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La Clinica Terapeutica May 2022Alcohol is a legal and yet detrimental psychoactive substance, capable of establishing addiction and impacting the physical, mental, social, and economic health of...
Alcohol is a legal and yet detrimental psychoactive substance, capable of establishing addiction and impacting the physical, mental, social, and economic health of people. Alcohol intake causes a large variety of tissue damages severely impacting the nervous system, digestive and cardiovascular systems and causing oral cavity, oropharyngeal, hypopharyngeal, esophageal, colon-rectal, laryngeal, liver and intrahepatic bile duct, and breast cancers. Alcohol can also play a role in the pathogenesis of diabetes mellitus, cardiomyopathy and hemorrhagic strokes. When drunk during pregnancy it is proved to be responsible for serious damage to fetuses causing a wide range of pathological conditions from miscarriage to Fetal Alcoholic Spectrum Disorder (FASD). Acute ethanol intoxication happens when the amount of alcohol consumed is greater than the disposal capacity of the liver, causing an accumulation of its metabolites displayed by initial dysphoria and disinhibition. Nausea, vomiting, memory loss could happen. Although, it can lead to more serious conditions like impaired speaking, impaired coordination, unstable gait, nystagmus, stupor, or coma. Respiratory depression and death could also happen in such cases. Unfortunately, diagnosis of acute alcohol intoxication is difficult because most of the drinkers deny or minimize their assumption. It is dramatically important to assess when the last intake happened to avoid withdrawal syndrome. Alcohol acute intoxication can be considered a serious harm to health and a relevant issue for healthcare provid-ers working in emergency rooms. Differential diagnosis is crucial to avoid serious outcomes. There is no consensus about therapies for acute intoxication, but supportive and symptomatic treatments were proved effective. The repercussions of alcohol misuse over drinkers' social, familiar, economical and working life enhance the importance of a multidisciplinary approach in such cases.
Topics: Acute Disease; Alcohol Drinking; Alcoholic Intoxication; Alcoholism; Ethanol; Humans; Substance Withdrawal Syndrome
PubMed: 35612344
DOI: 10.7417/CT.2022.2432 -
Handbook of Clinical Neurology 2014Alcohol intoxication refers to a clinically harmful condition induced by recent ingestion of alcohol, when alcohol and its metabolites accumulate in the blood stream... (Review)
Review
Alcohol intoxication refers to a clinically harmful condition induced by recent ingestion of alcohol, when alcohol and its metabolites accumulate in the blood stream faster than it can be metabolized by the liver. The major adverse effects of alcohol that gain clinical attention are the neurologic, gastrointestinal, and cardiovascular problems, which are usually related to blood alcohol concentration; however, the extent of acute alcohol intoxication also depends on several factors. Individuals who seek medical treatment for acute alcohol intoxication likely have additional medical problems related to chronic alcohol consumption or alcohol dependence. For this reason, additional investigations to identify potential problems needing particular attention should be considered, depending on the clinical features of the patient.
Topics: Alcoholic Intoxication; Alcoholism; Animals; Blood Alcohol Content; Ethanol; Humans; Treatment Outcome
PubMed: 25307571
DOI: 10.1016/B978-0-444-62619-6.00007-0 -
European Review For Medical and... Sep 2020Acute alcohol intoxication is actually a common admission cause in the Emergency Department and represents an increasing public health burden, in particular among... (Review)
Review
OBJECTIVE
Acute alcohol intoxication is actually a common admission cause in the Emergency Department and represents an increasing public health burden, in particular among adolescents. It involves possible and significant illness and injury, which can quickly get worse and may need to be managed in the emergency room.
MATERIALS AND METHODS
We conducted a narrative review of the literature regarding the effectiveness of first aid role of the Emergency Department setting.
