MOA of Alcohol• Multiple; Not well understood
• GABA receptor agonist
• NMDA (glutamate) receptor antagonist
• Believed to have either a direct or indirect effect on the mu-opioid receptor (associated with alcohol cravings and euphoria; reward pathway) |
• GABA is an inhibitor NT
• Glutamate is an excitatory NT Alcohol | Signs and Symptoms of IntoxicationSlurred speech | Loss of coordination | Unsteady gait (staggering) | Nystagmus (rapid, involuntary eye movement) | Impaired memory or attention | Stupor or coma |
Can be mistaken for sedative intoxication ⇨ If the patient is conscious, ask them what they took Signs & Symptoms of Alcohol WithdrawalSweating or HR > 100 BPM | ⬆ hand tremor | Insomnia | Nausea ± Vomiting | Transient visual, tactile, or auditory hallucinations | Psychomotor agitation | Anxiety | Tonic-Clonic Seizures |
Tonic-Clonic Seizure: a seizure that involves a loss of consciousness and violent muscle contractions | | PK of AlcoholAbsorption | Small intestine | | | Delayed gastric emptying and/or presence of food delays absorption | Metabolism | Zero-Order | | | Metabolized by alcohol dehydrogenase | Elimination | Mostly into CO2 and water |
Treatment of Alcohol IntoxicationED visit, hospitalization, ICU admissions | Supportive care based on symptoms and BAC | ABC's [Airway, Breathing, Circulation] | Manage nausea and vomiting | Prevent aspiration | Replace fluids (ie banana bags) |
Banana bags: Thiamine 100 mg, Folic Acid 1 mg, Multivitamin, ± magnesium Clinical Presentation of Alcohol Withdrawal6 to 12 hours | Minor Withdrawal | 12 to 24 hours | Alcohol Hallucinosis | 24 to 48 hours | Withdrawal Seizures | 72 to 96 hours | Delirium Tremens (DT) |
• Onset is measured based on the time of the patient's last drink
• Could be sooner in more severe cases Alcohol Withdrawal Presentations DefinedMinor Withdrawal | Peaks at 24 to 36 hours | | | May last up to 5 days | | | Presence of 2 to 3 symptoms of withdrawal | | | Tremors, anxiety, headache, diaphoresis, palpitations, nausea | Severe Withdrawal | Presence of ≥ 6 symptoms | | | Alcoholic hallucinosis (visual is most common; auditory or tactile); generally resolves within 48 hours | | | Seizures (generalized, tonic-clonic; can happen within hours of last drink) | Delirium Tremens (DTs) | Delirium, Disorientation, agitation, mydriasis, tachycardia, HTN, Temp > 104F, diaphoresis | | | Onset: 2 to 5 days after last drink | | | Prevalence: 3 to 5% of pt's with untreated alcohol withdrawal | | | Mortality rate: 5 to 15% |
Risk Factors of Withdrawal
• Environmental: increased frequency of quantity of consumption, prior withdrawals, concomitant sedative, hypnotic, or anxiolytic drugs
• Genetic: family history of withdrawal |
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