Acute Intoxication

In the nervous system, alcohol acts as a depressant, and small doses may lead to disinhibition or a slight euphoria. The toxic effects of alcohol become more prominent with rising blood levels, yet through repeated consumption, humans can become habituated rapidly. Although blood levels of 100 mg/dl typically cause drunkenness in occasional imbibers, chronic alcohol abusers can tolerate levels up to 500 mg/dl without any apparent effects. The toxic effects of alcohol can be produced in any individual who ingests sufficient quantities of the substance. The state of drunkenness or acute intoxication is recognized by slurred speech, an erratic gait, and disinhibited verbosity and behavior. The phenomenon of acute intoxication depends on the blood alcohol concentration, the rate at which it has been attained, and the time during which it has been maintained. y Pathological intoxication refers to an episode of uncharacteristic behavior during a drinking bout. This behavior may include violence and is mainly attributable to the disinhibiting effect of a heavy consumption of alcohol. This behavior typically abates as the blood alcohol level falls, but at times, the use of restraints and sedation may be necessary. Parenteral sedatives, including phenobarbital and benzodiazepines, may be used.

An alcoholic blackout refers to a period of time during acute alcoholic intoxication that a person subsequently does not recall. It is a blank space in the continuum of a person's memory and objectivity, and there are no outward signs other than those of typical drunkenness. The blackouts may be complete for the period or fragmentary, and memory may be restored during a later drinking bout. These blackout periods correlate poorly with withdrawal symptoms and are not associated with chronic memory disturbances, or the alcoholic dementia seen in some individuals. Blackout periods are associated with a high blood alcohol level and may occur in both the social and dependent drinker. Management includes supportive therapy and education.

The syndrome of drunkenness is so well recognized, even among lay people, that the main challenge for physicians is not to overlook concomitant intoxication with other drugs or other causes for ataxic gait, stupor, and coma. A blood alcohol level is the most important laboratory test to

support a diagnosis of alcohol intoxication. However, because habituated alcoholics can tolerate several times the levels of nonhabituated individuals, the test result must be interpreted in light of the person's status in this regard.

The most important therapeutic problem in the setting of acute intoxication is respiratory depression. With higher blood alcohol levels, stupor and coma can occur, yet there are no distinctive clinical characteristics of alcoholic coma. The diagnosis should be suggested by the clinical setting. Respiratory depression is an early feature, so the diagnosis must be made promptly and should be treated in an intensive care unit. Mechanical ventilatory support should be instituted when necessary, and hypovolemia, acid-base balance, electrolyte, and temperature abnormalities must be corrected. Glucose (50 ml of 5 percent solution) with 100 mg intravenous and 100 mg intramuscular should be given if hypoglycemia is suspected. Because alcohol is absorbed rapidly, gastric lavage with activated charcoal is not likely to be of value in preventing a deeper intoxication. Death has occurred with blood alcohol levels of 4000 mg/L, and a level of 5000 mg/L is lethal in 50 percent of patients. y Recovery from alcohol-induced coma with high blood alcohol levels can be hastened with hemodialysis, but this measure is rarely indicated. y Unless the patient develops fatal coma or suffers trauma as a result of incoordination, virtually all episodes of acute alcohol intoxication resolve without sequelae.

Free Yourself from Panic Attacks

Free Yourself from Panic Attacks

With all the stresses and strains of modern living, panic attacks are become a common problem for many people. Panic attacks occur when the pressure we are living under starts to creep up and overwhelm us. Often it's a result of running on the treadmill of life and forgetting to watch the signs and symptoms of the effects of excessive stress on our bodies. Thankfully panic attacks are very treatable. Often it is just a matter of learning to recognize the symptoms and learn simple but effective techniques that help you release yourself from the crippling effects a panic attack can bring.

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