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Features of Someone with Alcohol Intoxication

Discuss about the Alcohol Intoxication for Alcohol Use Disorders.

Alcohol intoxication is considered one of the AUD’s (Alcohol Use Disorders), risking the well-being of the masses on a global scale. Alcohol intoxication is commonly also known as alcohol poisoning occurs when a person happens to consume a substantial amount of alcohol in a very short period and very quickly (Liu et al., 2013). Due to the quick consumption of the alcohol and the lack of the sufficient time in metabolizing, the alcohol leads to alcohol intoxication. This state can prove to be harmful, as ethanol has been known to have damaging effects on the body when consumed in large quantity (Volkow et al., 2013). Extremely large levels of alcohol in the blood can even lead to death. The condition of alcohol intoxication has been responsible in causing the accidents and deaths due to the lack of judgement caused by the impairment of the motor co-ordination related to the central nervous system (Gross, 2013).

Alcohol poisoning is an emergency because it may result into death due to reduced respiration rate or choking over vomit. The assignment closely deals with the signs and symptoms as seen in someone with alcohol intoxication. The concerns related to the condition of alcohol intoxication have been discussed, followed by the strategies that have to be incorporated in or order to process the concerns.

A person with alcohol intoxication goes through six typical stages and the symptoms appear accordingly. The seven stages are namely,

Sub-Clinical phase, Euphoria phase, Excitement phase, Confusion phase, Stupor phase, Coma phase, Death

Sub-clinical phase is defined by a BAC (Breath Alcohol Concentration) reading of 0.01 – 0.05 (Jung & Namkoong, 2014). The effects are not visible however; an alcoholmeter will be able to detect the levels.

Euphoria phase is defined by a BAC reading of 0.03 – 0.12. The effects of alcohol toxicity is slightly visible where the functioning of the CNS (Central Nervous System) is slowly reduced resulting in reduction in attention, lack of efficiency in processing thoughts and information (Lieber, 2012). A reduced coordination in sensory and motor functioning is also observed.

Excitement phase is defined by a BAC reading of 0.09 – 0.25. In this phase, a visible lack of sensory and motor coordination is observed. Vomiting, drowsiness as well as nausea is experienced (Kissin, 2013). The speech tends to slur and a visible decrease in sensory response is observed. The peripheral vision is also affected under the influence of alcohol as seen in this stage.

Identification of the Key Concerns

Confusion phase is defined by a BAC reading of 0.18 – 0.34 (Elisaf & Kalaitzidis, 2015). As the euphoric phase veers away, the confusion sets in resulting into anxiety and restlessness. The muscle coordination fails and the person experiences lethargy. The psychological effects of the alcohol influence are more visible rather the physical. 

Stupor phase is defined by a BAC reading of 0.25 – 0.40. The muscle coordination fails further in this stage resulting in reduced response towards external stimuli (Fernandez-Sola, 2015). Incontinence in stool and urine is observed and the person goes into a state of unconsciousness under the influence of alcohol.

Coma phase is defined by a BAC reading of 0.35 – 0.50. This is an extreme phase of alcohol intoxication. The respiration rate reduces drastically in this phase and there is limited amount of oxygen in the system (Sebbane et al., 2012). The body temperature reduces in this stage as the person goes into a state of coma.

The last stage is dawns on the death of the person when the BAC reading exceeds 0.45 where the person possibly dies due to a cardiac arrest.

Several apparent symptoms and signs appear when someone is intoxicated by alcohol and they vary from individual to individual. The primary ones have been listed below:

Firstly, the patient appears to be in a state of semi-consciousness. The patient would fail to respond to any form of stimuli. Patient might respond in certain situations in the form of an incoherent mutter or a groan (Verelst et al., 2012). The patient may also appear to be in a confused state.

Secondly, the patient might even appear a little pale and in some cases, a slight bluish skin has also been observed due to the lessened rate of respiration. The skin turns bluish due to the lessened amount of oxygen (less than eight breaths in a single minute) in the blood (Harvey, Kneller & Campbell, 2013). Alcohol is known to reduce several functions of the body, especially breathing, blood pressure as well as heart rate (Langhan, 2013).

