Jozef De Dooy, MD, PhD

Paediatric Intensive care

Medical Aspects of Alcohol Intoxication in Young People

1. Definition, pharmacokinetics and pharmacology

Alcohol intoxication: definition

• Characterized by differences in consciousness, cognition, perception, affect, judgment, behaviour and other psychophysiological functions and responses

• Caused by acute pharmacological effects and learned responses to alcohol

• The differences resolve with time, with complete recovery, except from the tissue damage caused by the intake of alcohol

Binge Drinking

• Besides amount of alcohol intake, 3 other factors are of importance in the definition of binge drinking (Gill JS,

2002)• Gender: because of gender differences in pharmacology of

alcohol • Duration of consumption• Drinking frequency

=> NO “GENERAL” DEFINTION!

Gender differences in alcohol pharmacology

• Pharmacology in women:• Smaller first pass metabolism in the stomach• Higher alcohol elimination: oxidation in the liver• Slower gastric emptying• Smaller body distribution

=> Net effect: higher blood alcohol concentrations persist longer in women

Absorption and Elimination

• Absorption• Fast• Highest level serum: < 60 min when empty stomach• Ethanol : spasme of the pylorus

• Elimination• Constant• Independent of peak-level• Non-drinkers: drops 10 -25 mg/dl/h

(2.2 to 5.6 mmol/l/uur)• Chronic drinkers : drops 30 mg/dl/h

(6.7 mmol/l / uur)

Accumulation = toxic

2. Clinical presentation and diagnosis

Clinical presentation is influenced by:

• Quantity• Weight• Tolerance (age, gender)• % alcohol• Time of ingestion

Vonghia et al, 2008

Symptoms

• Metabolic• Hypoglycemia• Elektrolyte disturbances

• Cardiovascular• Tachycardia• Hypovolemic, VD• Hypothermia• Hypotension

• Cerebral embolism and AMI• Fibrinolysis• Clotting• Coronary spasms

Symptoms

• Respiratory• DEPRESSION OF RESPIRATION• Clearance mucus• Risk for aspiration

• Gastro-intestinal• Nausea, vomiting, diarrhea, gastritis, pancreatitis• Alcoholic hepatitis

Diagnosis

• Clinical signs• Blood

• alcohol

• others?

• Routine lab

• On indication• RX, ECG, CT

• Arterial blood gasses

• …

Alcohol % Severity

< 1.5 ‰ Mild

1.5-2.5 ‰ Moderate

> 2.5 ‰ Severe

3. Treatment

APLS/EPLS guidelines

• Airway and breathing• Airway assesment• Observation of respiratory function• Prevention of aspiration• Mechanical ventilation, if necessary

• Circulation• IV access• IV solution administration

• Correction hypoglycemia

• Corretion elektrolyte imbalances

• Thiamine! (multivitamins)

Further treatment

• Disability• Level of consciousness• Sedation if necessary

• Acceleration of elimination• metadoxine

• Watch out!• Trauma• Hypothermia• Hypoglycemia

4. Conclusion