49. Acute alcohol intoxications – ethyl, methyl

Acute exogenous poisoning with alcohols: ethanol, methanol, ethylene glycol

Ethanol poisoning

• CH3CH2OH chemical structure
• Metabolised in the liver, broken down by enzyme alcohol dehydrogenase where it is converted into acetaldehyde which itself is catabolized into acetic acid by acetaldehyde dehydrogenase. Finally, acetate is converted into fats, carbon dioxide and water

• Ethanol seems to act on GAB and N-methyl-D-asparate (NMDA) receptors, causing a CNS inhibitory effect, causing relaxation, anxiolysis, ataxia and reduced inhibitions
• Acute over consumption can lead to dehydration and severe CNS depression, longer term effects of acute intoxication include impaired sensory and motor function, slowed cognition, unconsciousness and death - a blood alcohol concentration of about 0.4% leads to a coma, above this can lead to death through respiratory paralysis
• Chronic toxicity leads to cirrhosis and hepatocellular carcinoma (and others)
• Supportive care is the main treatment, be aware for hypoglycemia and respiratory depression which are the most common causes of death from alcohol, especially in children - if hypotension is present, use fluids and vasopressors, glucose containing IV fluid is often required. Nasogastric tube evacuation can be helpful. In chronic alcohol abuse administer thiamine 100mg IV/IM to prevent neurological injury