ACUTE ALCOHOL POISONING

Symptoms of alcoholic poisoning following ingestion of a large amount of alcohol over a short period.

Cause

  • Deliberate consumption of excessive alcohol in a short period of time
  • Accidental ingestion (may occur in children)

Clinical features

  • Smell of alcohol in the breath
  • Slurred speech, uninhibited behaviour,
  • Altered cognition and perception
  • Nausea and vomiting
  • Excessive sweating, dilated pupils
  • Hypoglycaemia and hypothermia
  • In later stages, stupor and coma develop

As coma deepens the following appear:

  • Thready pulse and falling BP
  • Fall in body temperature
  • Noisy breathing

Differential diagnosis

Other causes of coma:

  • Malaria and other intracranial infections
  • Diabetes mellitus
  • Head injury
  • Stroke (cerebrovascular accidents)

Low blood sugar (hypoglycaemia) due to other causes

  • Poisoning by other medicines e.g. narcotics
  • Mental illness

Investigations

  • Blood: alcohol content, glucose level
  • Urine: for glucose and protein
  • Lumbar puncture

Management

  • Manage airways (ventilation may be needed)
  • Correct hypothermia and hypovolaemia if present
  • Check and correct hypoglycaemia with Dextrose
    50% 20-50 ml IV

    • Give it via NGT or rectal if IV not available
    • Maintain infusion of Dextrose 5-10% until patient wakes up and can eat
  • Thiamine IV 100 mg in 1 L of Dextrose 5%