RESULTS
This review included eighteen studies about alcohol intoxication management in the Emergency Department; most of all highlights the emerging phenomenon in Europe and around the world of acute alcohol intoxication management in first aid. The treatment of acute alcohol intoxication depends on general clinical conditions of the patient, vital signs, hemodynamic stability, cognitive state, alcohol-related complications, which are closely related to the blood alcohol concentration. At the same time, symptoms could be extremely variable due to individual differences in alcohol metabolism. In case of mild-moderate intoxication (blood alcohol concentration < 1 g/L), no drugs are necessary. In case of severe intoxication (blood alcohol concentration > 1 g/L), it is necessary to support with intravenous fluids, treat hypoglycemia, hypotension, hypothermia and electrolyte imbalance, administer complex B and C vitamins and accelerate alcohol elimination from blood with metadoxine. Unlike adults, adolescents are more exposed to the toxic effect of alcohol (because of their immature hepatic alcohol dehydrogenase activity), and then, acute alcohol-related complications are more frequent and dangerous in young people than in adult population. In many cases, patients affected by acute alcohol intoxication referring to an Emergency Department have mild-moderate transitory symptoms that do not require the use of drugs; they can benefit from a clinical observation, with a clinical course often completed within 24 hours with a favorable outcome. Clinical observation with vital signs control is necessary also to evaluate the possible development of the alcohol withdrawal syndrome (that involves a specific treatment) and to evaluate also possible pathological complications of the organism, above all acute liver damage.
CONCLUSIONS
Patients affected by acute alcohol intoxication are the best candidates to apply the rules of the Temporary Observation Unit in the Emergency Department, because of a clinical course often completed within 24 hours, a favorable outcome and without the need for hospitalization. In many cases, hospitalization could be not necessary, but the patient affected by Alcohol Use Disorder must be referred to an Alcohol Addiction Unit for the follow-up, to reduce the risk of alcohol relapse and complications related to alcohol abuse, and financial costs of hospitalization.
Topics: Alcoholic Intoxication; Blood Alcohol Content; Emergency Service, Hospital; First Aid; Hospitalization; Humans
PubMed: 32965003
DOI: 10.26355/eurrev_202009_22859 -
Tidsskrift For Den Norske Laegeforening... Sep 2019
Topics: Adolescent; Aftercare; Alcoholic Intoxication; Ambulatory Care Facilities; Dangerous Behavior; Humans; Substance-Related Disorders; Young Adult
PubMed: 31556530
DOI: 10.4045/tidsskr.19.0513 -
Pediatric Emergency Care Oct 2019Ethanol intoxication of infants and young children can be a challenging diagnosis in the pediatric emergency department, and features of the poisoning may differ in... (Review)
Review
Ethanol intoxication of infants and young children can be a challenging diagnosis in the pediatric emergency department, and features of the poisoning may differ in comparison with adolescents. The sources of ethanol exposures in this age are varied and include unintentional, malicious, and iatrogenic etiologies. Young children exposed to ethanol often present with mixed clinical signs and symptoms that may not fit the traditional ethanol or sedative-hypnotic toxidrome. Pediatric ethanol intoxications are often managed supportively, and recovery is usually rapid. The purpose of this review is to describe the sources of ethanol poisoning among children 6 years and younger, highlight presenting symptoms and pharmacokinetic considerations unique to this age group, and review management strategies. In addition, published cases of ethanol poisoning due to ingestion among young infants are compiled for presentation.
Topics: Alcoholic Intoxication; Child; Child, Preschool; Consciousness Disorders; Diagnosis, Differential; Eating; Emergency Service, Hospital; Ethanol; Female; Humans; Iatrogenic Disease; Infant; Infant, Newborn; Male; Poisoning
PubMed: 31593052
DOI: 10.1097/PEC.0000000000001946 -
BMJ (Clinical Research Ed.) Jan 1997
Topics: Alcoholic Intoxication; Ethanol; Humans; Methanol
PubMed: 9001463
DOI: 10.1136/bmj.314.7073.2 -
Behavioral Sciences & the Law 2011Judgments of whether a person is intoxicated by alcohol are important in a number of civil and law enforcement settings. This paper reviews how well people are able to... (Review)
Review
Judgments of whether a person is intoxicated by alcohol are important in a number of civil and law enforcement settings. This paper reviews how well people are able to make such judgments, the evidence for individual signs of intoxication, several structured rating techniques, and the use of sobriety tests. It is concluded that observers relying on common-sense clues of intoxication have limited ability to assess the blood alcohol concentration (BAC) levels of strangers, particularly below .10%. This generalization holds across professions that might be expected to show greater accuracy. Structured assessment instruments based on observable signs have shown promise but are confounded by the wide variations between casual social drinkers and those that have obtained a high level of tolerance. Among sobriety tests, only NHTSA's Standardized Field Sobriety Tests (SFSTs) have substantial, but seriously flawed, research support. Assessing the sobriety of strangers in the low to moderate BAC ranges without resort to chemical tests remains a daunting task.
