Initial Management of Mild Alcohol Intoxication
For an adult with mild alcohol intoxication, no significant past medical history, normal vital signs, and a noncontributory physical examination, supportive care with clinical observation is sufficient—no specific medications or interventions are required. 1, 2
Immediate Assessment
Assess cognitive function rather than waiting for a specific blood alcohol level to determine the patient's ability to participate in evaluation and make decisions. 1 The patient's mental status, orientation, and ability to cooperate are more clinically relevant than any numerical blood alcohol concentration. 1
Key Clinical Parameters to Evaluate:
- Vital signs: Confirm blood pressure, heart rate, respiratory rate, and temperature are within normal limits 1
- Mental status: Assess orientation, speech coherence, and ability to follow commands 1
- Airway protection: Ensure patient can protect their own airway and has intact gag reflex 2
- Gait and coordination: Observe for ataxia or falls risk 2
Supportive Care Measures
Clinical observation is the cornerstone of management for mild intoxication (blood alcohol concentration < 1 g/L). 2 No pharmacologic interventions are necessary in this population. 2
Observation Protocol:
- Monitor vital signs at regular intervals to detect any clinical deterioration 2
- Assess for development of withdrawal symptoms as blood alcohol level decreases, particularly in patients with chronic alcohol use 2
- Ensure patient safety through fall precautions and supervision 2
- Provide a quiet, low-stimulation environment to minimize agitation 2
Laboratory Testing
Routine laboratory testing is not indicated in alert, cooperative patients with normal vital signs and a noncontributory history and physical examination. 1
- Blood alcohol level measurement is unnecessary if the patient is clinically stable and cognitive function can be assessed at bedside 1
- Urine drug screening does not affect management in this population and is not routinely recommended 1
Nutritional Considerations
Administer thiamine 100 mg IV if there is any concern for chronic alcohol use or malnutrition to prevent Wernicke's encephalopathy. 3 This is a low-risk intervention with potentially significant benefit in preventing devastating neurological complications.
Disposition Planning
Most patients with mild alcohol intoxication can be managed in an observation unit with clinical courses typically completed within 24 hours and favorable outcomes without need for hospitalization. 2
Criteria for Safe Discharge:
- Patient demonstrates appropriate cognitive function and can ambulate safely 1
- Vital signs remain stable throughout observation period 2
- Patient has reliable transportation and safe environment to return to 2
Mandatory Counseling:
All patients with alcohol intoxication should be counseled to completely abstain from alcohol before discharge. 3 Consider brief alcohol intervention during the ED visit, as this has been shown to reduce future alcohol consumption. 1
Common Pitfalls to Avoid
- Do not delay psychiatric evaluation waiting for a specific blood alcohol level if the patient is alert with appropriate cognition and normal vital signs 1, 4
- Do not routinely order extensive laboratory panels in clinically stable patients, as results rarely change management 1
- Do not discharge patients prematurely before ensuring adequate cognitive recovery and safe ambulation 2
- Do not miss the opportunity for brief intervention counseling, as the ED visit represents a teachable moment for patients with alcohol use 1
When to Escalate Care
While this guidance addresses mild intoxication, be vigilant for signs requiring more intensive management: profound agitation requiring sedation, inability to protect airway, hemodynamic instability, or concern for co-ingestions. 5 These patients require a different management approach beyond simple observation.