to his present condition but prior to admission, he
had a good self-esteem as claimed by the client.
Self-Actualization
 He is hoping for fast recovery to have full rest at home and to continue his daily activities such as helping his
family in household chores and biking.

VI. PHYSICAL ASSESMENT (09-24-19 at 2pm)

GENERAL ASSESMENT
 With ectomorph body built
 With IVF of D5LRS1L x 30gtts/min hooked at the right metacarpal vein at full level
 With IFC connected to urine bag at 300cc level, yellowish in color and slightly turbid
 With poor hygiene and grooming
 Looks appropriate to his actual age
 Weak-looking
 Bruises and lacerated wounds on face, head, and both arms and both feet noted
 With pimples at the face
 On NPO
 V/S as follows:
Temp- 36.5degrees celcius
PR- 89bpm
RR- 20 cpm
Bp- 120/90 mmHg
P/S-7/10
FL- II
Oxygen saturation- 97%
MENTAL STATUS
 Had a poor eye-to-eye contact
 Conscious and coherent
 Able to follow instructions
 Had a good sense of reality
SKIN (INSPECTION AND PALPATION)
 With ununiformed skin color
 Bruises and lacerated wounds on face, head, and both arms and both feet noted
 With dry skin noted.
HAIR (INSPECTION AND PALPATION)
 With blackish hair color, thick and evenly distributed
 Scalp smooth and firm
 With brittleness and dryness noted
 No infestation and dandruff noted
HEAD AND SKULL (INSPECTION AND PALPATION)
 Normocephalic and symmetrical frontal, parietal, temporal and occipital prominences
 No mass, tenderness, depressions noted
 Proportionate to the body size
 With smooth skull contour
 Bruises and lacerated wounds noted
EARS (INSPECTION AND PALPATION)
 Aligned to the outer canthus of the eyes
 Equal in size with fair complexion to the body and face
 No lesions, discharges, visible lumps noted
 Non- tender auricle and tragus
 Smooth without nodules
 Good hearing acuity
 Pinnae recoiled and went back immediately when pinched
FACE (INSPECTION AND PALPATION)
 No nodules, mass, tenderness, involuntary muscle movements.
 With brownish complexion
 Face on center position
 Symmetrical facial movement
 Presence of pimples noted
 Bruises and lacerated wounds noted
EYES (INSPECTION)
 PERRLA (Pupils were Equally Round and Reactive to light Accommodation), with good visual acuity, eyes
symmetrical to the ears, pupils were blackish in color
 Lids closed symmetrically
 With good visual acuity
 No tearing, conjunctivitis noted
 Eyebrows were evenly distributed
 Irises were blackish in color
 With pinkish palpebral conjunctivae and whitish anicteric sclerae
 With short straight eyelashes and was evenly distributed
NOSE AND SINUSES (INSPECTION AND PALPATION)
 Nose had the same color to the face
 No mass, lesions, tenderness, nasal flaring and discharges noted
