Review article
Acute alcohol intoxication

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Abstract

Acute alcohol intoxication is a clinically harmful condition that usually follows the ingestion of a large amount of alcohol. Clinical manifestations are heterogeneous and involve different organs and apparatuses, with behavioral, cardiac, gastrointestinal, pulmonary, neurological, and metabolic effects. The management of an intoxicated patient occurs mainly in the emergency department and is aimed at stabilizing the clinical condition of the patient, depending on his/her clinical presentation. One specific drug that is useful in the treatment of acute alcohol intoxication is metadoxine, which is able to accelerate ethanol excretion. In patients presenting an acute alcohol intoxication, alcohol-related disorders should be detected so that the patient can be directed to an alcohol treatment unit, where a personalized, specific treatment can be established.

Introduction

Ethanol (CH3CH2OH) is a water-soluble compound that rapidly crosses cell membranes, resulting in ready equilibration between intra- and extra-cellular concentrations [1]. Its absorption occurs mainly in the proximal intestinal tract, namely, in the stomach (70%) and in the duodenum (25%), while only a small percentage occurs in the remaining intestinal tracts [1]. Gastric alcohol dehydrogenase (ADH) is responsible for 10% of alcohol metabolism (so called “first pass metabolism”) and has important gender-related differences [2]. The remaining 90% of ingested ethanol is metabolized in acetaldehyde along three liver enzymatic pathways in different percentages: (1) liver ADH (90%), (2) microsomal ethanol oxidizing system (MEOS; 8–10%), and (3) catalase (0–2%) [3].

Alcohol is a substance that is widely used, mostly in western countries. It also represents the oldest and the most diffuse substance of abuse. In the United States, 20–40% of the subjects admitted to hospitals have alcohol-related problems [4] and, in elderly people, alcohol-related disorders are as common a reason for hospitalization as myocardial infarctions [5].

In Italy, some four million individuals are reported to have alcohol-related disorders; of them, approximately one million satisfy the Diagnostic and Statistical Manual of Mental Disorders IV edition criteria [6] for alcohol dependence [7]. The social cost of alcohol-related disorders – including alcohol-related mortality, morbidity, loss of productivity, absenteeism, and hospitalization – is estimated to be around 5–6% of the gross national product (GNP) of Italy [8]. Similarly, in the rest of Europe, the full economic cost of alcohol abuse is calculated to be around 2–5% of the GNP (corresponding to €26–66 billion in the year 2003) [8].

Of the many alcohol-related disorders present in subjects referred to emergency care departments, acute alcohol intoxication is the most frequent [9]. This condition is present not only in adults but also in adolescents. Among the teenaged population evaluated in a recent Australian study, 29% of the subjects reported drinking to the point of intoxication [10]. It is a matter of great concern that data from the United States suggest that children of an increasingly younger age are using alcohol and that up to 32% of adolescents have difficulties with alcohol intoxication/self-poisoning or dependence [11]. In the European School Survey Project on Alcohol and Other Drugs, 7% of all males between 15 and 16 years of age and 2% of all females interviewed reported ten or more episodes of drunkenness in the previous year. Moreover, the percentage of subjects reporting three or more episodes of alcohol intoxication in the previous month increased from 3% in 1999 to 7% in 2003 [12].

The aim of the present paper is to focus attention on the main clinical aspects of acute alcohol intoxication and its pharmacological management, taking into account that this disorder is common, potentially life-threatening, and linked to other harmful conditions, such as trauma and chronic alcohol use disorders.

Section snippets

Clinical features

Acute alcohol intoxication is a clinically harmful condition that usually follows the ingestion of a large amount of alcohol. In the pediatric population, it may the result of the ingestion of household products that contain alcohol, such as colognes, mouthwash, after shave, hair tonics, medication, and solvents.

The Diagnostic and Statistical Manual of Mental Disorders IV edition criteria [6] for acute alcohol intoxication include: (a) recent alcohol ingestion; (b) clinically significant

Acute alcohol intoxication or chronic alcohol abuse?

All patients admitted to an emergency department for acute alcohol intoxication should be examined for chronic alcohol abuse and/or dependence [6]. At an initial screening, both the daily consumption and the weekly frequency of drinking should be recorded, and one or more tests, such as the AUDIT or AUDIT-C [66], [67] and/or the CAGE [68], should be administered. A positive result on either of these tests indicates the probable presence of an alcohol-related disorder and calls for further

Conclusions

Acute alcohol intoxication is a clinically harmful condition that usually follows the ingestion of a large amount of alcohol. It can manifest itself clinically in various ways and have behavioral, cardiac, gastrointestinal, pulmonary, neurological, and metabolic effects. The management of acute alcohol intoxication is aimed primarily at stabilizing the patient's clinical condition, hastening the elimination of alcohol, and defining and treating all of the abovementioned clinical alterations.

Learning points

  • Acute alcohol intoxication is a clinically harmful condition that usually follows the ingestion of a large amount of alcohol.

  • Clinical manifestations involve different organs and apparatuses. Behavioral, cardiac, gastrointestinal, pulmonary, neurological, and metabolic manifestations can occur.

  • The management of an intoxicated patient occurs mainly in the emergency department and is aimed at stabilizing the clinical condition of the patient, depending on his/her clinical presentation.

  • Metadoxine

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    Alcoholism Treatment Study Group: L. Abenavoli M.D., C. D'Angelo M.D., S. Cardone M.D., A. Mirijello M.D, V. Leso M.D., S. Piano M.D., A. Nesci M.D.; Institute of Internal Medicine, Catholic University of Rome; Italy. E. Capristo M.D., N. Malandrino M.D.; Metabolic Unit, Institute of Internal Medicine, Catholic University of Rome; Italy. F. Caputo M.D., S. Francini M.D., M. Stoppo, T. Vignoli M.D., M. Bernardi M.D.; “G. Fontana” Centre for the Study and Multidisciplinary Treatment of Alcohol Addiction, Institute of Internal Medicine, Cardioangiology and Epatology, University of Bologna; Italy.

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