Ethanol intoxication in adults
- Ethan Cowan, MD
Ethan Cowan, MD
- Assistant Professor
- 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. 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.
The primary pathway of ethanol metabolism occurs in the liver via alcohol dehydrogenase . Although the majority of ethanol metabolism takes place in the liver, other tissues do contribute to alcohol metabolism. Alcohol dehydrogenase is also located in the gastric mucosa, but this gastric metabolism of alcohol is decreased in women. Decreased "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'.)
- Kanny D, Brewer RD, Mesnick JB, et al. Vital signs: alcohol poisoning deaths - United States, 2010-2012. MMWR Morb Mortal Wkly Rep 2015; 63:1238.
- Pletcher MJ, Maselli J, Gonzales R. Uncomplicated alcohol intoxication in the emergency department: an analysis of the National Hospital Ambulatory Medical Care Survey. Am J Med 2004; 117:863.
- Nutrition and your health dietary guidelines for America. Home and garden bulletin, 4th ed, no. 232, US Department of Health and Human Services and the US Department of Agriculture (USDA), Washington, DC 1995.
- Vonghia L, Leggio L, Ferrulli A, et al. Acute alcohol intoxication. Eur J Intern Med 2008; 19:561.
- Norberg A, Jones AW, Hahn RG, Gabrielsson JL. Role of variability in explaining ethanol pharmacokinetics: research and forensic applications. Clin Pharmacokinet 2003; 42:1.
- Lieber CS. Metabolism of ethanol. In: Medical disorder of alcoholism, Lieber CS. (Ed), WB Saunders, Philadelphia 1982.
- Frezza M, di Padova C, Pozzato G, et al. High blood alcohol levels in women. The role of decreased gastric alcohol dehydrogenase activity and first-pass metabolism. N Engl J Med 1990; 322:95.
- Cherpitel CJ. Breath analysis and self-reports as measures of alcohol-related emergency room admissions. J Stud Alcohol 1989; 50:155.
- Naimi TS, Brewer RD, Mokdad A, et al. Binge drinking among US adults. JAMA 2003; 289:70.
- Yost DA. Acute care for alcohol intoxication. Be prepared to consider clinical dilemmas. Postgrad Med 2002; 112:14.
- Boba A. Management of acute alcoholic intoxication. Am J Emerg Med 1999; 17:431.
- Jones AW, Andersson L. Comparison of ethanol concentrations in venous blood and end-expired breath during a controlled drinking study. Forensic Sci Int 2003; 132:18.
- Currier GW, Trenton AJ, Walsh PG. Innovations: Emergency psychiatry: Relative accuracy of breath and serum alcohol readings in the psychiatric emergency service. Psychiatr Serv 2006; 57:34.
- Sullivan JB Jr, Hauptman M, Bronstein AC. Lack of observable intoxication in humans with high plasma alcohol concentrations. J Forensic Sci 1987; 32:1660.
- O'Brien MC, McCoy TP, Rhodes SD, et al. Caffeinated cocktails: energy drink consumption, high-risk drinking, and alcohol-related consequences among college students. Acad Emerg Med 2008; 15:453.
- Ferreira SE, de Mello MT, Rossi MV, Souza-Formigoni ML. Does an energy drink modify the effects of alcohol in a maximal effort test? Alcohol Clin Exp Res 2004; 28:1408.
- Howland J, Rohsenow DJ, Arnedt JT, et al. The acute effects of caffeinated versus non-caffeinated alcoholic beverage on driving performance and attention/reaction time. Addiction 2011; 106:335.
- Howland J, Rohsenow DJ. Risks of energy drinks mixed with alcohol. JAMA 2013; 309:245.
- Chase PB, Biros MH. A retrospective review of the use and safety of droperidol in a large, high-risk, inner-city emergency department patient population. Acad Emerg Med 2002; 9:1402.
- Nobay F, Simon BC, Levitt MA, Dresden GM. A prospective, double-blind, randomized trial of midazolam versus haloperidol versus lorazepam in the chemical restraint of violent and severely agitated patients. Acad Emerg Med 2004; 11:744.
- Bogusz M, Pach J, Staśko W. Comparative studies on the rate of ethanol elimination in acute poisoning and in controlled conditions. J Forensic Sci 1977; 22:446.
- Jones AW. Disappearance rate of ethanol from the blood of human subjects: implications in forensic toxicology. J Forensic Sci 1993; 38:104.
- Shpilenya LS, Muzychenko AP, Gasbarrini G, Addolorato G. Metadoxine in acute alcohol intoxication: a double-blind, randomized, placebo-controlled study. Alcohol Clin Exp Res 2002; 26:340.
- Díaz Martínez MC, Díaz Martínez A, Villamil Salcedo V, Cruz Fuentes C. Efficacy of metadoxine in the management of acute alcohol intoxication. J Int Med Res 2002; 30:44.
- 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