Physical Assessment

The physical examination should pay close attention to vital signs. Elevated BP, pulse, or respiration can be a clue to the severity of alcohol withdrawal. The smell of ethanol on the breath will point to acute intoxication; the comorbid "dry mouth" may then be a local effect and not related to dehydration. Skin changes can be seen in alcoholics and may include rhinophyma, red swollen facies, and porphyria cutanea tarda. A thorough neurologic examination is in order, including cranial nerves, extraocular movements, gait, and cerebellar signs, as well as a sensory assessment of the lower extremities. Ataxia and nystagmus can be clues to possible intoxication or Wernicke's encephalopathy. Percussion and palpation of the liver are important in alcoholism. Examination of the extremities can include visualization of Dupuytren's contractures and palmar erythema. An irregular heart rhythm suggests atrial fibrillation, or "holiday heart."

In women, diagnosis of pregnancy should also be excluded (see Alcohol Use Disorder in Women). Alcoholism in pregnancy has severe perinatal effects. Cardiovascular, liver, GI, neurologic, and other sequelae of alcohol and other drugs of abuse have been reviewed (Gordis, 2003). Alcohol abuse is frequently associated with hypertension.


Evidence on the effectiveness of counseling to reduce alcohol consumption during pregnancy is limited; however, studies in the general adult population show that behavioral counseling interventions are effective among women of childbearing age. The benefits of behavioral counseling interventions to reduce alcohol misuse by adults outweigh any potential harm (USPSTF, USDHHS, 2006) (SOR: B).

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