Alcohol intoxication
Alcohol intoxication, commonly described in higher doses as drunkenness or inebriation, and known in overdose as alcohol poisoning, is the behavior and physical effects caused by recent consumption of alcohol. The technical term intoxication in common speech may suggest that a large amount of alcohol has been consumed, leading to accompanying physical symptoms and deleterious health effects. Mild intoxication is mostly referred to by slang terms such as tipsy or buzzed. In addition to the toxicity of ethanol, the main psychoactive component of alcoholic beverages, other physiological symptoms may arise from the activity of acetaldehyde, a metabolite of alcohol. These effects may not arise until hours after ingestion and may contribute to a condition colloquially known as a hangover.
Symptoms of intoxication at lower doses may include mild sedation and poor coordination. At higher doses, there may be slurred speech, trouble walking, impaired vision, mood swings and vomiting. Extreme doses may result in a respiratory depression, coma, or death. Complications may include seizures, aspiration pneumonia, low blood sugar, and injuries or self-harm such as suicide. Alcohol intoxication can lead to alcohol-related crime, with perpetrators more likely to be intoxicated than victims.
Alcohol intoxication typically begins after two or more alcoholic drinks. Alcohol has the potential for abuse. Risk factors include a social situation where heavy drinking is common and a person having an impulsive personality. Diagnosis is usually based on the history of events and physical examination. Verification of events by witnesses may be useful. Legally, alcohol intoxication is often defined as a blood alcohol concentration of greater than 5.4–17.4 mmol/L. This can be measured by blood or breath testing. Alcohol is broken down in the human body at a rate of about 3.3 mmol/L per hour, depending on an individual's metabolic rate. The DSM-5 defines alcohol intoxication as at least one of the following symptoms that developed during or close after alcohol ingestion: slurred speech, incoordination, unsteady walking/movement, nystagmus, attention or memory impairment, or near unconsciousness or coma.
Management of alcohol intoxication involves supportive care. Typically, this includes putting the person in the recovery position, keeping the person warm, and making sure breathing is sufficient. Gastric lavage and activated charcoal have not been found to be useful. Repeated assessments may be required to rule out other potential causes of a person's symptoms.
Acute intoxication has been documented throughout history, and alcohol remains one of the world's most widespread recreational drugs. Some religions, such as Islam, consider alcohol intoxication to be a sin.
Symptoms
Alcohol intoxication leads to negative health effects due to the recent drinking of large amount of ethanol. When severe it may become a medical emergency. Some effects of alcohol intoxication, such as euphoria and lowered social inhibition, are central to alcohol's desirability.As drinking increases, people become sleepy or fall into a stupor. At very high blood alcohol concentrations, for example, above 0.3%, the respiratory system becomes depressed and the person may stop breathing. Comatose patients may aspirate their vomit. CNS depression and impaired motor coordination, along with poor judgment, increase the likelihood of accidental injury occurring. It is estimated that about one-third of alcohol-related deaths are due to accidents, and another 14% are from intentional injury.
In addition to respiratory failure and accidents caused by its effects on the central nervous system, alcohol causes significant metabolic derangements. Hypoglycaemia occurs due to ethanol's inhibition of gluconeogenesis, especially in children, and may cause lactic acidosis, ketoacidosis, and acute kidney injury. Metabolic acidosis is compounded by respiratory failure. Patients may also present with hypothermia.
Pathophysiology
Alcohol is metabolized by a normal liver at the rate of about 8 grams of pure ethanol per hour. 8 grams or is one British standard unit. An "abnormal" liver with conditions such as hepatitis, cirrhosis, gall bladder disease, and cancer is likely to result in a slower rate of metabolism.Diagnosis
Alcohol intoxication is described as a mental and behavioural disorder by the International Classification of Diseases.. Definitive diagnosis relies on a blood test for alcohol, usually performed as part of a toxicology screen. Law enforcement officers in the United States and other countries often use breathalyzer units and field sobriety tests as more convenient and rapid alternatives to blood tests. There are also various models of breathalyzer units that are available for consumer use. Because these may have varying reliability and may produce different results than the tests used for law-enforcement purposes, the results from such devices should be conservatively interpreted.Many informal intoxication tests exist, which, in general, are unreliable and not recommended as deterrents to excessive intoxication or as indicators of the safety of activities such as motor vehicle driving, heavy equipment operation, machine tool use, etc.