 With good smell acuity
 Septum was in normal position
 Able to breathe in normally at atmospheric room temperature with an oxygen saturation of 97%
MOUTH AND OROPHARYNX (INSPECTION)
 Lips were relatively symmetrical in contour and pinkish in color
 Had the ability to purse lips
 No angular lesions, swelling, mouth ulcer, no inflammation of tonsils noted
 With complete set of teeth
 Raised papillae noted
 Presence of Adam’s apple
 Uvula was at the middle of soft palate
 Tonsils and Oropharynx were pinkish in color
 With good sense of taste
 Plaques and cavities at the upper molars
 Tonsils were not inflamed
 Dry lips noted
NECK (INSPECTION AND PALPATION)
 Sternocleidomastoid and trapezius were equal in size
 With normal head reflex
 With normal range of motion
 No distention or bulging of jugular veins, trachea deviations, lumps, mass, tenderness, lymph nodes and enlarged thyroid noted
 Had the same color with the face
CHEST, THORAX AND LUNGS (IPPA)
 With symmetrical chest expansion
 Normal thorax and lungs noted
 No masses, lesions, tenderness, vocal fremitus and chest indrawing, cracklings, wheezing, gurgling and friction rub
noted
 Respiratory rate: 20cpm
BREASTS AND AXILLAE ( INSPECTION AND PALPATION)
 Had the same color with the body
 No dimpling and swelling , localized discoloration or hyperpigmentation, mass, tenderness, swelling, nodules,
discharges and ulcerations noted
 Areolae and nipples were brownish in color
 Symmetrically equal in size
 Flat and mongo-like brownish nipples
ABDOMEN ( IAPP )
 With liquor-belly abdomen
 Navel was centrally located
 No over-distention, tenderness, lesions, and mass noted
 With borborygmi sounds
UPPER EXTREMITIES ( INSPECTION AND PALPATION)
 With With IVF of D5LRS1L x 30gtts/min hooked at the right metacarpal vein at full level
 Arms were proportionate to the color of the body
 Capillary refill went back within 2 seconds
 Nails were trimmed
 With complete set of fingers noted
 With limited range of motion at lower back and at both legs
 No beau’s line and onychomicosis noted
 Bruises and lacerated wounds on face and both arms noted
 With poor ROM at both arms
GENITO-URINARY TRACT ( INSPECTION )
 With IFC connected to urine bag at 300cc level, yellowish in color and slightly turbid
 Not defecated within the shift
 With normal genitals
LOWER EXTREMITIES ( INSPECTION AND PALPATION )
 Fair complexion noted
 With IFC connected to urine bag at 300cc level, yellowish in color and slightly turbid
 Capillary refill went back within 2 seconds
 Toenails were untrimmed and uncleaned
 With complete set of toes
 No lesions and tenderness noted
 Presence of bruises at the left leg
 With poor gait at both legs
 With poor range of motion at both legs

