Alcohol (Ethanol) Intoxication

Basics

Description

  • Acute ingestion (accidental or intended) of alcohol, resulting in loss of inhibition, often associated with unruly/violent behavior, 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 drug by young people: 30% of 8th graders, 69% of 12th graders, and 81% of college students have consumed alcohol.

Prevalence

  • 71% of high school students have consumed alcohol in their lifetime.
    • 21% had their first drink before age 13 years.
    • 39% had one drink in past 30 days.
    • 54% of 12th graders and 13% of 8th graders have been drunk at least once.
  • Underage (12 to 20 years old) drinkers are 3 times more likely than adults to use illicit drugs with alcohol.
  • >90% of alcohol is consumed through binge drinking (>5 drinks for males or >4 drinks for females); prevalence of binge alcohol use in past 2 weeks in 2012 was 5% of 8th graders, 16% of 10th graders, 24% of 12th graders, 37% of college students, and 36% of young adults.
  • Among college students, 20% of males and 8% of females report having consumed double the binge threshold (>10 drinks for males and >8 for females).
  • 24% of high school students have ridden in a car driven by someone who had been drinking alcohol; 8% had driven a car when they had been drinking.
  • 56% of college students mixed energy drinks with alcohol in the past month.
  • 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.

Risk Factors

Patients with psychiatric conditions are at an increased risk for abuse of alcohol and other drugs.

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 NADH/NAD+ ratio associated with ethanol metabolism.
  • Alcohol affects the CNS primarily through the γ-aminobutyric acid (GABA) and glutamate neurotransmitter systems.

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.
  • Alcohol is often consumed concurrently with other substances (licit and illicit), presenting a mixed clinical picture of intoxication.

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.
  • Among college students, alcohol use is highly associated with intimate partner violence and sexual assault.

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