For determining whether someone is intoxicated by alcohol by some means other than a blood-alcohol test, it is necessary to rule out other conditions such as hypoglycemia, stroke, usage of other intoxicants, mental health issues, and so on. It is best if their behavior has been observed while the subject is sober to establish a baseline. Several well-known criteria can be used to establish a probable diagnosis. For a physician in the acute-treatment setting, acute alcohol intoxication can mimic other acute neurological disorders or is frequently combined with other recreational drugs that complicate diagnosis and treatment.
Management
Acute alcohol poisoning is a medical emergency due to the risk of death from respiratory depression or aspiration of vomit if vomiting occurs while the person is unresponsive. Emergency treatment strives to stabilize and maintain an open airway and sufficient breathing while waiting for the alcohol to metabolize. This can be done by removal of any vomit or, if the person is unconscious or has impaired gag reflex, intubation of the trachea.Other measures may include
- Administer the vitamin thiamine to prevent Wernicke–Korsakoff syndrome, which can cause a seizure.
- Hemodialysis if the blood concentration is very high at >130 mmol/L
- Provide oxygen therapy as needed via nasal cannula or non-rebreather mask.
- Administration of intravenous fluids in cases involving hypoglycemia and electrolyte imbalance.
- While the medication metadoxine may speed the breakdown of alcohol, use in alcohol intoxication requires further study as of 2017. It is approved in a number of countries in Europe, as well as India and Brazil.
Clinical findings
Hospital admissions
Alcohol intoxication was found to be prevalent in clinical populations within the United States involving people treated for trauma and in the age group of people aged within their 18th–24th years. In the United States during the years 2010–2012, acute intoxication was found to be the direct cause of an average of 2,221 deaths, in the sample group of those aged within their 15th year or older. The same mortality route is thought to cause indirectly more than 30,000 deaths per year.Prognosis
A normal liver detoxifies the blood of alcohol over a period of time that depends on the initial level and the patient's overall physical condition. An abnormal liver will take longer but still succeeds, provided the alcohol does not cause liver failure.People who have drunk heavily for several days or weeks may have withdrawal symptoms after the acute intoxication has subsided.
A person consuming a dangerous amount of alcohol persistently can develop memory blackouts and idiosyncratic intoxication or pathological drunkenness symptoms. Long-term persistent consumption of excessive amounts of alcohol can cause liver damage and have other deleterious health effects.
Society and culture
Alcohol intoxication is a risk factor in some cases of catastrophic injury, in particular for unsupervised recreational activity. A study in the province of Ontario based on epidemiological data from 1986, 1989, 1992, and 1995 states that 79.2% of the 2,154 catastrophic injuries recorded for the study were preventable, of which 346 involved alcohol consumption. The activities most commonly associated with alcohol-related catastrophic injury were snowmobiling, fishing, diving, boating and canoeing, swimming, riding an all-terrain vehicle, and cycling. These events are often associated with unsupervised young males, often inexperienced in the activity, and may result in drowning. Alcohol use is also associated with unsafe sex.Legal issues
Laws on drunkenness vary. In the United States, it is a criminal offense for a person to be drunk while driving a motorized vehicle, except in Wisconsin, where it is only a fine for the first offense. It is also a criminal offense to fly an aircraft or to assemble or operate an amusement park ride while drunk. Similar laws also exist in the United Kingdom and most other countries.In some jurisdictions, it is also an offense to serve alcohol to an already-intoxicated person, and, often, alcohol can only be sold by persons qualified to serve responsibly through alcohol server training.
The blood alcohol content for legal operation of a vehicle is typically measured as a percentage of a unit volume of blood. This percentage ranges from 0.00% in Romania and the United Arab Emirates; to 0.05% in Australia, South Africa, Germany, Scotland, and New Zealand ; to 0.08% in England and Wales, the United States and Canada.
The United States Federal Aviation Administration prohibits crew members from performing their duties within eight hours of consuming an alcoholic beverage, while under the influence of alcohol, or with a BAC greater than 0.04%.
In the United States, the United Kingdom, and Australia, public intoxication is a crime.
In some countries, there are special facilities, sometimes known as "drunk tanks", for the temporary detention of persons found to be drunk.