Thirdly, the most common sign of alcohol intoxication seen in a patient is the acute smell of alcohol. The patient might even vomit which is also a commonly seen effect of alcohol intoxication (Stock et al., 2016). The patient may also suffer from seizures.

Fourthly, in several instances, the patient might even develop hypothermia. It may also result into renal failure due to the inhibitory action of ethanol towards gluconeogenesis, which may further lead to lactic acidosis as well as ketoacidosis (Klein et al., 2017).

Management

On consumption of alcohol, it tends to be absorbed into the blood stream, rapidly, which is circulated evenly throughout the system. The level of alcohol in the system affects the central nervous system resulting in the restriction of the motor and sensory coordination (Harvey et al., 2013). The higher the level, the greater a threat it poses to the patient. This is the reason why that even if the patient does not die under the circumstance of alcohol intoxication, however, a risk of suffering a severe brain damage remains (Jung & Namkoong, 2014). Although a breath analyzer could be used to determine the BAC in the system, blood and urine tests must be carried out to further confirm the levels. The health personnel can use an alcoholmeter in order to confirm the condition of alcohol intoxication (Sebbane et al., 2012). It is used to determine the BAC to determine the typical stage the patient is in.

The reduced respiration rate is the primary concern in the case of alcohol intoxication. Lack of sufficient oxygen in the blood leads to reduced oxygen in the brain, which may result into coma (Langhan, 2013). Hence, oxygen help must be provided to the patient as soon as possible to facilitate breathing.

Secondly, the patient should also be treated for hypoglycaemia. It can lead to coma. The alcohol tends to remain in the blood stream for a considerably longer duration and due to its readily adsorbing ability, it takes longer to eliminate it from the tissues (Thomson et al., 2012). The alcohol prevents the liver from releasing the glucose into the circulation, which results into hypoglycaemia.  

Thirdly, a significant high blood pressure is also a key concern and must be treated with haste. A high blood pressure may lead to a stroke if not treated. Alcohol being an effective depressant affects the nervous system, reducing the functionality of the heart (Klein et al., 2017). Such a situation may result into the patient suffering a cardiac arrest.

Fourthly, the patient must lie on his side in order to prevent the inhalation of vomit or retention of vomit in the lungs. The alcohol is known to cause irritation in the lining of the stomach, which leads to vomiting (Allison et al., 2014). One of the key concerns in such a situation will be to hydrate the patient as soon as possible as well as avoid the patient to choke over the vomit. 

Before the management strategies are chalked, several immediate steps require to be employed in order to lower the risk of a possible life-threatening situation. The patient needs to be laid on his side in order to facilitate breathing as well as if the patient has vomited, to prevent the vomit to accumulate in the lungs. Accumulation of fluid into the lungs leads to reducing the ability of the lungs to inflate which facilitates the process of breathing (Verelst et al., 2012). As a result, this condition leads to a rapid lowering of the blood oxygen level.

Firstly, in order to treat the patient for the reduced respiration rate, external help such as oxygen being provided by oxygen masks or nasal cannula. This strategy will duly help the patient to breathe which will increase the oxygen concentration in the blood (Langhan, 2013). Intubation can also be used to facilitate breathing. Intubation also helps in removing any type of blockages in the windpipe. 

Secondly, the method of gastric lavage can be used in order to induce vomiting if the patient has not done that already. However, this method is restricted due to the several side effects it has and should only be administered during a life-threatening situation. Gastric lavage leads to perforation, laryngospasm, pneumonia as well as hypoxia. Therefore, other options such as intramuscular administration of apomorphine have been devised (Muller & Desel, 2013).

Thirdly, the method of hemodialysis can be used in order to rapidly remove alcohol from blood. This method is applied when the blood pressure of the patient appears to be as high as more than 400mg/dL (Husain, Ansari & Ferder, 2014). In case of metabolic acidosis, hemodialysis is an irrefutable option (White & Cosnick, 2014).

