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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

Tests

Treatment

  • 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.

Other alcohols

  • 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

Illicit drugs

  • 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