Quick Reference
Alcohol or Drug Intoxication - Quick Reference
- This is a Quick Reference article. See also the main article Poisonings caused by inebriating substances (alcohols, drugs) Alcohol Poisoning.
Alcohol (ethanol) intoxication
- Medicinal charcoal can be given to patients with drug or polysubstance intoxication.
- In alcohol intoxication, medicinal charcoal is ineffective and gastric aspiration only effective immediately after drinking.
- Monitor the patient at an outpatient clinic, if
- the breathalyzer result exceeds 3 ‰ in a patient with a lowered level of consciousness
- speech contact is not possible
- the breathalyzer result is inconsistent with the patient's state.
- If no need for treatment or monitoring is observed, the intoxicated person can be discharged if he/she is capable of taking care of him-/herself or if someone else will take care of him/her (an accompanying person who is able to function, or monitoring at a sobering-up station).
- Hospital monitoring is warranted for children, patients who are deeply unconscious and patients with respiratory or circulatory symptoms.
- Remember to make sufficient entries in the medical record.
- Isopropanol (anti-freeze agents, carburettor cleaner, windscreen washer fluid): treatment as for ethanol intoxication
- Methanol (adulterated alcohol, windscreen washer fluid, paint strippers)
- Even small doses may be lethal.
- Symptoms may not occur until 12-24 hours after ingestion.
- In addition to normal symptoms of intoxication, dyspnoea or hyperventilation (metabolic acidosis), eye symptoms ("seeing snow", blindness, fixed, dilated pupils, papilloedema)
- Always treat at a central hospital with dialysis facilities.
- Ethylene glycol (car radiator fluids, antifreeze agents)
- Small doses may be lethal.
- Symptoms and treatment otherwise as for methanol intoxication but there are no eye symptoms
- Hyperglycaemia and renal symptoms (haematuria and proteinuria) possible
- The effects of drugs may be
- Heroin
- Risk of fatal overdose particularly after i.v. use
- Symptoms: respiratory depression followed by hypoxia, bradycardia, pinpoint pupils (but dilated in a life-threatening state)
- The antagonist is naloxone.
- Dose 0.08 mg i.v. at intervals of 15-30 seconds until spontaneous respiration is resumed (up to 2 mg), subsequently more slowly until the patient wakes up (approx. 10 min); 0.4-0.8 mg is often needed.
- Can also be given s.c. or i.m., in which case the single dose is 0.8 mg.
- Ensure patent airway if oxygenation is not rapidly restored or there is loud stertor.
- Amphetamine and other stimulants
- Cannabis
- Effects include a pleasurable feeling, increased appetite, passiveness, fits of laughter, relaxation, dry mouth, bloodshot conjunctivae. Impairs coordination and balance.
- No cases of fatal overdose are known to have occurred.
- Designer drugs
- Dozens of new designer drugs are launched every year.
- The largest groups include various amphetamine derivatives and synthetic cannabinoids.
- Most designer drugs cannot be detected by drug screens in emergency situations.
- Examples of designer drugs and their effects
- Gamma hydroxybutyrate (GHB) and its precursor gamma butyrolactone (GBL)
- Cause tiredness, an overdose may rapidly lead to coma
- Short half-life
- Effects resemble alcohol poisoning
- Mild bradycardia is a characteristic symptom
- Rarely requires intubation
- The amphetamine derivatives MDMA (ecstasy) and MDPV with effects resembling cocaine, mephedrone
- Cannabinoids: JWH, smoked and sedative like cannabis