| Alcohol intoxication | |
|---|---|
| Other names | Inebriation, drunkenness, ethanol intoxication, internal damage by alcohol[1][2] |
 | |
| The Drunkenness of Noah byMichelangelo, 1509 | |
| Specialty | Toxicology,psychiatry |
| Symptoms | Mild: Mildsedation, decreased coordination[3] Moderate:Slurred speech, trouble walking, vomiting[3] Severe:Decreased effort to breathe, coma[3] |
| Complications | Seizures,aspiration pneumonia, injuries,low blood sugar[3][4] |
| Usual onset | Over minutes to hours (depends on how much one drinks)[5] |
| Duration | Several hours[5] |
| Causes | Alcohol (ethanol)[6] |
| Risk factors | Social environment,impulsivity,anxiety, alcoholism[5][7] |
| Diagnostic method | Typically based on history of events andphysical examination[6] |
| Differential diagnosis | Hepatic encephalopathy,Wernicke encephalopathy,methanol toxicity,meningitis,traumatic brain injury[6] |
| Treatment | Supportive care[6] |
| Frequency | Very common |
| Deaths | c. 2,200 per year (U.S.)[8] |
Alcohol intoxication, commonly described in higher doses asdrunkenness orinebriation,[9] and known inoverdose asalcohol poisoning,[1] is the behavior and physical effects caused by recent consumption ofalcohol.[6][10] The technical termintoxication in common speech may suggest that a large amount of alcohol has been consumed, leading to accompanying physical symptoms and deleterious health effects. Mild intoxication is mostly referred to by slang terms such astipsy orbuzzed. In addition to thetoxicity ofethanol, the mainpsychoactive component of alcoholic beverages, other physiological symptoms may arise from the activity ofacetaldehyde, ametabolite of alcohol.[11] These effects may not arise until hours after ingestion and may contribute to a condition colloquially known as ahangover.
Symptoms ofintoxication at lower doses may include mildsedation and poor coordination.[3] At higher doses, there may be slurred speech,trouble walking, impaired vision, mood swings and vomiting.[3] Extreme doses may result in arespiratory depression, coma, or death.[3] Complications may includeseizures,aspiration pneumonia,low blood sugar, and injuries or self-harm such assuicide.[3][4] Alcohol intoxication can lead toalcohol-related crime, with perpetrators more likely to be intoxicated than victims.[12]
Alcohol intoxication typically begins after two or morealcoholic drinks.[5] Alcohol has the potential for abuse. Risk factors include a social situation where heavy drinking is common and a person having an impulsive personality.[5] Diagnosis is usually based on the history of events and physical examination.[6] Verification of events by witnesses may be useful.[6] Legally, alcohol intoxication is often defined as ablood alcohol concentration (BAC) of greater than 5.4–17.4 mmol/L (25–80 mg/dL or 0.025–0.080%).[13][14] This can be measured by blood orbreath testing.[5] Alcohol is broken down in the human body at a rate of about 3.3 mmol/L (15 mg/dL) per hour,[6] depending on an individual'smetabolic rate (metabolism).[15] TheDSM-5 defines alcohol intoxication as at least one of the following symptoms that developed during or close after alcohol ingestion: slurred speech, incoordination, unsteady walking/movement, nystagmus (uncontrolled eye movement), attention or memory impairment, or near unconsciousness or coma.[16]
Management of alcohol intoxication involves supportive care.[6] Typically, this includes putting the person in the recovery position, keeping the person warm, and making sure breathing is sufficient.[4]Gastric lavage andactivated charcoal have not been found to be useful.[6] Repeated assessments may be required to rule out other potential causes of a person's symptoms.[6]
Acute intoxication has been documented throughout history, and alcohol remains one of the world's most widespreadrecreational drugs.[17][18] Some religions, such as Islam, consider alcohol intoxication to be a sin.[5][19]
Alcohol intoxication leads to negative health effects due to the recent drinking of large amount ofethanol (alcohol).[6][20] When severe it may become amedical emergency. Some effects of alcohol intoxication, such as euphoria and loweredsocial inhibition, are central to alcohol's desirability.[21]
As drinking increases, people become sleepy or fall into astupor. At very highblood alcohol concentrations, for example, above 0.3%, the respiratory system becomes depressed and the person may stop breathing.[22] Comatose patients may aspirate their vomit (resulting in vomitus in the lungs, which may cause "drowning" and laterpneumonia if survived). CNS depression and impaired motor coordination, along with poor judgment, increase the likelihood of accidental injury occurring. It is estimated that about one-third of alcohol-related deaths are due to accidents, and another 14% are from intentional injury.[23]
In addition to respiratory failure and accidents caused by its effects on the central nervous system, alcohol causes significant metabolic derangements.Hypoglycaemia occurs due to ethanol's inhibition ofgluconeogenesis, especially in children, and may causelactic acidosis,ketoacidosis, andacute kidney injury. Metabolic acidosis is compounded by respiratory failure. Patients may also present with hypothermia.
