Jozef De Dooy, MD, PhD Paediatric Intensive care Medical Aspects of Alcohol Intoxication in Young People

1. Definition, pharmacokinetics and pharmacology

Alcohol intoxication: definition Characterized by differences in consciousness, cognition, perception, affect, judgment, behaviour and other psychophysiological functions and responses Caused by acute pharmacological effects and learned responses to alcohol The differences resolve with time, with complete recovery, except from the tissue damage caused by the intake of alcohol

Binge Drinking Besides amount of alcohol intake, 3 other factors are of importance in the definition of binge drinking (Gill JS, 2002) Gender: because of gender differences in pharmacology of alcohol Duration of consumption Drinking frequency => NO “GENERAL” DEFINTION!

Gender differences in alcohol pharmacology Pharmacology in women: Smaller first pass metabolism in the stomach Higher alcohol elimination: oxidation in the liver Slower gastric emptying Smaller body distribution => Net effect: higher blood alcohol concentrations persist longer in women

Absorption and Elimination Absorption Fast Highest level serum: < 60 min when empty stomach Ethanol : spasme of the pylorus Elimination Constant Independent of peak-level Non-drinkers: drops mg/dl/h (2.2 to 5.6 mmol/l/uur) Chronic drinkers : drops 30 mg/dl/h (6.7 mmol/l / uur)

Accumulation = toxic

2. Clinical presentation and diagnosis

Clinical presentation is influenced by: Quantity Weight Tolerance (age, gender) % alcohol Time of ingestion

Vonghia et al, 2008

Symptoms Metabolic Hypoglycemia Elektrolyte disturbances Cardiovascular Tachycardia Hypovolemic, VD Hypothermia Hypotension Cerebral embolism and AMI Fibrinolysis Clotting Coronary spasms

Symptoms Respiratory DEPRESSION OF RESPIRATION Clearance mucus Risk for aspiration Gastro-intestinal Nausea, vomiting, diarrhea, gastritis, pancreatitis Alcoholic hepatitis

Diagnosis Clinical signs Blood alcohol others? Routine lab On indication RX, ECG, CT Arterial blood gasses …

3. Treatment

APLS/EPLS guidelines Airway and breathing Airway assesment Observation of respiratory function Prevention of aspiration Mechanical ventilation, if necessary Circulation IV access IV solution administration Correction hypoglycemia Corretion elektrolyte imbalances Thiamine! (multivitamins)

Further treatment Disability Level of consciousness Sedation if necessary Acceleration of elimination metadoxine Watch out! Trauma Hypothermia Hypoglycemia

4. Conclusion