I. Clinical manifestations

  1. Depend on body weight, tolerance, and amount and time period of alcohol ingestion; full absorption may not occur until 6h after ingestion.
  2. Osmolal gap (measured serum osmolarity - calculated serum osmolality) increases by 22 mOsm/L for each 100mg/dL increase in blood alcohol concentration
  3. Most adults metabolize EtOH at 13-25 mg/dL/h
  4. Decreased fine motor function
  5. Impairment in judgment and physical coordination (including balance)
  6. Decreased level of consciousness, up to coma
  7. Nausea and vomiting
  8. Diplopia
  9. Can present with hypovolemia (from diuresis and vomiting)
  10. Leukocytosis (from "stress"?)
  11. Thombocytopenia
  12. Electrolyte abnormalities including hyponatremia, hypokalemia, hypomagnesemia, and hypophosphatemia
  13. Hypoglycemia (due to impaired gluconeogenesis)
  14. Aspiration (due to inhibited airways reflexes)
  15. Respiratory depression and/or arrest
  16. Hypothermia
  17. Cardiac arrhythmias and/or arrest

II.Workup and management

  1. Serial blood alcohol concentration measurements
  2. Complete blood count
  3. Metabolic panel
  4. PT/PTT
  5. ABs
  6. Tox screen for other drugs
  7. Gastric lavage (only if ingestion was < 60min prior)
  8. IV fluids (if evidence of hypovolemia is present)
  9. Note that activated charcoal is ineffective.
  10. Thiamine if chronic alcohol dependence is suspected (give priori to correcting hypoglycemie to prevent Wernicke-Korsakoff syndrome)
  11. Metadoxine-May help to speed metabolism of alcohol

(Sources include Core Content Review of Family Medicine, 2012)