Topics: Alcoholic Intoxication; Automobile Driving; Humans; Law Enforcement; Substance Abuse Detection
PubMed: 20623796
DOI: 10.1002/bsl.935 -
Emergency Medicine Clinics of North... Nov 1990Acute alcohol intoxication is a commonly encountered clinical presentation in Emergency Medicine. Its role should be considered in many Emergency Department... (Review)
Review
Acute alcohol intoxication is a commonly encountered clinical presentation in Emergency Medicine. Its role should be considered in many Emergency Department presentations, specifically in major and minor trauma, and in gastrointestinal, metabolic, neurologic, and psychiatric disorders. The differential diagnosis of change in mental status must be considered in all intoxicated patients. Management of intoxicated patients is generally supportive although complications of chronic alcoholism should be considered. Management should consist of correction of complications resultant from intoxication, as well as observation and the provision of a safe environment for the patient during the recovery phase of acute intoxication.
Topics: Aftercare; Alcoholic Intoxication; Clinical Protocols; Diagnosis, Differential; Emergency Medicine; Humans; Patient Admission; Patient Discharge
PubMed: 2171904
DOI: No ID Found -
Vnitrni Lekarstvi Apr 2008Patients with acute alcohol intoxication often present with pathological electrocardiographic (ECG) changes. The changes are more frequent and prognostically more... (Review)
Review
Patients with acute alcohol intoxication often present with pathological electrocardiographic (ECG) changes. The changes are more frequent and prognostically more significant in chronic alcoholics, in patients with ischaemic heart disease (IHD), in alcohol cardiomyopathy or another organic heart disease, but they can also occur in young and healthy individuals. The typical ECG changes in inebriety are disturbances of heart rate having the nature of electric impulse generation disorder or of impulse conduction pathology. In persons without clinical evidence of heart disease, they are classified as 'holiday heart syndrome'. The most frequent tachyarrhythmia is atrial fibrillation; less frequent but prognostically much more significant is torsades de pointes (TdP) polymorphous ventricular tachycardia. Among bradyarrhythmias, the most significant is alcohol-induced sinus bradycardia which may be manifested by recurrent syncope. The higher the blood alcohol concentration, the higher the occurrence of a significant extension of ECG intervals with possible manifestation of latent conduction disturbance or even sudden cardiac death. Apart from heart rate disturbances, ECG picture very often shows non-specific repolarisation changes. Ischaemia, which is mostly asymptomatic in the form of silent myocardial ischaemia, is worsened in alcohol-intoxicated IHD patients. The resulting ECG may be to a large extent influenced by states which often associate with inebriety, such as hypothermia, hypoglycaemia or electrolyte imbalance. ECG changes similar to those due to acute alcohol intoxication are also present in acute abstinence syndrome, especially in delirium tremens. There is convincing evidence that not only chronic alcoholism, but also single episodes of excessive alcohol consumption are associated with increased cardiovascular mortality.
Topics: Alcoholic Intoxication; Arrhythmias, Cardiac; Cardiomyopathy, Alcoholic; Electrocardiography; Humans
PubMed: 18630621
DOI: No ID Found -
Nordisk Medicin 1992Alcohol intoxication is the commonest cause of unconsciousness among patients admitted to hospital. Studies have shown that, of all acute admissions to medical wards,... (Review)
Review
Alcohol intoxication is the commonest cause of unconsciousness among patients admitted to hospital. Studies have shown that, of all acute admissions to medical wards, approximately 20 per cent are patients who are intoxicated or have alcohol-related damage. A study cited in the article showed patients in deep stupor generally to have a blood alcohol concentration above 70 mmol/l, and to be at increased risk of respiratory complications and aspiration of regurgitated stomach content. In cases of severe alcohol intoxication, treatment includes the following: freeing of the airways, perhaps combined with respiratory support; tracheobronchial lavage and aspiration, followed by antibiotic treatment; liberal parenteral thiamine administration; cramp, hypoglycaemia and muscle damage may require special measures; in the acute stage, cardiac arrhythmia usually normalizes without special antiarrhythmic treatment.
Topics: Alcohol Withdrawal Delirium; Alcoholic Intoxication; Craniocerebral Trauma; Critical Care; Crush Syndrome; Humans; Hypothermia; Pneumonia, Aspiration
PubMed: 1608747
DOI: No ID Found