DESCRIPTION

• Acute ingestion (accidental or intended) of alcohol depresses the central nervous system and results in loss of inhibition, impaired judgment and/or coordination, diminished alertness/responsiveness, and sedation or coma.
• Accidental ingestion is more common in toddlers and younger children.
• Frequency of intentional alcohol use increases with age.
• Alcohol–drug interactions are common because acute intoxication reduces hepatic clearance for other drugs, thereby increasing their serum concentrations.
• Signs and symptoms of intoxication vary depending on the type and quantity of alcohol, the rate of consumption, and the patient’s pattern of prior use of alcohol.

EPIDEMIOLOGY

Alcohol is the most used substance in the United States and is common among young people, although overall the prevalence of alcohol use has declined over the past decade.

• Approximately 15% of high school students in the United States had their first drink of alcohol before the age of 13 years; these adolescents are 9 times more likely to engage in problem drinking than youth who initiate at later ages.
• Among adolescents aged 12 to 17 years, 8.2% report alcohol use within the past month, and 2.8% meet the criteria for an alcohol use disorder.
• Among college students, 57% of females and 54% of males report drinking within the past 3 months.
• White non-Hispanic youth have the highest rates of alcohol use among high school students (34.2%), followed by non-Hispanic American Indian/Alaskan Native (32.6%), Hispanic (28.4%), multiracial (26.0%), Black (16.8%), and Asian (13.9%) youth.
• White non-Hispanic youth have the highest rates of binge drinking (17.3%), followed by Hispanic (12.4%) and non-Hispanic Black youth (6.2%).
• 16.7% of high school students have ridden in a car driven by someone who had been drinking alcohol; 5.4% had driven a car when they had been drinking.
• 32% of young adults have mixed energy drinks with alcohol, a practice that can mask the effects of alcohol and lead to higher rates of injuries.
• Household products (medicinal, cosmetic, cleaning, hygiene) can contain up to 100% ethanol; rates of accidental exposure to and intentional intoxication from hand sanitizers are increasing.

ETIOLOGY

• Alcohol is produced from fermentation/distillation of sugar from grapes (wine), grains/corn (beer/whiskey), potatoes (vodka), or sugar cane (rum) and then mixed into solution to make specific beverages.
  • Products are marketed according to alcohol content or proof (twice the percent).
  • Alcohol content ranges from 3–6% (6 to 12 proof) in beer to 40–75% (80 to 150 proof) in vodka/rum/whiskey.
  • A standard drink contains 14 g of ethanol, which equates to 12 oz of beer, 5 oz of wine, or 1.5 oz of hard alcohol.
• Alcohol is often consumed concurrently with other substances (licit and illicit), presenting a mixed clinical picture of intoxication.

RISK FACTORS

Youth with the following genetic and environmental risk factors are at a higher risk for early initiation of use and problematic alcohol use:

• Comorbid psychiatric conditions
• Family history of alcohol use and alcohol use disorder
• Permissive parental attitudes about youth alcohol use
• Greater exposure to media and advertising regarding alcohol

GENERAL PREVENTION

• Promote family discussions about alcohol use and abuse.
• Provide safety recommendations to prevent accidental ingestions.

PATHOPHYSIOLOGY

• Effects of alcohol ingestion are related to dose, the time in which alcohol was consumed and then absorbed, and the patient’s history of alcohol exposure; peak serum concentrations occur 30 to 60 minutes after ingestion.
• Alcohol absorption, decreased by the presence of food in the stomach and increased if liquid is carbonated, occurs rapidly and largely in the small intestine.
  • Minimal quantities of alcohol are excreted in urine, sweat, and breath.
  • >90% of alcohol oxidized in liver follow zero-order kinetics, primarily by alcohol dehydrogenase (ADH) and then acetaldehyde dehydrogenase (ALDH).
  • Rate of metabolism is fixed (not related to dose or time) and is proportional to body weight.
  • Ethnic/racial and gender variabilities exist on quantity and efficacy of ADH.
  • Ethanol is metabolized by ADH to acetaldehyde, then to acetate, and finally to ketones, fatty acids, or acetone; ketosis and, infrequently, metabolic acidosis can occur.
• Respiratory acidosis can occur secondary to carbon dioxide retention from respiratory depression due to ethanol intoxication.
• Hypoglycemia occurs during acute ethanol intoxication due to impaired gluconeogenesis resulting from changes in the oxidized and reduced forms of nicotinamide adenine dinucleotide (NADH/NAD+) ratio associated with ethanol metabolism.
• Alcohol affects the CNS primarily through the γ-aminobutyric acid (GABA) and glutamate neurotransmitter systems.

COMMONLY ASSOCIATED CONDITIONS

• Alcohol is involved in 30% of all drug overdoses.
• A significant percentage of adolescent trauma patients, especially victims of gunshot wounds, have positive toxicology screens for alcohol and other drugs. Ethanol use increases trauma risk by 3- to 7-fold.
• A blood alcohol concentration (BAC) of 50 mg/dL doubles the risk of involvement in a motor vehicle crash.
• Alcohol is involved in 3,500 deaths annually among adolescents and young adults aged <21 years.
• Among high school students, 21% report having used alcohol or drugs before their last sexual intercourse.
• Among college students, alcohol use is highly associated with intimate partner violence, sexual assault, and unprotected sex.