What is Ethanol Toxicity?
Ethanol toxicity, or alcohol poisoning, happens when a person consumes too much ethanol. This substance is commonly found in several products, like alcoholic beverages, mouthwash, cologne, and cough medicine. The most typical source of ethanol is alcohol, which is both widely consumed and misused, particularly in Western societies, making it the oldest and most commonly abused substance.
The people most likely to be treated for severe alcohol intoxication, or alcohol poisoning, are teenagers and young adults. Emergency rooms tend to see more cases of this than other medical facilities.
What Causes Ethanol Toxicity?
Ethanol toxicity, or alcohol poisoning, can happen both in short-term and long-term situations, each showing different types of health problems. Acute ethanol intoxication, also known as alcohol poisoning, typically happens after drinking a lot of alcohol at once and it can be dangerous to your health.
Risk Factors and Frequency for Ethanol Toxicity
Alcohol affects all demographic groups, but teenagers and young adults commonly experience intoxication and toxicity from its use. They also have a higher likelihood to sustain injuries from accidents while under the influence of alcohol. Annually, around 3.3 million deaths worldwide are linked to alcohol, making it a leading preventable cause of death in the United States. In fact, one in twelve adults struggles with alcohol use disorder.
- Teenagers and young adults are most likely to experience alcohol intoxication and toxicity.
- These age groups are also more prone to injuries from accidents related to alcohol use.
- Approximately 3.3 million deaths worldwide each year are attributed to alcohol.
- Alcohol is the fourth leading preventable cause of death in the United States.
- One in twelve adults suffers from alcohol use disorder.
- This disorder is characterised by consuming more than 3 drinks a day in men, more than 2 drinks a day in women, or binge drinking.
Signs and Symptoms of Ethanol Toxicity
Alcohol intoxication, essentially excessive drinking, could be diagnosed through multiple signs. Things to consider include: known alcohol consumption, behavioral changes, slurred speech, unsteadiness, nystagmus (rapid, uncontrolled eye movements), memory loss, and absence of another medical condition that could explain these effects. The severity of these signs largely depends on one’s blood alcohol concentration (BAC).
As the BAC increases, the symptoms get worse. At a BAC between 0 and 0.05%, people can experience relaxation, increased talkativeness, and decreased fine motor control. BAC levels of 0.05% to 0.1% can lead to impaired judgment and coordination. A range from 0.1% to 0.2%, can cause walking instability, slurred speech, and changes in mood and behavior. Nausea, vomiting, hypothermia, amnesia, double vision, and nystagmus can develop with a BAC of 0.2% to 0.4%. In cases where BAC exceeds 0.4%, patients can experience severe complications including respiratory depression, coma, and even death. These outcomes can also greatly fluctuate based on the speed of alcohol consumption and how fast BAC rises and falls.
The absorption rate of alcohol can be influenced by factors like food, an individual’s gender, smoking habits, and the concentration of alcohol in the drink. Also, people who have a history of heavy drinking may have developed a tolerance, meaning they can have high BAC levels without showing severe symptoms. It’s also essential to know how much, what type, and over how long the alcohol was consumed. People may complain of nausea, vomiting, and diarrhea. A thorough physical examination is necessary, looking at things like vital signs, nutritional status, and skin conditions such as spider veins, redness on the palms, and muscle wasting.
First and foremost, as with all physical exams, the patient’s airway, breathing, and circulation should be assessed. This is because excessive alcohol can depress the respiratory system, so confirm that the patient’s airway is unobstructed is of the utmost importance. Lastly, frequent physical check-ups are necessary as some patients may start feeling injuries or issues as they sober up.
Testing for Ethanol Toxicity
When someone drinks alcohol heavily, it can cause many changes to their body’s normal functions, such as increased acidity in the blood (lactic acidosis), low blood sugar (hypoglycemia), and low levels of certain minerals in the blood (hypokalemia, hypomagnesemia, hypocalcemia, and hypophosphatemia). To check these, the doctor might order a full set of tests for electrolytes (minerals that help your body manage its fluid levels, nerve activity, and muscle functions) and to see how well the liver is working.
