Ethanol intoxication in adults
- Ethan Cowan, MD, MS
Ethan Cowan, MD, MS
- Associate Professor of Clinical Emergency Medicine and Clinical Epidemiology & Population Health
- Albert Einstein College of Medicine
- Mark Su, MD, MPH
Mark Su, MD, MPH
- Clinical Associate Professor of Emergency Medicine
- New York University School of Medicine
Two-thirds of American adults consume beverages containing ethanol (ethyl alcohol), and moderate ethanol intake appears to reduce the risk of myocardial infarction and other heart diseases. However, up to 10 percent of adults in the United States abuse ethanol, and worldwide acute ethanol intoxication is associated with numerous complications, including traffic accidents, domestic violence, homicide, and suicide. Death from alcohol poisoning remains a major concern . Uncomplicated ethanol intoxication is estimated to be responsible for over 600,000 emergency department visits each year in the United States alone . (See "Cardiovascular benefits and risks of moderate alcohol consumption" and "Risky drinking and alcohol use disorder: Epidemiology, pathogenesis, clinical manifestations, course, assessment, and diagnosis".)
An overview of the pathophysiology, clinical features and management of acute ethanol intoxication in adults will be presented here. The health effects of chronic alcohol abuse, the recognition and management of alcohol withdrawal, and ethanol intoxication in children are discussed separately. (See "Management of moderate and severe alcohol withdrawal syndromes" and "Ethanol intoxication in children: Epidemiology, estimation of toxicity, and toxic effects".)
According to the Department of Health and Human Services and the United States Department of Agriculture, one standard drink contains approximately 0.5 ounces of ethanol . This corresponds to 12 fluid ounces of regular beer, 5 fluid ounces of wine, or 1.5 fluid ounces of 80-proof distilled spirit. In the United States, powdered alcohol was approved by the Alcohol and Tobacco Tax and Trade Bureau in 2015 under the brand name Palcohol. These products are typically 50 percent alcohol by weight and are intended to be mixed to form a product that is 10 percent alcohol by volume . Ethanol is also found in a variety of common household products, including mouthwash, perfume, cologne, cooking extracts, and over-the-counter medications.
Ethanol (CH3CH2OH) is a water-soluble alcohol that rapidly crosses cell membranes . Absorption of ethanol occurs via the gastrointestinal system, primarily in the duodenum and remainder of the small intestine (approximately 80 percent) and stomach (approximately 20 percent) . When the stomach is empty, peak blood ethanol levels are reached between 30 and 90 minutes after ingestion. There are no data on how the absorption of powdered alcohol may differ from its liquid form, but presumably the absorption is similar.
The primary pathway of ethanol metabolism occurs in the liver via alcohol dehydrogenase . Although the majority of ethanol metabolism is hepatic, other tissues do contribute. Alcohol dehydrogenase is also located in the gastric mucosa. The enzyme is found in decreased quantities in women. Less "first-pass metabolism", combined with a smaller volume of distribution, may explain the enhanced vulnerability of women to acute complications of alcohol intoxication . (See "Pathogenesis of alcoholic liver disease", section on 'Alcohol metabolism'.)
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- CLINICAL FEATURES
- DIFFERENTIAL DIAGNOSIS: A CRITICAL CONSIDERATION
- LABORATORY EVALUATION
- Serum alcohol concentration and associated signs
- Additional studies
- Mild ethanol intoxication and ethanol clearance
- Moderate ethanol intoxication
- Severe ethanol intoxication (ethanol poisoning)
- FUTURE DIRECTIONS
- ADDITIONAL RESOURCES
- INFORMATION FOR PATIENTS
- SUMMARY AND RECOMMENDATIONS