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Alcohol ismetabolized by a normalliver at the rate of about 8 grams of pureethanol per hour. 8 grams or 10 mL (0.34 US fl oz) is one Britishstandard unit. An "abnormal" liver with conditions such ashepatitis,cirrhosis,gall bladder disease, andcancer is likely to result in a slower rate of metabolism.[24]
Alcohol intoxication is described as amental andbehaviouraldisorder by theInternational Classification of Diseases. (ICD-10).[25] Definitivediagnosis relies on a blood test for alcohol, usually performed as part of atoxicology screen.Law enforcement officers in the United States and other countries often usebreathalyzer units andfield sobriety tests as more convenient and rapid alternatives to blood tests.[26] There are also various models of breathalyzer units that are available for consumer use. Because these may have varying reliability and may produce different results than the tests used for law-enforcement purposes, the results from such devices should be conservatively interpreted.
Many informal intoxication tests exist, which, in general, are unreliable and not recommended as deterrents to excessive intoxication or as indicators of the safety of activities such as motor vehicle driving, heavy equipment operation, machine tool use, etc.
For determining whether someone is intoxicated by alcohol by some means other than a blood-alcohol test, it is necessary to rule out other conditions such ashypoglycemia, stroke, usage of other intoxicants, mental health issues, and so on. It is best if their behavior has been observed while the subject is sober to establish a baseline. Several well-known criteria can be used to establish a probable diagnosis. For a physician in the acute-treatment setting, acute alcohol intoxication can mimic other acute neurological disorders or is frequently combined with otherrecreational drugs that complicate diagnosis and treatment.
Acute alcohol poisoning (anoverdose of the drug) is amedical emergency due to the risk of death fromrespiratory depression oraspiration of vomit if vomiting occurs while the person is unresponsive. Emergency treatment strives to stabilize and maintain an open airway and sufficient breathing while waiting for the alcohol to metabolize. This can be done by removal of any vomit or, if the person is unconscious or has impairedgag reflex, intubation of the trachea.[27]
Other measures may include
Additional medication may be indicated for treatment ofnausea,tremor, andanxiety.
Alcohol intoxication was found to be prevalent in clinical populations within the United States involving people treated for[31] trauma[32] and in the age group of people aged within their 18th–24th years (in a study of a group for the years 1999–2004).[33] In the United States during the years 2010–2012, acute intoxication was found to be the direct cause of an average of 2,221 deaths, in the sample group of those aged within their 15th year or older.[8] The same mortality route is thought to cause indirectly more than 30,000 deaths per year.[5]
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A normal liver detoxifies the blood of alcohol over a period of time that depends on the initial level and the patient's overall physical condition. An abnormal liver will take longer but still succeeds, provided the alcohol does not causeliver failure.[34]
People who have drunk heavily for several days or weeks may havewithdrawal symptoms after the acute intoxication has subsided.[35]
A person consuming a dangerous amount of alcohol persistently can develop memory blackouts and idiosyncratic intoxication or pathological drunkenness symptoms.[36]Long-term persistent consumption of excessive amounts of alcohol can cause liver damage and have other deleterious health effects.