Alcohol can also cause acute, or short-term, effects on the heart, such as an irregular heartbeat (atrial and ventricular tachyarrhythmias). An echocardiogram (EKG) can be used to study the electrical signals in the heart, which helps to identify these abnormalities. Heavy drinking can sometimes cause a condition known as “holiday heart syndrome,” characterized by a new-onset irregular heartbeat following binge drinking, most commonly atrial fibrillation. If this is suspected, multiple EKGs may be done over time since these changes usually go away on their own once the person stops drinking alcohol. However, if the changes persist, it could suggest that there’s an alternate cause needs to be investigated.
In cases where a person’s mental state is altered and a detailed history can’t be obtained, a CT scan (a special type of X-ray) of the brain might be performed. This is to make sure that no other brain conditions might be contributing to the person’s mental state.
Lastly, many people who are intoxicated might express suicidal thoughts or act in ways that suggest they’re thinking about suicide. In these instances, a mental health evaluation should be performed, and it might need to be done again as the person becomes less intoxicated and more clear-headed.
Treatment Options for Ethanol Toxicity
The treatment for acute alcohol poisoning mainly focuses on supporting the patient’s bodily functions. The first concern is always to make sure the patient can breathe, as one of the main risks of severe alcohol poisoning is that it can slow or stop a person’s breathing.
There’s some debate about whether IV fluids should be given to people who’ve drunk a lot of alcohol. While many people might think alcohol makes you dehydrated because it can cause you to urinate more often, it isn’t clear whether IV fluids are effective in treating severe alcohol poisoning. When a person has alcohol poisoning, their blood sugar levels can also drop. This is because in people with alcoholism, alcohol can use up the store of sugar in your liver, leading to low blood sugar. This needs to be checked and treated, ideally before doctors give vitamins such as thiamine.
You might wonder why vitamins are important here. Some people who drink a lot might not have enough vitamins, so doctors might consider giving them an IV feed with multiple vitamins. One particular vitamin, thiamine, is usually given to all patients with alcoholism, especially if they’re showing signs of confusion or problems with thinking. This is because a deficiency in thiamine can lead to a condition called Wernicke’s encephalopathy which is hard to diagnose and can be fatal. So, it’s safer just to give the vitamin.
While giving fluids can seem helpful, in some people with a history of excessive drinking, their heart can be weakened to the point that giving fluids might do more harm than good. This is called alcoholic cardiomyopathy.
Some people might become agitated or aggressive due to alcohol poisoning. In these situations, they might need sedative drugs to help calm them down, such as droperidol or haloperidol. However, these drugs might interact with the alcohol, so their use should be carefully monitored.
Depending on how severe the alcohol poisoning is, and whether there are complications like Wernicke’s encephalopathy, liver inflammation, or irregular heartbeats, the person might need to stay in hospital for further treatment.
What else can Ethanol Toxicity be?
When a person displays symptoms of alcohol poisoning, doctors need to consider a range of other conditions that can also cause changes in mental state. The list of diseases to consider is diverse and might even occur together with alcohol poisoning. It’s crucial to thoroughly examine the patient and if necessary, run lab tests and brain scans.
The diagnosis might become complicated if the patient has consumed non-beverage alcohol. This could include products like cologne, cough syrup, and rubbing alcohol, and might occur accidentally (for instance in children) or intentionally (in persons with alcohol addiction who can’t access alcoholic drinks).
- Trauma
- Infections (sepsis or brain infections)
- Seizures
- Drugs or toxic substances
- Extreme body temperature (too high or too low)
- Thyroid problems (too much or too little thyroid hormone)
- Lack of oxygen (hypoxia)
- Issues with bodily metabolism
After confirming alcohol use, doctors also need to assess the possibility of other related disorders such as Wernicke’s encephalopathy (a brain disorder due to vitamin deficiency) and hepatic encephalopathy (a decline in brain function as a result of severe liver disease).
