Alcohol Poisoning (Acute Alcohol Intoxication)

Alcohol Poisoning (Acute Alcohol Intoxication) – Treatment Options

Introduction
Alcohol poisoning, or acute alcohol intoxication, is a potentially life-threatening condition resulting from excessive ethanol ingestion in a short time. It causes CNS depression, impaired judgment, hypoglycemia, vomiting, respiratory depression, hypothermia, and in severe cases, coma or death. Blood alcohol concentrations above 300–400 mg/dL are often associated with severe toxicity. Management focuses on stabilization, supportive care, and complication prevention, since there is no direct antidote for ethanol.

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1. Immediate Stabilization (ABCs)

• Airway: Ensure patency; intubation if GCS <8 or aspiration risk.

• Breathing: Provide supplemental oxygen; monitor for respiratory depression.

• Circulation: IV fluids for hypotension; continuous cardiac monitoring.

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2. Supportive Management

• IV fluids (normal saline): Correct dehydration and hypotension.

• Glucose supplementation:

  • IV dextrose if hypoglycemia is present or suspected.

  • Always administer thiamine (100 mg IV/IM before glucose) to prevent Wernicke’s encephalopathy.

• Temperature regulation: Warm blankets for hypothermia.

• Electrolyte monitoring: Correct hypokalemia, hypomagnesemia, or hypophosphatemia.

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3. Monitoring and Observation

• Frequent vital signs and neurologic status checks.

• Continuous monitoring of blood glucose, renal function, electrolytes, and arterial blood gases.

• Blood ethanol concentration measurement for severity assessment.

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4. Management of Complications

• Seizures: Treat with benzodiazepines (e.g., lorazepam).

• Aspiration pneumonia: Early airway protection and antibiotics if infection develops.

• Arrhythmias: Monitor ECG and correct electrolyte abnormalities.

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5. Enhanced Elimination (Rarely Required)

• Hemodialysis: Considered for extremely high ethanol levels (>500 mg/dL), severe metabolic derangements, or multi-organ failure not improving with supportive measures.

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6. Long-Term Considerations

• Referral for alcohol use disorder treatment if recurrent intoxication or dependence suspected.

• Brief interventions, counseling, and rehabilitation programs to prevent recurrence.

• Screening for liver disease, pancreatitis, and psychiatric comorbidities in chronic drinkers.