Alcohol intoxication is arisk factor in some cases ofcatastrophic injury, in particular for unsupervisedrecreational activity. A study in theprovince ofOntario based onepidemiological data from 1986, 1989, 1992, and 1995 states that 79.2% of the 2,154 catastrophic injuries recorded for the study were preventable, of which 346 (17%) involved alcohol consumption.[37] The activities most commonly associated with alcohol-related catastrophic injury weresnowmobiling (124), fishing (41),diving (40),boating (31) andcanoeing (7), swimming (31), riding anall-terrain vehicle (24), and cycling (23).[37] These events are often associated with unsupervised young males, often inexperienced in the activity, and may result indrowning.[37] Alcohol use is also associated with unsafe sex.
Laws on drunkenness vary. In the United States, it is a criminal offense for a person to bedrunk while driving a motorized vehicle, except inWisconsin, where it is only afine for the first offense.[38] It is also a criminal offense to fly an aircraft or (in someAmerican states) to assemble or operate anamusement park ride while drunk.[39] Similar laws also exist in the United Kingdom and most other countries.
In some jurisdictions, it is also an offense to serve alcohol to an already-intoxicated person,[40] and, often, alcohol can only be sold by persons qualified to serve responsibly throughalcohol server training.
Theblood alcohol content (BAC) for legal operation of a vehicle is typically measured as a percentage of a unit volume of blood. This percentage ranges from 0.00% in Romania and the United Arab Emirates; to 0.05% in Australia, South Africa, Germany, Scotland, and New Zealand (0.00% for underage individuals); to 0.08% inEngland and Wales, the United States and Canada.[41]
The United StatesFederal Aviation Administration prohibitscrew members from performing their duties within eight hours of consuming an alcoholic beverage, while under the influence of alcohol, or with a BAC greater than 0.04%.[42][43]
In the United States, the United Kingdom, and Australia,public intoxication is a crime (also known as "being drunk and disorderly" or "being drunk and incapable").[44]
In some countries, there are special facilities, sometimes known as "drunk tanks", for the temporary detention of persons found to be drunk.
Some religious groups permit the consumption of alcohol; some permit consumption but prohibit intoxication; others prohibit any amount of alcohol consumption altogether.
Mostdenominations of Christianity, such asCatholicism,Orthodoxy andLutheranism, use wine as a part of theEucharist (Holy Communion) and permit its consumption, but consider it sinful to become intoxicated.[45]
Romans 13:13–14,[46]1 Corinthians 6:9–11,Galatians 5:19–21[47] andEphesians 5:18[48] are among a number of other Bible passages that speak against intoxication.
SomeProtestant Christian denominations prohibit the consumption of alcohol[49] based upon biblical passages that condemn drunkenness,[50] but others allow amoderate rate of consumption.[51]
In theChurch of Jesus Christ of Latter-day Saints, alcohol consumption is forbidden,[52] andteetotalism has become a distinguishing feature of its members.Jehovah's Witnesses allow moderate alcohol consumption among its members.
In theQuran,[53][54][55] there is a prohibition on the consumption of grape-based alcoholic beverages, and intoxication is considered an abomination in thehadith ofMuhammad. Theschools of thought ofIslamic jurisprudence have interpreted this as a strict prohibition of the consumption of all types of alcohol and declared it to beharam (lit. 'forbidden [inIslam]'), although other uses may be permitted.[56]
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InBuddhism, in general, the consumption of intoxicants is discouraged for both monastics and lay followers. Many Buddhists observe a basic code of ethics known as thefive precepts, of which the fifth precept is an undertaking to refrain from the consumption of intoxicating substances[57] (exceptfor medical reasons).[58] In thebodhisattva vows of theBrahmajala Sutra, observed byMahayana Buddhist communities, distribution of intoxicants is likewise discouraged, as well as consumption.[59]
In theGaudiya Vaishnavism branch ofHinduism, one of the four regulative principles forbids the taking of intoxicants, including alcohol.
