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Toxicology – Ethanol (Alcohol) Intoxication
Source
Ethanol is commonly found in alcoholic beverages such as beer, wine, and spirits, but also in products like mouthwash, perfumes, cooking extracts, certain medications, and even hand sanitizers.
Typical Presentation
Patients usually present after excessive intake, ranging from mild intoxication to severe central nervous system depression. In extreme cases, individuals may be unconscious and require airway support.
Clinical Features
Ethanol produces a hypnosedative toxidrome. Common findings include slurred speech, impaired coordination, unsteady gait, nystagmus, and disinhibition. As toxicity worsens, patients may develop hypotension, low body temperature, nausea, vomiting, and memory impairment. Severe cases can progress to stupor, coma, respiratory depression, and death.
Metabolic disturbances may include hypoglycemia, lactic acidosis, ketoacidosis, electrolyte imbalances (low potassium, magnesium, calcium), and an increased osmolal gap.
Mechanism of Action
Ethanol acts as a central nervous system depressant by enhancing GABA activity. It is metabolized in the liver:
Treatment is mainly supportive:
Source
Ethanol is commonly found in alcoholic beverages such as beer, wine, and spirits, but also in products like mouthwash, perfumes, cooking extracts, certain medications, and even hand sanitizers.
Typical Presentation
Patients usually present after excessive intake, ranging from mild intoxication to severe central nervous system depression. In extreme cases, individuals may be unconscious and require airway support.
Clinical Features
Ethanol produces a hypnosedative toxidrome. Common findings include slurred speech, impaired coordination, unsteady gait, nystagmus, and disinhibition. As toxicity worsens, patients may develop hypotension, low body temperature, nausea, vomiting, and memory impairment. Severe cases can progress to stupor, coma, respiratory depression, and death.
Metabolic disturbances may include hypoglycemia, lactic acidosis, ketoacidosis, electrolyte imbalances (low potassium, magnesium, calcium), and an increased osmolal gap.
Mechanism of Action
Ethanol acts as a central nervous system depressant by enhancing GABA activity. It is metabolized in the liver:
- Alcohol dehydrogenase converts ethanol → acetaldehyde
- Aldehyde dehydrogenase converts acetaldehyde → acetate
Treatment is mainly supportive:
- Ensure airway protection and adequate breathing
- Provide IV fluids for dehydration
- Administer thiamine (vitamin B1) in chronic alcohol users, especially if mental status is altered, to prevent neurological complications
- Severe intoxication can lead to life-threatening respiratory depression.
- Children are at higher risk of dangerous hypoglycemia.
- Ethanol is primarily metabolized in the liver at a relatively constant rate.
- Non-beverage sources (e.g., mouthwash, sanitizers) can cause significant toxicity.
- Average metabolism rate is about 0.017% blood alcohol per hour.
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