What to expect with Ethanol Toxicity
The outlook for those suffering from ethanol toxicity (harm caused by consuming too much alcohol) relies on several factors. These include how long they’ve been consuming alcohol, the level of their intoxication, any injuries they’ve sustained due to alcohol consumption, and any damage to their organs.
Patients experiencing uncomplicated ethanol toxicity generally have a good prognosis, which means they are likely to recover. It’s important for these patients to be advised on abstaining from alcohol. With complete abstinence from alcohol, most of the long-term complications that result from ethanol toxicity can improve and sometimes even be reversed.
Possible Complications When Diagnosed with Ethanol Toxicity
Alcohol can harm multiple parts of the body and can lead to various issues with both short-term and long-term use. People who are under the influence of alcohol are more likely to get hurt in accidents. Injured patients who’ve consumed alcohol usually stay longer in the hospital, have a higher chance of dying, and are more likely to get injured again in the future.
Alcoholic liver disease is a main cause of chronic liver disease. Drinking too much alcohol at once can lead to alcoholic hepatitis and rapid worsening of existing liver disease. This generally happens in people who constantly abuse alcohol or those already suffering from alcoholic cirrhosis. Excessive drinking is the second most common cause for rapid worsening of existing liver disease; the most common cause is bacterial infection.
A useful treatment for alcoholic liver disease is to completely stop drinking alcohol. Alcohol can lead to short-term and long-term problems with the heart. In the short term, it can cause abnormal heart rhythms like atrial fibrillation, super-fast heart rate above the ventricles, and super-fast heart rate in the ventricles. It can also lead to fatal heart rhythms in patients with heart attacks. Additionally, it can make the heart less effective at pumping blood, leading to heart failure, stroke, and a heightened risk of heart-related death.
People who drink heavily have a much higher chance of heart failure compared to those who do not drink.
Wernicke syndrome, or Wernicke encephalopathy, happens because of a thiamine deficiency and is marked by unsteady movements, eye movement issues, and overall confusion. It develops over a few days to weeks. Even though it’s most often seen in people with alcohol use disorder, it can happen in any condition that leads to a thiamine deficiency. Symptoms of Wernicke syndrome include lack of attention, memory issues, and disorientation. In severe cases, it can cause a coma. If left untreated, Wernicke encephalopathy can become Korsakoff syndrome, which is marked by severe memory loss without impaired alertness and no extra eye movement issues. Long-term drinking can lead to dementia, brain damage, and peripheral nerve damage.
In Simple Terms:
- Alcohol can harm multiple body parts and lead to problems both in short-term and long-term use.
- Drinking increases the chance of injuries and causes longer hospital stays.
- Alcoholic liver disease is a common reason for long-term liver disease.
- Abstaining from alcohol is an effective treatment for alcoholic liver disease
- Drinking can lead to heart problems, both short-term and long-term.
- Heavy drinkers have a much higher risk of heart failure.
- A condition called Wernicke syndrome is common with people who have alcohol disorders
- Long-term drinking can lead to severe memory loss, dementia, brain damage, and nerve damage.
Preventing Ethanol Toxicity
Any patient who arrives at the emergency department because they’ve consumed too much alcohol should be evaluated for alcohol use disorder. This is a medical condition that involves being unable to stop or control the consumption of alcohol even when it’s causing harm. If a patient is found to have this disorder or is reliant on alcohol, it’s critical that they are guided towards treatment for alcohol. If a patient is drinking alcohol to the point where it’s harmful, the best approach is to step in as early as possible. A visit to the emergency department due to excessive drinking may be a signal that the person’s alcohol consumption has reached an unhealthy level.