In the Bible, theBook of Proverbs contains several chapters related to the negative effects of drunkenness and warns to stay away fromintoxicating beverages. TheBook of Genesis refers to the use of wine byLot's daughters to rape him. The story ofSamson in theBook of Judges tells of a monk from theIsraelite tribe of Dan who, as aNazirite, is prohibited from cutting his hair and drinking wine.[50]Proverbs 31:4 warns against kings and other rulers drinking wine and similar alcoholic beverages, Proverbs 31:6–7 promotes giving such beverages to the perishing and wine to those whose lives are bitter as a coping mechanism against the likes of poverty and other troubles.[60]
In Judaism, in accordance with the biblical stance against drinking,[50] drinking wine is restricted for priests.[61] The biblical command to sanctify theSabbath and other holidays has been interpreted as having three ceremonial meals with wine orgrape juice, known asKiddush.[62][63] A number ofJewish marriage ceremonies end with the bride and groom drinking a shared cup of wine after recitingseven blessings; this occurs after a fasting day in someAshkenazi traditions. It has been customary and in many cases even mandated to drink moderately so as to staysober, and only after the prayers are over.[64]
During theSeder onPassover, there is an obligation to drink four ceremonial cups of wine while reciting theHaggadah. It has been assumed to be the source of the wine-drinking ritual at communion in some Christian groups.[65] DuringPurim, there is an obligation to become intoxicated; however, as with many other decrees, this has been avoided in many communities by allowing sleep during the day as a replacement.[66]
During theU.S. Prohibition era in the 1920s, arabbi from theReform Judaism movement proposed using grape juice for the ritual instead of wine. Although refuted at first, the practice became widely accepted byorthodox Jews as well.[67]
In the filmAnimals Are Beautiful People, an entire section was dedicated to showing many different animals, including monkeys, elephants, hogs, giraffes, and ostriches, eating over-ripemarula tree fruit, causing them to sway and lose their footing in a manner similar to human drunkenness.[68] Birds may become intoxicated with fermented berries, and some die colliding with hard objects when flying under the influence.[69][70]
In elephant warfare, practiced by the Greeks during theMaccabean revolt and byHannibal during thePunic wars, it has been recorded that the elephants would be given wine before the attack, and only then would they charge forward after being agitated by their driver.[71]
It is a regular practice to give small amounts of beer to race horses in Ireland. Ruminant farm animals have natural fermentation occurring in their stomach, and adding small quantities of alcoholic beverages to their water is generally harmless and will not cause them to become drunk.
Alcoholic beverages are extremely harmful to dogs,[72] and often for reasons of additives such asxylitol, an artificial sweetener in some mixers. Dogs can absorb ethyl alcohol in dangerous amounts through their skin as well as through drinking the liquid or consuming it in foods. Even fermenting bread dough can be dangerous to dogs.[73] In 1999, one of the royal footmen for Britain's QueenElizabeth II was demoted fromBuckingham Palace due to his "party trick" ofspiking the meals and drinks of theQueen's pet corgi dogs with alcohol which in turn would lead the dogs to run around drunk.[74]
Alcohol poisoning presents in two forms, acute and chronic. However, these are most often referred to as alcohol intoxication and alcohol addiction respectively.
{{cite book}}: CS1 maint: location missing publisher (link)In case of severe intoxication (blood alcohol concentration >1 g/L), it is necessary to prevent and to treat the potentially lethal metabolic effects of alcohol libation (in particular in adolescents) and to accelerate alcohol elimination from blood. It is necessary to support with intravenous fluids, treat hypoglycemia, hypotension, hypothermia and electrolyte imbalance, administer complex B and C vitamins, and support ventilation when necessary. To accelerate the elimination of ethanol from blood (assisting a faster recovery of the patient), two possible strategies can be applied: to perform a gastric lavage within two hours after drinking a considerable amount of alcohol or to administer metadoxine (pyridoxol L-2-pyrrolidone-5-carboxylate) that may be capable of decreasing ethanol blood levels by accelerating the urinary elimination of ethanol and acetaldehyde. Hypoglycemia is fasting-related and develops more frequently in young people (because of a lower reserve of liver glycogen); it is necessary to administer intravenous 5% glucose solution or, if possible, to invite the patient to eat fructose-rich foods and complex carbohydrates. Other metabolic effects could be electrolyte imbalance such as hypokalemia, hypomagnesaemia, hypocalcemia which must be appropriately and individually treated and replaced.
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