Alcoholism
Ethanol-related deaths >100,000 each year; 5% of all deaths in United States. Problem drinkers: 7% of all adults, 19% of adolescents in United States addicted to ethanol or have problems when they drink.
Ethanol Intoxication
Signs of cerebral disinhibition (euphoria, jocularity, sociability) precede signs of global cerebral depression (lethargy, stupor, coma).
Alcoholic blackout: amnesia for period of intoxication, sometimes hours, although consciousness at times seemingly undisturbed.
Acute ethanol poisoning can be fatal due to respiratory depression. In stuporous alcoholic patients, consider also subdural hematoma, meningitis, hypoglycemia. Serum osmolarity may be increased (measured > calculated).
Treatment: respiratory support; correct hypovolemia, acid-base or electrolyte imbalance, hypoglycemia (give both glucose and thiamine); return temperature to normal. Avoid sedatives.
Takes 6 hours to clear mildly intoxicating alcohol level (blood ethanol concentration [BEC] of 100 mg/dL); BEC of 400 mg/dL takes 20 hours to return to zero in nonhabitual drinker. Hemodialysis or peritoneal dialysis for: BEC >600 mg/dL; severe acidosis; concurrent ingestion of methanol, ethylene glycol, or other dialyzable drugs; also for severely intoxicated children. Magnesium sulfate may further depress sensorium in intoxicated patient.
Ethanol-Drug Interactions
Combination of ethanol with other drugs, often in suicide attempts, causes 2,500 deaths annually. Alcohol particularly dangerous with: barbiturates (lowered lethal dose of either drug), morphine (increased potency when repeatedly used together), propoxyphene (death reported).
Ethanol Dependence and Withdrawal
Dependence: confirmed by signs of withdrawal during abstinence.
Early Withdrawal (Hours to Days)
Onset 0 to 48 hours. Duration to 2 weeks; usually few days.
Tremulousness: increasing severity with insomnia, easy startle, agitation, facial and conjunctival flushing, sweating, anorexia, nausea, retching, weakness, tachypnea, tachycardia, hypertension.
Perceptual disturbances: in about 25%; nightmares, illusions, hallucinations (visual, auditory, tactile, olfactory, or combination). May progress to persistent auditory hallucinosis.
Seizures: (a) ethanol can precipitate seizures in any person with epilepsy. (b) “Alcohol-related” seizures (otherwise nonepileptic person) early in withdrawal; during active drinking or after >1 week of abstinence. Focal features in 25%. Electroencephalogram abnormal in <10%.
Phenytoin does not prevent seizures during withdrawal. Status epilepticus treated as in other situations. Long-term anticonvulsants superfluous for ethanol withdrawal seizures or abstainers; drinkers do not take them.
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