VII. ANATOMY AND PHYSIOLOGYOF CENTRAL NERVOUS SYSTEM

The central nervous system consists of the brain and spinal cord. The brain plays a central role in the control of
most bodily functions, including awareness, movements, sensations, thoughts, speech, and memory. Some
reflex movements can occur via spinal cord pathways without the participation of brain structures. The spinal
cord is connected to a section of the brain called the brainstem and runs through the spinal canal. Cranial nerves
exit the brainstem. Nerve roots exit the spinal cord to both sides of the body. The spinal cord carries signals
(messages) back and forth between the brain and the peripheral nerves.
Central Nervous System (CNS) Definition
Damage to the brain can be caused by many things, for example, trauma and ALS.
The central nervous system consists of the brain and spinal cord. The brain plays a central role in the control of
most bodily functions, including awareness, movements, sensations, thoughts, speech, and memory. Some
reflex movements can occur via spinal cord pathways without the participation of brain structures. The spinal
cord is connected to a section of the brain called the brainstem and runs through the spinal canal. Cranial nerves
exit the brainstem. Nerve roots exit the spinal cord to both sides of the body. The spinal cord carries signals
(messages) back and forth between the brain and the peripheral nerves.
Cerebrospinal fluid surrounds the brain and the spinal cord and also circulates within the cavities (called
ventricles) of the central nervous system. The leptomeninges surround the brain and the spinal cord. The
cerebrospinal fluid circulates between 2 meningeal layers called the pia matter and the arachnoid (or pia-
arachnoid membranes). The outer, thicker layer serves the role of a protective shield and is called the dura
matter. The basic unit of the central nervous system is the neuron (nerve cell). Billions of neurons allow the
different parts of the body to communicate with each other via the brain and the spinal cord. A fatty material
called myelin coats nerve cells to insulate them and to allow nerves to communicate quickly.
Brain and Cerebrum Location
The cerebrum is the largest part of the brain and controls voluntary actions, speech, senses, thought, and
memory.
The surface of the cerebral cortex has grooves or infoldings (called sulci), the largest of which are termed
fissures. Some fissures separate lobes.
The convolutions of the cortex give it a wormy appearance. Each convolution is delimited by two sulci and is
also called a gyrus (gyri in plural). The cerebrum is divided into two halves, known as the right and left
hemispheres. A mass of fibers called the corpus callosum links the hemispheres. The right hemisphere controls
voluntary limb movements on the left side of the body, and the left hemisphere controls voluntary limb
movements on the right side of the body. Almost every person has one dominant hemisphere. Each hemisphere
is divided into four lobes, or areas, which are interconnected.
The frontal lobes are located in the front of the brain and are responsible for voluntary movement and, via their
connections with other lobes, participate in the execution of sequential tasks; speech output; organizational
skills; and certain aspects of behavior, mood, and memory.
The parietal lobes are located behind the frontal lobes and in front of the occipital lobes. They process sensory
information such as temperature, pain, taste, and touch. In addition, the processing includes information about
numbers, attentiveness to the position of one's body parts, the space around one's body, and one's relationship to
this space.
The temporal lobes are located on each side of the brain. They process memory and auditory (hearing)
information and speech and language functions.
The occipital lobes are located at the back of the brain. They receive and process visual information.
The cortex, also called gray matter, is the most external layer of the brain and predominantly contains neuronal
bodies (the part of the neurons where the DNA-containing cell nucleus is located). The gray matter participates
actively in the storage and processing of information. An isolated clump of nerve cell bodies in the gray matter
is termed a nucleus (to be differentiated from a cell nucleus). The cells in the gray matter extend their
projections, called axons, to other areas of the brain.
Fibers that leave the cortex to conduct impulses toward other areas are termed efferent fibers, and fibers that
approach the cortex from other areas of the nervous system are termed afferent (nerves or pathways). Fibers that
go from the motor cortex to the brainstem (for example, the pons) or the spinal cord receive a name that
