ETHANOL INTOXICATION, TOXICITY, AND POISONING

Question 1

MANAGEMENT: SEVERE INTOXICATION

Answer 1

AIRWAY / BREATHING

NPO until they can tolerate PO

Intubate if GCS 8 or unable to protect airway

GABAergic agents: Propofol, Benzodiazepines

Avoid face mask or NIPPV if unable to protect airway / vomiting

DISABILITY

STAT POC Glucose

25 g D50 if hypoglycemica

Aggitation:
Midazolam 4-8 mg IV / IM / IN q 5-10 min

Lorazepam:
2-4 mg IV / IM q 15-20 min

Thiamine 500 mg IV q 8hr x 3 days

Folate 1 mg

MgSulfate 2 g

Ondansetron 4 - 8 mg PO / SL / IV

Famotidine 20-40 mg PO / IV

Pantoprazole 40 - 80 mg PO / IV

INVESTIGATION

POC Glucose

Serum Ethanol

Question 2

DOCUMENTATION

Answer 2

Ask about:
Onset of Symptoms
Ethanol ingestion time
Quantity
Consumption pattern
Co-ingestion

Collateral history

Look for Signs of Ethanol Intoxication:
Ataxia
Slurred Speech
Horizontal Nystagmus
Ethanol of Breath

Trauma Evaluation

Central Nervous System Exam

Serial Clinical Exams

Question 3

MANAGEMENT: STABLE INTOXICATION WITHOUT TRAUMA

Answer 3

POC glucose at triage

Serial clinical exam

Question 4

DDx

Answer 4

Trauma

Seizure

Encephalopathy

CVA

Sepsis

Encephalitis

Hypoxia / Hypercapnia

Acidosis

Electrolytes

Hypothyroid

Co-ingestant