What is the treatment for a patient with severe ethanol intoxication (Blood Alcohol Concentration of 0.252)?

Treatment for Severe Ethanol Intoxication (BAC 0.252)

Benzodiazepines are the first-line treatment for severe ethanol intoxication with a BAC of 0.252, combined with supportive care to stabilize vital functions and prevent complications. 1

Initial Management

Airway and Vital Sign Stabilization

• Ensure patent airway and adequate ventilation
• Monitor vital signs closely (heart rate, blood pressure, respiratory rate, oxygen saturation)
• Establish IV access for fluid administration
• Position patient to prevent aspiration

Pharmacological Management

• Benzodiazepines: First-line treatment for moderate to severe alcohol intoxication
  • Lorazepam 2-4 mg IV for severe symptoms or seizures
  • Diazepam 5-10 mg IV for severe agitation

Fluid and Electrolyte Management

• IV fluids (normal saline) to correct dehydration and hypotension
• Monitor and correct electrolyte abnormalities, particularly potassium, magnesium, and phosphate

Specific Interventions for BAC 0.252

Consider Hemodialysis

• With a BAC of 0.252, hemodialysis should be considered, especially if:
  • Patient has respiratory depression
  • Patient remains hemodynamically unstable despite supportive care
  • Patient has significant metabolic acidosis
  • Patient has comorbidities that impair ethanol metabolism 2

Thiamine Administration

• Administer thiamine 100 mg IV before glucose to prevent Wernicke's encephalopathy 1
• Follow with glucose administration if hypoglycemia is present

Medication to Accelerate Ethanol Metabolism

• Consider metadoxine if available, which accelerates ethanol excretion 3, 4

Monitoring and Complications Management

Neurological Monitoring

• Regular assessment of consciousness level using Glasgow Coma Scale
• Monitor for signs of increased intracranial pressure
• Assess for withdrawal symptoms as BAC decreases

Seizure Management

• For alcohol withdrawal seizures, administer lorazepam 2-4 mg IV immediately 1
• Monitor for at least 6 hours after seizure resolution

Hypoglycemia Management

• Check blood glucose levels regularly
• Administer D50W if hypoglycemia is present (after thiamine)

Disposition and Follow-up

Criteria for Inpatient Admission

• BAC > 0.250
• Persistent altered mental status
• Respiratory depression
• Hemodynamic instability
• History of withdrawal seizures or delirium tremens
• Significant comorbidities

Post-Acute Management

• Screen for underlying alcohol use disorder
• Consider medications to prevent relapse (acamprosate, naltrexone, baclofen) 5, 1
• Refer to addiction services for ongoing care
• Encourage participation in mutual help groups like Alcoholics Anonymous 1

Pitfalls and Caveats

• Do not use antipsychotics as standalone treatment as they may lower the seizure threshold 1
• Do not administer glucose before thiamine in alcoholic patients
• Do not discharge patients until they are clinically sober and can safely care for themselves
• Do not use naltrexone in patients with alcoholic liver disease 5, 1
• Be aware that clinical manifestations of intoxication may not correlate perfectly with BAC, especially in chronic alcohol users who may have developed tolerance 6, 7

Remember that severe alcohol intoxication (BAC 0.252) is potentially life-threatening and requires aggressive management to prevent respiratory depression, aspiration, and cardiovascular collapse.