generally reflects the connections (that is, corticopontine tract for the former and corticospinal tract for the
latter). Axons are surrounded in their course outside the gray matter by myelin, which has a glistening whitish
appearance and thus gives rise to the term white matter.
Cortical areas receive their names according to their general function or lobe name. If in charge of motor
function, the area is called the motor cortex. If in charge of sensory function, the area is called a sensory or
somesthetic cortex. The calcarine or visual cortex is located in the occipital lobe (also termed occipital cortex)
and receives visual input. The auditory cortex, localized in the temporal lobe, processes sounds or verbal input.
Knowledge of the anatomical projection of fibers of the different tracts and the relative representation of body
regions in the cortex often enables doctors to correctly locate an injury and its relative size, sometimes with
great precision.
Base of the Brain
The base of the brain contains the cerebellum and the brainstem. These structures serve complex functions.
Below is a simplified version of these roles:
Traditionally, the cerebellum has been known to control equilibrium and coordination and contributes to the
generation of muscle tone. It has more recently become evident, however, that the cerebellum plays more
diverse roles such as participating in some types of memory and exerting a complex influence on musical and
mathematical skills.
The brainstem connects the brain with the spinal cord. It includes the midbrain, the pons, and the medulla
oblongata. It is a compact structure in which multiple pathways traverse from the brain to the spinal cord and
vice versa. For instance, nerves that arise from cranial nerve nuclei are involved with eye movements and exit
the brainstem at several levels. Damage to the brainstem can therefore affect a number of bodily functions. For
instance, if the corticospinal tract is injured, a loss of motor function (paralysis) occurs, and it may be
accompanied by other neurologic deficits, such as eye movement abnormalities, which are reflective of injury to
cranial nerves or their pathways in the brainstem.
The midbrain is located below the hypothalamus. Some cranial nerves that are also responsible for eye muscle
control exit the midbrain.
The pons serves as a bridge between the midbrain and the medulla oblongata. The pons also contains the nuclei
and fibers of nerves that serve eye muscle control, facial muscle strength, and other functions.
The medulla oblongata is the lowest part of the brainstem and is interconnected with the cervical spinal cord.
The medulla oblongata also helps control involuntary actions, including vital processes, such as heart rate,
blood pressure, and respiration, and it carries the corticospinal (that is, motor function) tract toward the spinal
cord.
Peripheral Nervous System Function
Nerve fibers that exit the brainstem and spinal cord become part of the peripheral nervous system. Cranial
nerves exit the brainstem and function as peripheral nervous system mediators of many functions, including eye
movements, facial strength and sensation, hearing, and taste.
The optic nerve is considered a cranial nerve but it is generally affected in a disease of the central nervous
system known as multiple sclerosis, and, for this and other reasons, it is thought to represent an extension of the
central nervous system apparatus that controls vision. In fact, doctors can diagnose inflammation of the head of
the optic nerve by using an ophthalmoscope, as if the person's eyes were a window into the central nervous
system.
Nerve roots leave the spinal cord to the exit point between two vertebrae and are named according to the spinal
cord segment from which they arise (a cervical eight nerve root arises from cervical spinal cord segment eight).
Nerve roots are located anterior with relation to the cord if efferent (for example, carrying input toward limbs)
or posterior if afferent (for example, to spinal cord).
Fibers that carry motor input to limbs and fibers that bring sensory information from the limbs to the spinal cord
grow together to form a mixed (motor and sensory) peripheral nerve. Some lumbar and all sacral nerve roots
take a long route downward in the spinal canal before they exit in a bundle that resembles a horse's tail, hence
its name, cauda equina.
The spinal cord is also covered, like the brain, by the pia matter and the arachnoid membranes. The
cerebrospinal fluid circulates around the pia and below the outer arachnoid, and this space is also termed the
subarachnoid space.
VIII. PATHOPHYSIOLOGY PRECIPITATING FACTORS:
 Low socio-economic status
PREDISPOSING FACTORS:  History of hypertension and stroke
 Age (35y/o) (paternal side)
 Gender (male)  Ectomorph body built
 Alcoholic drinker and cigarette smoker

