From the Guidelines
Alcohol intoxication symptoms include a range of physical and cognitive impairments, and the most effective management approach is supportive care, ensuring airway protection, and monitoring vital signs, with benzodiazepines being the gold standard treatment for alcohol withdrawal syndrome (AWS) 1.
Symptoms of Alcohol Intoxication
Alcohol intoxication symptoms can vary widely but typically include:
- Slurred speech
- Impaired coordination
- Unsteady gait
- Nystagmus (involuntary eye movements)
- Impaired attention
- Poor judgment
- Mood changes like euphoria or aggression Physical symptoms may include:
- Flushed face
- Nausea
- Vomiting
- In severe cases, respiratory depression These symptoms occur because alcohol is a central nervous system depressant that enhances inhibitory neurotransmission through GABA receptors while inhibiting excitatory glutamate transmission.
Management of Alcohol Withdrawal Syndrome
The management of AWS is critical to prevent severe complications such as delirium tremens, seizures, coma, cardiac arrest, and death.
- Benzodiazepines are considered the gold standard treatment for AWS due to their efficacy in reducing both withdrawal symptoms and the risk of seizures and/or delirium tremens 1.
- Long-acting benzodiazepines (e.g., diazepam, chlordiazepoxide) provide more protection against seizures and delirium but may not be suitable for all patients, especially the elderly and those with hepatic dysfunction.
- Short and intermediate-acting benzodiazepines (e.g., lorazepam, oxazepam) are safer in these patient groups.
- Other medications like baclofen and sodium oxybate are being evaluated for their efficacy in treating AWS and alcohol use disorder (AUD) but are not yet considered first-line treatments.
Treatment Approach
The treatment approach for alcohol intoxication and AWS should prioritize supportive care, ensuring the patient's safety and comfort.
- Monitoring vital signs is crucial, especially in severe cases.
- Thiamine supplementation is recommended for all patients with AWS to prevent diminished cognitive function due to thiamine deficiency 1.
- The Clinical Institute Withdrawal Assessment for Alcohol (CIWA-Ar) can be useful in assessing the severity of AWS, guiding treatment decisions, and facilitating communication between healthcare providers 1.
From the Research
Symptoms of Alcohol Intoxication
- Nausea and vomiting 2
- Memory loss 2
- Impaired speaking and coordination 2
- Unstable gait 2
- Nystagmus (involuntary eye movements) 2, 3
- Stupor or coma 2
- Respiratory depression 2, 4
- Dysphoria and disinhibition 2
- Double vision, dysarthria, and ataxia 3
Serious Health Consequences
- Alcohol intoxication can lead to serious health consequences, including respiratory depression and death 2, 4
- It can also cause delayed stroke treatment, as the symptoms of alcohol intoxication can mimic those of vertebrobasilar stroke 3
- Acute alcohol intoxication can cause hypoventilation, which is common among adolescents and young adults 4
Diagnosis and Treatment
- Diagnosis of acute alcohol intoxication can be difficult, as most drinkers deny or minimize their alcohol consumption 2
- Quantitative ethanol measurement can rapidly confirm the diagnosis or prompt further evaluation 5
- Supportive and symptomatic treatments have been proven effective in treating acute alcohol intoxication 2
- Capnography should be considered as an additional monitoring device to detect hypoventilation and enhance patient safety 4