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 Intoxication
Slurred 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 Withdrawal
Sweating 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
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PK of Alcohol
Absorption |
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 Intoxication
ED 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 Withdrawal
6 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 Defined
Minor Withdrawal |
Peaks at 24 to 36 hours |
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May last up to 5 days |
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Presence of 2 to 3 symptoms of withdrawal |
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Tremors, anxiety, headache, diaphoresis, palpitations, nausea |
Severe Withdrawal |
Presence of ≥ 6 symptoms |
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Alcoholic hallucinosis (visual is most common; auditory or tactile); generally resolves within 48 hours |
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Seizures (generalized, tonic-clonic; can happen within hours of last drink) |
Delirium Tremens (DTs) |
Delirium, Disorientation, agitation, mydriasis, tachycardia, HTN, Temp > 104F, diaphoresis |
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Onset: 2 to 5 days after last drink |
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Prevalence: 3 to 5% of pt's with untreated alcohol withdrawal |
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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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