Alcohol poisoning

Classification according to ICD-10
F10.0	Mental and behavioral disorders due to alcohol: Acute intoxication [acute intoxication]
T51	Toxic effects of alcohol
T51.0	Ethanol
ICD-10 online (WHO version 2019)

The alcohol intoxication (including alcohol intoxication or ethanol poisoning in hospital jargon because of the chemical structure of ethanol and C2 Intox ) is a poisoning of the human body by ethanol ( "ethyl alcohol") which the functioning of the brain temporarily impaired. Ethanol is one of the liver poisons ( obligatorily hepatotoxic ), impairs blood formation ( erythropoiesis- inhibiting ), damages the embryo ( embryotoxicity ) and belongs to the nerve toxins ( neurotoxicity)). Severe alcohol intoxication can therefore lead to death from respiratory failure and / or circulatory failure. Acute alcohol intoxication due to (one-time) excessive intake of ethanol (drinking alcoholic beverages) must be differentiated from chronic alcohol intoxication or alcohol sickness, which is caused by continued or repeated alcohol consumption and which results in permanent organic changes.

In addition to ethanol, poisoning with other alcohols such as methanol , ethylene glycol , isopropanol , diethylene glycol or propylene glycol are also counted as alcohol intoxications. These substances are found in industrial (e.g. car paints), medical (e.g. high doses of Lorazepam), but also in products for end customers such as antifreeze. Poisoning occurs particularly with suicidal intent or unintentional ingestion.

Stages

In acute alcohol intoxication, there are four different stages that depend on the blood alcohol concentration . (Due to individual differences in reaction to alcohol, the limits given are only rough guidelines.)

First stage

Excitation ( blood alcohol concentration between 0.2 and 2.0 per thousand):

Disinhibition symptoms (from 0.2 per mille)
Talkativeness , flippancy (from 0.2 per mille)
extended reaction time (from 0.3 per mil)
reduced pain perception (from 0.5 per thousand)
disturbed balance (from 0.8 per mille)
reddened eyes
slightly indistinct language

Second stage

Hypnosis ( blood alcohol concentration between 2.0 and 2.5 parts per thousand):

possibly aggressiveness
Speech and articulation disorders
Incoordination
Visual disturbances
Slackness (muscles)
constricted pupils
amnesia
Vomit

Third stage

Anesthesia ( blood alcohol concentration between 2.5 and 4.0 parts per thousand):

Fourth stage

Asphyxia ( blood alcohol concentration above 4.0 per mil):

coma
dilated and unresponsive pupils
State of shock → circulatory failure → death
Irregular spontaneous breathing → respiratory arrest → death
Hypothermia → death

The lethal dose of ethanol varies from person to person and depends not only on factors such as body weight and genetic disposition but also on the consumer's habit of alcohol . For example, some people die at 3 per mille, while others survive 6 per mille. Extreme cases can only survive with rapid intensive medical care (dialysis, infusions to dilute the alcohol concentration in the blood, glucose infusions ).

Chronic alcohol abuse leads (as chronic alcohol intoxication) to gastroenteritis as well as damage to the liver parenchyma and can also cause polyneuritis and neurological-psychotic conditions of Korsakoff's syndrome and delirium tremens .

Therapeutic measures

The therapeutic measures are basically dependent on the alcohol in question. In the case of ethanol, the primary aim is to maintain vital functions ( breathing , circulation ). Therefore, placement in an intensive care unit is necessary. Since there is an acute risk of shock from a blood alcohol concentration of approx. 2 per mille, the fight against shock takes a central place in therapy. A glucose solution is administered as an infusion additive in the event of impending hypoglycaemia . Because of the neurotoxicity of ethanol, vomiting often occurs (protective reflex against poisoning) and thus there is a risk of aspiration , which requires constant readiness for suction. In the event of loss of consciousness, a combined stable side and shock position is necessary.

Poisoning with other alcohols such as methanol or ethylene glycol can be recognized by medical staff using information from the anamnesis and laboratory parameters such as the osmotic gap and the anion gap . A laboratory confirmation of certain substances is usually only possible with a delay and is therefore not clinically relevant. Either the much less toxic ethanol or the drug fomepizole can be used therapeutically . Both block alcohol dehydrogenase , an enzyme that is responsible for breaking down alcohols into toxic metabolites. In severe cases, the substance itself can be removed using dialysis procedures .

literature

Jeffrey A. Kraut, Ira Kurtz: Toxic Alcohol Ingestions: Clinical Features, Diagnosis, and Management . In: Clin J Am Soc Nephrol . No. 3 , 2008, p. 208-225 ( Article Abstract ).
Jeffrey A. Kraut, Michael E. Mullins: Toxic Alcohols . In: New England Journal of Medicine . Volume 378, No. 3, pp. 270-280, doi: 10.1056 / NEJMra1615295

Web links

Wiktionary: Alcohol poisoning - explanations of meanings, word origins, synonyms, translations

Individual evidence

^ Helmut Schubothe: Poisonings. In: Ludwig Heilmeyer (ed.): Textbook of internal medicine. Springer-Verlag, Berlin / Göttingen / Heidelberg 1955; 2nd edition ibid 1961, pp. 1195-1217, here: pp. 1200 f. ( Alcohol poisoning ).
↑ Jeffrey A. Kraut, Michael E. Mullins: Toxic Alcohols . In: New England Journal of Medicine . tape 378 , no. 3 , p. 270-280 , doi : 10.1056 / NEJMra1615295 .

[1] Helmut Schubothe: Poisonings. In: Ludwig Heilmeyer (ed.): Textbook of internal medicine. Springer-Verlag, Berlin / Göttingen / Heidelberg 1955; 2nd edition ibid 1961, pp. 1195-1217, here: pp. 1200 f. ( Alcohol poisoning ).

[2] Jeffrey A. Kraut, Michael E. Mullins: Toxic Alcohols . In: New England Journal of Medicine . tape 378 , no. 3 , p. 270-280 , doi : 10.1056 / NEJMra1615295 .