Alcohol Poisoning: Causes, Symptoms and treatment

Introduction

Alcohol poisoning, also called acute alcohol intoxication, happens when too much alcohol is consumed quickly, surpassing the body’s ability to handle it.

This can lead to high blood alcohol levels that affect critical functions like breathing and the central nervous system.

In serious cases, it may result in coma or death, making it vital to identify symptoms early and seek medical help fast to avoid severe issues.

Causes

The main cause of alcohol poisoning is drinking too much alcohol in a short timeframe. Alcohol enters the bloodstream through the stomach and small intestine, and the liver breaks it down.

When alcohol is ingested quickly or in large amounts, the liver cannot process it fast enough. This causes blood alcohol concentration (BAC) to rise, impairing brain functions and vital systems.

Several factors can impact how severe alcohol poisoning is:

1. Amount of Alcohol Consumed: More alcohol consumed in a short time increases the chance of alcohol poisoning. A BAC of 0.08% is usually seen as impaired, while over 0.3% can be fatal.
2. Rate of Consumption: Drinking a lot quickly (like binge drinking) raises the risk of poisoning, as this leads to faster alcohol buildup in the bloodstream than the liver can handle.
3. Tolerance: People with higher alcohol tolerance may not feel drunk at lower alcohol levels, which can lead them to drink more and risk poisoning without realizing it.
4. Body Size and Makeup: Bigger people might process more alcohol than smaller ones, but body makeup (like fat versus muscle) also affects alcohol distribution in the body.
5. Food Intake: Drinking on an empty stomach can speed up alcohol absorption, raising blood alcohol levels rapidly.

Other causes of alcohol poisoning can involve drinking alcohol mixed with drugs or harmful substances, increasing the toxic effects of alcohol on the body.

Symptoms

Alcohol poisoning symptoms can vary based on how intoxicated someone is and how much alcohol they drank. The following are common symptoms as blood alcohol levels go up:

1. Mild to Moderate Symptoms:
   • Confusion or disorientation
   • Slurred speech
   • Poor coordination or balance
   • Vomiting
   • Strange or aggressive behavior
   • Drowsiness or sluggishness
   • Low blood sugar, causing dizziness or fainting
2. Severe Symptoms:
   • Unconsciousness or cannot be woken up
   • Slow or irregular breathing (less than 8 breaths per minute or gaps longer than 10 seconds between breaths)
   • Seizures
   • Bluish skin, especially around the lips or fingertips
   • Low body temperature
   • Low blood pressure
   • Irregular heartbeats
   • Breathing problems

In serious cases, alcohol poisoning can lead to coma, respiratory failure, and death. Fast medical help is crucial to prevent life-threatening situations.

Risk Factors

Many factors can raise the risk of alcohol poisoning, including:

1. Binge Drinking: This is defined as having five or more drinks in two hours for men (or four for women), which greatly increases the chances of alcohol poisoning.
2. Age: Young adults, especially those under 21, are more prone to binge drinking and often struggle to gauge their limits, which raises the risk of poisoning.
3. Gender: Women typically have a lower alcohol tolerance than men due to differences in body makeup, hormone levels, and enzymes. as CT or MRI scans may be needed to rule out these conditions. Women get higher risk of alcohol poisoning with less alcohol intake.
4. Chronic Alcohol Use: Even those with high alcohol tolerance may not be safe from alcohol poisoning despite consuming large amounts of alcohol. Chronic drinkers often may drink more and might end up with dangerous doses.
5. Use of Other Substances: Combining alcohol with other drugs, like prescription or recreational drugs, can heighten alcohol’s negative effects on the body and increase poisoning risks.
6. Drinking on an Empty Stomach: Consuming large amounts of alcohol quickly without food can lead to faster symptoms, including poisoning.

Differential Diagnosis

Alcohol poisoning has symptoms similar to various other conditions, which should be considered in diagnosis. These include:

• Hypoglycemia: Low blood sugar can cause confusion and dizziness, resembling alcohol poisoning. It’s vital to distinguish between these conditions, especially in diabetics or those who haven’t eaten recently.
• Drug Overdose: Some drugs like opioids and benzodiazepines can lead to confusion and unconsciousness, much like alcohol poisoning. Checking for other drugs is essential.
• Head Injury: A head injury can alter consciousness and cause confusion or vomiting, appearing similar to alcohol poisoning. Recent injuries should be taken into account.
• Hypothermia: Extreme cold can cause confusion and slurred speech. Environmental factors and the person’s body temperature are key to telling hypothermia from alcohol poisoning apart.
• Sepsis: A severe infection can lead to altered mental status and fever, which may mimic alcohol toxicity. It is key to differentiate between infection and alcohol effects, especially in at-risk individuals.
• Stroke or Seizures: Both conditions can cause confusion and unconsciousness. Neurological signs and imaging tests can differentiate them from alcohol poisoning.