Fourthly, in order to treat the condition of low blood sugar level in the patient, a combination of dextrose solution and saline flush can be used (Allison & McCurdy, 2014). Since the alcohol induces this form of hypoglycaemia, it is unresponsive to glucagon. Dextrose being a simple sugar, it is easier for the body to break it down and utilize it for increasing the blood sugar level (Hindmarch, Land & Wright, 2012). The combination of dextrose solution and saline flush, administered through I.V., is the most effective remedy to treat the condition.

Fifthly, in order to treat the seizures, thiamine must be administered (Isenberg-Grzeda, Chabom & Nicolson 2014). This water-soluble vitamin is necessary to maintain the functionality of the heart. Alcohol intoxication leads to flushing of the thiamine from the system. Hence, it needs to be replenished to avoid developing the Wernicke-Korsakoff syndrome where the patient may suffer from impairment of the memory functions that takes place in the brain (Thomson, Guerrini & Marshall, 2012).

Sixthly, metadoxine can be provided parenterally. Metadoxine is known to aid in flushing the alcohol out of the system (Golovenko et al., 2016). It restores the proper functionality of the liver as well as that neuro-physical disorders that are acutely associated with alcohol intoxication is also relieved by Metadoxine (Karpova et al., 2016).

Seventhly, the patient may suffer from incontinence in urine and stool and in such a case, a urinary catheter can be used to prevent it.

Conclusion

A large number of people lose their lives to alcohol intoxication every year. Effective community programs need to be developed in order to keep people from binge drinking in order to avoid alcohol intoxication. The severity of the alcohol intoxication should be discussed thoroughly with the patients so that they get to comprehend the gravity of their situation.

Alcohol intoxication can prove to be life threatening if not taken care of immediately. Several vital organs of the body such as the liver, heart, brain, kidneys as well as the lungs pose a serious threat towards their functionality in the case of alcohol intoxication. Other than the harm caused to the organs, one can be injured due to accidents in the intoxicated state.

Lack of several effective therapeutic agents to treat alcohol intoxication poses a serious threat for patients.  However, several novel drugs are being devised to treat alcohol intoxication. One of them is known as Dihydromyricetin (DHM), which has been currently tested on rats (Shen et al., 2012). However, its efficiency in being able to treat alcohol intoxication makes it a contender of a potent anti-alcohol intoxication drug. The drug comprises of a flavonoid component, which has been obtained from herbal medicines and it is effective even on recipients suffering from alcohol withdrawal symptoms.

It is necessary that health care personnel must resort to immediate and effective measures to treat alcohol-intoxicated patients. The patients should also be counselled and admitted into therapy in order to avoid a similar situation in the future.

References

Allison, M. G., & McCurdy, M. T. (2014). Alcoholic metabolic emergencies. Emergency medicine clinics of North America, 32(2), 293-301.

Elisaf, M., & Kalaitzidis, R. (2015). Metabolic abnormalities in alcoholic patients: focus on acid base and electrolyte disorders. Journal of Alcoholism & Drug Dependence.

Fernández-Solà, J. (2015). Cardiovascular risks and benefits of moderate and heavy alcohol consumption. Nature Reviews Cardiology, 12(10), 576-587.

Golovenko, M. Y., Karpova, O. V., & Borisyuk, I. Y. (2016). Metadoxine regulation of elimination of ethanol and its metabolites from the rat’s body. Klìnì?na farmacìâ, 20(3), 24-28.

Gross, M. M. (2013). Alcohol Intoxication and Withdrawal-IIIb: Studies in Alcohol Dependence(Vol. 85). Springer Science & Business Media.

Harvey, A. J., Kneller, W., & Campbell, A. C. (2013). The effects of alcohol intoxication on attention and memory for visual scenes. Memory, 21(8), 969-980.

Hindmarch, P. N., Land, S., & Wright, J. (2012). Emergency physicians’ opinions on the use of intravenous fluids to treat patients intoxicated with ethanol (alcohol): attitudes of emergency medicine physicians in the North East of England toward the use of intravenous fluids to treat individuals intoxicated with ethanol (alcohol) attending the emergency department compared with the scientific evidence. European Journal of Emergency Medicine, 19(6), 379-383.