increase renin-angiotensin system activity

increase NAPDH (Nicotinamide adenine dinucleotide phosphate) oxidase activity

increase transforming growth factor beta expression and activation

decrease lung epithelial barrier function

increase risk of acute lung injury

Signs and Symptoms:

•Bruises and lacerated wounds on face, head and both arms and both
feet, few minutes PTA

ALCOHOL INTOXICATION

TREATMENT: UNTREATED:
• seizures
 medical management • aspiration pneumonia
•
 nursing management •
injuries including suicide
hyponatremia
 pharmacological management • pancreatitis
 surgical management • dysrhythmia

RECOVERY DEATH
IX. DIAGNOSTIC EXAMINATIONS
Ideal
In addition to checking for visible signs and symptoms of alcohol poisoning, your doctor will likely order blood
and urine tests to check blood alcohol levels and identify other signs of alcohol toxicity, such as low blood
sugar.
Actual
-CBC, BT, head CT scan still requested

X. MANAGEMENT
NURSING MANAGEMENT
Ideal
 Carefully monitor vital signs
 Prevent breathing or choking problems with a breathing tube that opens the airways
 Give oxygen therapy
 Give intravenous (IV) fluids to prevent dehydration
 Give vitamins and glucose (sugar) to prevent complications
 Fit a catheter, which allows urine to drain into a bag, so they don’t wet themselves
 Pump the stomach (gastric lavage) to minimize the body’s absorption of already ingested alcohol
 Give activated charcoal to further minimize the body’s absorption of alcohol
Actual
 Established a good patient-nurse relationship.
 Kept clean and wrinkle-free bed.
 Regulated and monitored IVF accordingly.
 Monitored and recorded vital signs.
 Kept things within easy reach.
 Repositioned if possible.
 Assisted in doing activities such as positioning.
 Seen at times.
 Provided with 24-hour watcher.
 Due medications given.
 NPO maintained.
 Edified the significant others to help patient to modify home environment as needed to secure personal
assistance.
 Instructed not to lift heavy materials.
 Advised to do proper hygiene and grooming.
 Promoted rest and sleep to restore energy.
MEDICAL MANAGEMENT
Ideal
 Careful monitoring
 Prevention of breathing or choking problems
 Oxygen therapy
 Fluids given through a vein (intravenously) to prevent dehydration
 Use of vitamins and glucose to help prevent serious complications of alcohol poisoning
Actual
 Intravenous Fluid
 NPO
 TPRqshift
 VS
 IFC
SURGICAL MANAGEMENT
Ideal

Actual
 None
PHARMACOLOGICAL MANAGEMENT
Ideal
One specific drug that is useful in the treatment of alcohol intoxication is metadoxine, which is able to
accelerate ethanol excretion.
Benzodiazepines are the mainstay of therapy. Dosage and route depend on degree of agitation, vital signs, and
mental status. Diazepam, given 5 to 10 mg IV or po hourly until sedation occurs, is a common initial
intervention; lorazepam 1 to 2 mg IV or po is an alternative. Chlordiazepoxide 50 to 100 mg po q 4 to 6 h, then
tapered, is an older acceptable alternative for less severe cases of withdrawal. Phenobarbital may help if
benzodiazepines are ineffective, but respiratory depression is a risk with concomitant use.
Phenothiazines and haloperidol are not recommended initially because they may lower the seizure threshold.
For patients with a significant liver disorder, a short-acting benzodiazepine (lorazepam) or one metabolized by
glucuronidation (oxazepam) is preferred. (Note: Benzodiazepines may cause intoxication, physical dependence,
and withdrawal in alcoholics and therefore should not be continued after the detoxification period.
Carbamazepine 200 mg po qid may be used as an alternative and then tapered.) For severe hyperadrenergic
activity or to reduce benzodiazepine requirements, short-term therapy (12 to 48 h) with titrated beta-blockers
(eg, metoprolol 25 to 50 mg po or 5 mg IV q 4 to 6 h) and clonidine 0.1 to 0.2 mg IV q 2 to 4 h can be used.
Actual
 D50W 50mg IV now
 Paracetamol 300mg IV q4
 Ampicillin 500mg IV q6
HEALTH TEACHINGS
 Facilitated home medications.
 Told to have follow-up check-up after 1 week.
 Stressed to the patient to move himself as much as possible.
 Advised to have a physical therapy to help regain or maintain muscle strength, occupational therapy to
help relearn ways to do the tasks that he previously did and speech therapy to help if the patient if he has
problems with swallowing, speaking, or understanding words.
 Taught ways to move safely.
 Emphasized the importance of resting while recovering. Told him to get at least 7 to 9 hours of sleep
each night.
 Reinforced exercises or rehabilitation treatment plan as the healthcare provider told him to do.
 Encouraged to eat high protein to prevent pressure injuries or high fiber diet to help with bowel care.
 Encouraged to avoid alcohol intake and cigarette smoking.
UPDATES
SOURCE: www.bjsm.bmj.com
Updated on: June 28, 2019

Fomepizole (eg, 4-methylpyrizole, 4-MP, Antizol) has greater affinity for alcohol dehydrogenase than ethanol
or methanol and has a considerably better safety profile than ethanol. Fomepizole has been approved by the US
Food and Drug Administration (FDA) for ethylene glycol poisoning, but it is also useful for managing methanol
poisoning. B vitamins (ie, folic acid, pyridoxine, thiamine) may be useful in selected cases to reduce the toxicity
of alcohol metabolites.