Investigation

Diagnosing alcohol poisoning is mainly clinical, relying on the patient’s history and medical examination. Yet, some tests may be useful to assess severity and complications:

• Blood Alcohol Concentration (BAC): The main measure for alcohol poisoning is BAC, usually through a blood test. A BAC over 0.08% indicates intoxication, while levels above 0.3% suggest severe poisoning.
• Blood Glucose Level: Hypoglycemia can happen as a result, especially if the person hasn’t eaten. Blood sugar levels should be checked, with glucose given if needed.
• Electrolyte and Kidney Function Tests: Alcohol poisoning can cause imbalances and kidney issues. Levels of vital electrolytes and creatinine may be monitored to assist with treatment.
• Arterial Blood Gas (ABG): This test can help analyze respiratory function and detect metabolic changes due to alcohol poisoning.
• Liver Function Tests: Alcohol effects on the liver can be monitored through liver enzyme tests (AST, ALT).
• Electrocardiogram (ECG): Alcohol can cause heart rhythm issues, especially with electrolyte problems. An ECG will help check for any abnormalities.
• Imaging Studies: If there is concern for head injury, stroke, or complications, CT or MRI scans may be required to exclude these conditions. as a CT scan or MRI might be needed.

Treatment

The approach to alcohol poisoning focuses on supportive care to stabilize the patient and avoid complications. The treatment varies based on how bad the poisoning is and the patient’s health status:

1. Monitoring and Supportive Care:

• Airway Management: Patients may be unconscious or have difficulty breathing. Keeping the airway clear and providing respiratory support (like oxygen therapy or ventilation) is critical.
• IV Fluids: IV fluids are required to treat dehydration, fix electrolyte issues, and help circulation. Sometimes, glucose is given for low blood sugar.
• Monitoring Vital Signs: It’s vital to keep track of heart rate, blood pressure, breathing rate, and oxygen levels at all times. Blood alcohol levels should also be checked.

2. Gastric Decontamination:

• Activated Charcoal: If a patient has alcohol poisoning shortly after drinking, activated charcoal might be used. However, because alcohol is absorbed quickly, this approach is not commonly used.
• Nasogastric Lavage: In very serious cases, gastric lavage might be done to clear out any alcohol left in the stomach if the patient comes in within 1-2 hours after drinking.

3. Correction of Electrolyte Imbalances:

Electrolyte imbalances (like low sodium, potassium, or calcium) can be fixed with IV replacements, based on lab results. Potassium, magnesium, and calcium problems often need attention. It’s important to monitor kidney function since alcohol can cause dehydration and kidney issues, worsening imbalances.

4. Glucose Administration: For patients with low blood sugar, especially if they haven’t eaten before drinking, IV glucose may be given to avoid or treat hypoglycemia. This is important, as low blood sugar can result in seizures, coma, or increased confusion.
5. Naloxone: If there’s a chance of opioid overdose, naloxone (an opioid blocker) can be given. This is especially important in mixed substance overdoses involving opioids and alcohol.
6. Thiamine Administration: Long-term alcohol use can lead to a lack of thiamine (vitamin B1), risking Wernicke-Korsakoff syndrome, a serious brain disorder. For those suspected of chronic alcohol use, thiamine should be given to prevent related complications.
7. Intubation and Mechanical Ventilation: In serious cases where the patient is unconscious, has trouble breathing, or is not getting enough oxygen, intubation and ventilation may be essential to maintain airway safety and proper breathing support.
8. Management of Seizures: If seizures happen due to alcohol poisoning, drugs like lorazepam or diazepam might be used to control them. Seizures are more common in those with a history of chronic alcohol use and withdrawal.
9. Cardiac Monitoring and Treatment: If alcohol poisoning leads to heart issues or instability, the right antiarrhythmic medications may be given. Continuous ECG monitoring is crucial for promptly identifying and treating any arrhythmias.
10. Observation and Discharge Criteria: Patients with mild alcohol poisoning who are stable, conscious, and have normal breathing and blood pressure can be sent home once their blood alcohol level is below a certain point and they are alert. However, those with moderate to severe poisoning may need to be watched for 6 to 12 hours to check for complications. like problems with breathing or worsening health issues.

Prognosis

The outlook for alcohol poisoning varies based on how serious the intoxication is, any other medical issues, and how quickly medical help is given. Most individuals with mild to moderate alcohol poisoning who get fast and proper care usually recover well without lasting problems. However, those with severe alcohol poisoning who do not get urgent treatment might face dangerous complications like:

• Breathing failure: This happens because the central nervous system is depressed, which affects how well one breathes.
• Low body temperature: Alcohol poisoning can cause a drop in body temperature, hurting other body functions and raising the chance of heart rhythm issues.
• Heart failure: Severe alcohol poisoning can cause irregular heartbeats, leading to heart failure if not treated swiftly.
• Long-term brain damage: If there is a lack of oxygen for too long or a deficiency in thiamine, patients might experience lasting neurological issues like Wernicke-Korsakoff syndrome.
• Death: In severe cases, especially when combined with other substance use or health problems, death can happen, often due to breathing failure, heart issues, or choking on vomit.

Conclusion

Alcohol poisoning is a serious condition from too much alcohol and needs fast medical care.

Main symptoms include confusion, vomiting, seizures, slow breathing, and unconsciousness.

Care focuses on support, such as keeping the airway open, giving IV fluids, and checking vital signs, with stronger actions in critical cases.

It’s important to educate the public about binge drinking and responsible alcohol practices to prevent this. With quick treatment, mild cases usually have a good chance for recovery, but severe cases are emergencies.