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INTOXICATION
Consider acute alcohol intoxication in any patient presenting with:
-coma
-syncope
-any inappropriate behavior
-any neurological abnormality
-trauma
-traffic accident
-hypothermia
Inappropriate Behavior; in coordination, confusion, slurred speech, aggressive,
inappropriately sensitive behavior etc
Neurological Abnormality; e.g. ataxia, nystagmus, divergent bulbae etc.
Reliable history gives more helpful information in contrast to physical examination which
is less sensitive and specific.
MANAGEMENT
Assess vital functions
-Airway
-Breathing
-Circulation
Assess level of consciousness
Assess and treat for complications of alcohol
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CIRCULATION
Weak pulse
Measure blood pressure
If systolic <90mmHg
- Give saline 0.9% 500ml by rapid I/V infusion; repeat as needed
Evaluate for bleeding; aspirate stomach fluid via nasogastric cannula and consider
endoscopy
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Aggressive patients
-try to listen, talk
-Haloperidol 10mg PO,I/V,I/M,S/C
-physical restraints are only a last resort
LABORATORY INVESTIGATIONS
BLOOD TESTS
Peripheral Blood Cell Count
-initially concentration of Hemoglobin and RBCs will be unchanged
-with bleeding, plasma and blood cells are lost
-ultimately leads to decrease in Hemoglobin and RBC concentration
Blood Ethanol levels
-poorly correlate with intoxication due to tolerance
Osmolal Gap
Anion Gap
Potassium levels
Arterial Blood Gas Analysis
BREATH TESTS
Roadside breath test
Calibrated breathalyzer
URINE
VITREOUS HUMOUR
Only taken postmortem and is most useful when blood not available or unsuitable for
analysis
GENERAL FEATURES
-Signs of general neglect and malnutrition or obese and even edematous due
to chronic heart failure
INTERNAL FEATURES
-LIVER DAMAGE
In early stages, there will be fatty change and enlargement with increase in
weight up to 2000g.
Surface will be pale and greasy.
Patchy yellowish area may be visible within normal hepatic
parenchyma.
If abuse continues, fatty change may give way to fibrosis.
Cirrhosis of liver with nodules of 5-10 cm in diameter.
In late stage, liver becomes smaller and contracts to a hard, grayish yellow
block of only 800-1200g.
-CARDIAC DAMAGE
Heart is enlarged and shows patchy fibrosis with mixed cellular infiltrate,
hypertrophy of muscle fibers, patchy necrosis, hyalinization, edema and vacuolization,
nuclear enlargement and polymorphism.
Specific myocardium damage cause by cobalt added to commercial beers.
-SPLEEN
May be enlarged and firm, portal varices may be present at the gastroesophageal junction
-OTHER FINDINGS
Systemic fat embolism
Micro infarcts in brain and myocardium
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