Husain, K., Ansari, R. A., & Ferder, L. (2014). Alcohol-induced hypertension: Mechanism and prevention. World journal of cardiology, 6(5), 245.

Isenberg-Grzeda, E., Chabon, B., & Nicolson, S. E. (2014). Prescribing thiamine to inpatients with alcohol use disorders: how well are we doing?. Journal of addiction medicine, 8(1), 1-5.

Jung, Y. C., & Namkoong, K. (2014). Alcohol: intoxication and poisoning, diagnosis and treatment. Handb Clin Neurol, 125, 115-21.

Karpova, O. V., Shayakhmetova, G. M., Voronina, A. K., & Golovenko, N. Y. (2016). State of biochemical system of white rat’s blood in conditions of alcoholic hepatic injury and preventive action metadoxine. Ukraïns’ kij bìofarmacevti?nij žurnal, (2 (43)), 22-26.

Kissin, B. (Ed.). (2013). The Biology of Alcoholism: Volume 1: Biochemistry. Springer Science & Business Media.

Klein, L. R., Cole, J. B., Driver, B. E., Battista, C., Jelinek, R., & Martel, M. L. (2017). Unsuspected Critical Illness Among Emergency Department Patients Presenting for Acute Alcohol Intoxication. Annals of Emergency Medicine.

Langhan, M. L. (2013). Acute alcohol intoxication in adolescents: frequency of respiratory depression. The Journal of emergency medicine, 44(6), 1063-1069.

Lieber, C. S. (2012). Medical and nutritional complications of alcoholism: mechanisms and management Springer Science & Business Media.

Liu, Y., Du, J., Yan, M., Lau, M. Y., Hu, J., Han, H., ... & Li, J. (2013). Biomimetic enzyme nanocomplexes and their use as antidotes and preventive measures for alcohol intoxication. Nature nanotechnology, 8(3), 187-192.

Müller, D., & Desel, H. (2013). Common causes of poisoning: etiology, diagnosis and treatment. Deutsches Ärzteblatt International, 110(41), 690.

Sebbane, M., Claret, P. G., Jreige, R., Dumont, R., Lefebvre, S., Rubenovitch, J., ... & de la Coussaye, J. E. (2012). Breath analyzer screening of emergency department patients suspected of alcohol intoxication. The Journal of emergency medicine, 43(4), 747-753.

Shen, Y., Lindemeyer, A. K., Gonzalez, C., Shao, X. M., Spigelman, I., Olsen, R. W., & Liang, J. (2012). Dihydromyricetin as a novel anti-alcohol intoxication medication. Journal of Neuroscience, 32(1), 390-401.

Sobell, M. (2013). Behavioral treatment of alcohol problems: Individualized therapy and controlled drinking (Vol. 563). Springer Science & Business Media.

Stock, A. K., Schulz, T., Lenhardt, M., Blaszkewicz, M., & Beste, C. (2016). High?dose alcohol intoxication differentially modulates cognitive subprocesses involved in response inhibition. Addiction biology, 21(1), 136-145.

Thomson, A. D., Guerrini, I., & Marshall, E. J. (2012). The evolution and treatment of Korsakoff's syndrome. Neuropsychology review, 22(2), 81-92.

Verelst, S., Moonen, P. J., Desruelles, D., & Gillet, J. B. (2012). Emergency department visits due to alcohol intoxication: characteristics of patients and impact on the emergency room. Alcohol and alcoholism, 47(4), 433-438.

Volkow, N. D., Kim, S. W., Wang, G. J., Alexoff, D., Logan, J., Muench, L., ... & Benveniste, H. (2013). Acute alcohol intoxication decreases glucose metabolism but increases acetate uptake in the human brain. Neuroimage, 64, 277-283.

White, S. R., & Kosnik, J. (2014). Toxic alcohols. Marx: Rosen’s Emergency Medicine: Concepts and Clinical Practice.

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