Health Tips

Alcohol intoxication: Knowing your limits

How do you know if you need to seek medical care when you drink more than you can handle? We know that alcohol intoxication can lead to traffic accidents, domestic violence, homicide, as well as suicide but sometimes we do not consider drinking another glass that harmful. Therefore, it is important to know your limits, recognise the signs and know what to do. Alcohol intoxication is said to occur when a person has drank too much that there are behavioral and physical impairements. Alcohol intake often refers to ethanol as it is the only drinkable form of alcohol, other forms such as methanol is highly poisonous. 

So, how does alcohol causes mental and physical impairments?

Ethanol has depressive effects over the brain causing progressive mental and physical impairments as one’s alcohol level increases. The signs and symptoms of intoxication seen are:

• slurred speech

• nystagmus

• disinhibited behavior

• Incoordination

• unsteady gait

• memory impairment

• stupor

• coma. 

• Hypotension and tachycardia may occur as a result of ethanol-induced peripheral vasodilation, or secondary to volume loss

• Acute intoxication signs may be misleading therefore there is a need to rule out other potential problems. 

• Acute alcohol intoxication can also induce multiple metabolic imbalance such as hypoglycemia, hyperlactemia, hypokalemia and so forth.

However, not all mental and physical impairments mean alcohol intoxication. Alcohol intoxication as a cause of altered mental status is a diagnosis of exclusion and should be considered only after ruling out more serious conditions such as head trauma, hypoxia, hypoglycemia, hypothermia, hepatic encephalopathy, and other metabolic and physiologic derangements. Diagnosis is usually confirmed with serum ethanol concentrations, which is also used for legal and forensic investigations. 

Treatment goals:

1. Supportive care 

2. Prevent drug absorption

3. Administering antidotes

Treatment itself actually starts with recognising the signs, the severity and identify the agents (and if any other drugs are involved). Patients are then tested to determine if hypoglycemia is present and then assessed thoroughly for traumatic injuries. Patients who present with coma will be given thiamine (an antidote) to prevent or treat Wernicke’s encephalopathy along with dextrose. If patients are uncooperative, sedation is occasionally administered to prevent themselves and others from harm. 

Most people experience mild ethanol intoxication, which usually require no treatment other than observation and serial examinations until sobriety is achieved.

However, patients with moderate ethanol intoxication will have signs of dehydration where they will need fluid hydration. Moreover, they will need further investigations if they have altered mental status. Severe ethanol intoxication will need aggressive supportive care as their airway and breathing may be compromised. At this stage, they will definitely need to be admitted for further management.
 

Our take home message:

Know your drinking limit and look out for your friends and family as well. Drink responsibly.

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Reference:

1. https://www.uptodate.com/contents/ethanol-intoxication-in-adults#H12

2. https://www.emedicinehealth.com/alcohol_intoxication/article_em.htm#alcohol_intoxication_causes

Picture credit:

1. http://bestdrugrehabilitation.com/blog/information/alcohol-stages-intoxication/

2. https://coalitionrecovery.com/alcohol/

3. https://www.thehealthy.com/first-aid/what-causes-fainting/

4. https://lazypenguins.com/tips-on-how-to-enjoy-your-drink-responsibly/

Written By

Dr. Jessamine Chong Sze Lynn

Reviewed By

Doc2us Medical Board