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25.6 Alcohol Intoxication

Table of Contents

It is a physiological state that include psychological alteration of consciousness induced by ingestion of ethanol (alcohol), methanol.

Diagnostic Criteria:

  • Nausea, vomiting, abdominal pain, euphoria, slurred speech, ataxia, altered level of consciousness, CNC depression, hypothermia, airway compromise, respiratory depression and hypotension and hypoglycaemia, hypokalaemia and metabolic acidosis and renal failure

Investigations:

  • Blood glucose
  • ECG
  • Ethanol levels

Non-Pharmacological Treatment:

  • Airway protection-intubation and ventilation
  • Insert urinary catheter
  • NGT for aspiration

Pharmacological Treatment:

D: Fomepizole

Load 15 mg/kg IV infusion over 30 min;
Then 10 mg/kg IV 12 hourly for 4 doses;
Then increase to 15mg/kg 12 hourly until Ethylene glycol or Methanol levels are <20mg/dL

A: Give Ethanol

Adults: Loading dose 600 mg/kg IV (i.e, 7.6mL/kg of 10% ethanol (EtOH) solution) or 600–700mg/kg PO/NG using a 95% solution diluted to ≤20% with water or juice

  • Maintenance dose: 155 mg/kg/hr depending on alcohol consumption status (lower for non-drinkers)
  • Oral maintenance: 0.15 mL/kg/hr (IV = 1.4 mL/kg/hr) 10% EtOH
  • Chronic alcoholics and hemodialysis patients need increased dose; increased maintenance dose of EtOH by 50%; non-alcohol users may need less.
  • Maintain serum ethanol of 100-150mg/dL [21.7-32.55 mmol/L]

Children: Oral loading dose

  • 95% EtOH: 0.8–1 mL/kg
  • 40% EtOH (80 proof undiluted liquor): 2 mL/kg
  • 43% EtOH (86 proof undiluted liquor): 1.8 mL/kg
    Maintenance dose (orally)
  • 43% EtOH: 0.1 mL/kg/hr
  • 95% EtOH: 0.1 mL/kg/hr
    IV dose (10% EtOH)
  • 10% EtOH = 7.9 g/dL
  • Loading: 8-10 mL/kg IV; not to exceed 200 mL
  • Maintenance: 0.83 mL/kg/hr IV
  • 10% EtOH = 7.9 g/dL
  • 40% EtOH (80 proof undiluted liquor) = 31.6 g/dL
  • 43% EtOH (86% proof undiluted liquor) = 34 g/dL
  • 95% EtOH (absolute alcohol) = 75 g/dL
  • Continue maintenance dose until methanol or ethylene glycol levels are below 10 mg/dL
Note:
Asses for toxic co-ingestion, aspiration pneumonia, head injury,
Children and adolescent with suicidal ideation-visit psychiatrist

The codes will be shown below

Seconds
First: 170598
Seconds
Second: 180198

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