Alcohol Intoxication

Alcohol Intoxication

A DSM-IV diagnosis of alcohol intoxication is given when, shortly after alcohol consumption, there are maladaptive behaviors such as aggression or inappropriate sexual behavior, or there are psy-chological changes such as labile mood and impaired judgment. Clinical signs indicative of alcohol intoxication include slurred speech, lack of coordination, unsteady gait, nystagmus, impair-ment of attention and memory and, in the most severe cases, stu-por and coma. Alcohol intoxication may also present with severe disturbances in consciousness and cognition (alcohol intoxication delirium), especially when large amounts of alcohol have been ingested or after alcoholic intoxication has been sustained for extended periods. Usually, this condition subsides shortly after alcohol intoxication ends. Physical and mental status examina-tions accompanied by analysis of blood and urine allow the clini-cian to rule out general medical conditions or psychiatric disor-ders mimicking this condition. In this regard, urine toxicology is a valuable tool in ruling out intoxication with benzodiazepines, barbiturates, or other sedatives that can present with a similar clinical picture. Collateral information from relatives or friends confirming the ingestion of alcohol is also useful, and should be actively pursued by the clinician. The blood alcohol level (BAL) is frequently used as a measure of alcohol intoxication, although this measure is less reliable in persons with a high degree of tolerance to alcohol. Alcohol is metabolized in the average adult at a rate of 1 oz or 7 to 10 g/hour. When this clearance rate is surpassed, signs of alcohol intoxication begin to appear. During the ascend-ing limb of the BAL curve, euphoria, anxiolysis and mild deficits in coordination, attention and cognition can be observed at levels between 0.01 and 0.10%. Marked deficits in coordination and psy-chomotor skills, decreased attention, ataxia, impaired judgment, slurred speech and mood lability can be observed at a greater BAL. Severe intoxication, characterized by lack of coordination, incoherent thoughts, confusion, nausea and vomiting can be ob-served at BALs between 0.20 and 0.30. However, at these levels some heavy drinking individuals who have developed tolerance to the effects of alcohol may not appear intoxicated and may per-form well on psychomotor or cognitive tasks. Stupor and loss of consciousness often occur when the BAL is between 0.30 and 0.40. Beyond this level, coma, respiratory depression and death are possible outcomes. It should also be noted that alcohol intoxi-cation is often associated with toxicity and overdose with other drugs, particularly those with depressant effects on the CNS.