Alcohol poisoning can be acute or chronic, resulting from excessive alcohol intake over a short time or long-term heavy drinking combined with poor nutrition.
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Acute Alcohol Poisoning
Causes
- Deliberate consumption of large amounts of alcohol quickly
- Accidental ingestion, especially in children
Clinical Features
- Smell of alcohol on breath
- Slurred speech and uninhibited behaviour
- Altered cognition and perception
- Nausea, vomiting
- Excessive sweating, dilated pupils
- Hypoglycaemia and hypothermia
- Progression to stupor and coma with thready pulse, falling blood pressure, body temperature drop, and noisy breathing
Differential Diagnosis
Other causes of coma including malaria, intracranial infections, diabetes, head injury, stroke, poisoning by other medicines, and mental illness
Investigations
- Blood alcohol content and glucose level
- Urine tests for glucose and protein
- Lumbar puncture if needed
Management
- Airway management ensured; ventilation provided if necessary
- Hypothermia and hypovolaemia corrected if present
- Hypoglycaemia corrected with Dextrose 50% (20-50 ml IV), or via nasogastric tube (NGT) or rectal route if IV unavailable
- Infusion of Dextrose 5-10% maintained until patient wakes and can eat
- Thiamine 100 mg given IV in 1 L of Dextrose 5%
Chronic Alcohol Poisoning
Causes
- Heavy habitual drinking combined with poor nutrition
Clinical Features
- Malnutrition signs: weight loss, dry scaly skin, brittle hair, pale mucous membranes
- Cerebral damage: memory loss, hallucinations, tremors
- Liver disease: poor appetite, ascites due to cirrhosis
- Withdrawal symptoms:
- Mild: anxiety, agitation, insomnia, tremors, palpitations, sweating (12-48 hours after last drink)
- Severe: seizures, hallucinations (12-48 hours after last drink)
- Very severe (delirium tremens): hallucinations, disorientation, rapid heartbeat, high blood pressure, fever, agitation, sweating lasting up to 7 days
- Wernicke encephalopathy caused by thiamine deficiency with confusion, unstable gait, and abnormal eye movements
Management
- Withdrawal syndrome:
- Supportive care provided with IV fluids and nutrition
- Hypoglycaemia corrected with Dextrose 50% (20-50 ml IV or via NGT/rectal)
- Diazepam 5-10 mg administered every 10 minutes until sedation is achieved (respiration monitored)
- Phenobarbital 100-200 mg slow IV considered if unresponsive, with caution for respiratory depression
- Thiamine 100 mg given IV in 1 L Dextrose 5%
- Persistent delirium or hallucinations treated with haloperidol 2.5-5 mg up to 3 times daily
- Wernicke encephalopathy treated with Thiamine 100 mg IV or IM every 8 hours for 3-5 days
