Alcohol Intoxication is a clinical condition caused by recent consumption of alcohol resulting in clinically significant behavioural, psychological, or physical changes due to the effects of alcohol on the central nervous system.

The severity of intoxication depends on the amount of alcohol consumed, rate of consumption, individual tolerance, body size, and concurrent use of other substances.

Epidemiology

• Alcohol intoxication is one of the most common substance-related emergency presentations worldwide

• It contributes significantly to injuries, road traffic crashes, violence, accidental deaths, and healthcare utilization

• Severe intoxication may result in respiratory depression, coma, and death

Risk Factors

• Heavy or binge alcohol consumption

• Previous history of alcohol misuse

• Low alcohol tolerance

• Young age

• Coexisting substance use

• Use of alcohol with sedative medications

• Underlying medical conditions affecting alcohol metabolism

Pathophysiology

Alcohol acts mainly by enhancing gamma-aminobutyric acid (GABA) inhibitory neurotransmission and reducing glutamate excitatory activity in the central nervous system. This results in impaired cognition, reduced coordination, altered judgement, sedation, and at high concentrations, respiratory depression and coma.

Clinical Presentation

Clinical features vary according to blood alcohol concentration and individual tolerance.

Mild to Moderate Intoxication

• Euphoria

• Reduced inhibition

• Impaired judgement

• Slurred speech

• Poor coordination

• Unsteady gait

• Impaired attention and memory

• Nystagmus

• Emotional instability

Severe Intoxication

• Confusion

• Reduced level of consciousness

• Stupor

• Coma

• Respiratory depression

• Hypothermia

• Aspiration risk

• Hypoglycaemia

Diagnostic Criteria (DSM-5)

Diagnosis requires:

• Recent alcohol use

• Clinically significant problematic behavioural or psychological changes developing during or shortly after alcohol consumption

The condition is characterized by at least one of the following:

• Slurred speech

• Incoordination

• Unsteady gait

• Nystagmus

• Impairment in attention or memory

• Stupor or coma

The symptoms should not be better explained by another medical condition or another substance use.

Differential Diagnosis

• Alcohol withdrawal

• Opioid intoxication

• Sedative-hypnotic intoxication

• Hypoglycaemia

• Head injury

• Stroke

• Sepsis

• Epileptic seizure

• Metabolic encephalopathy

Investigations

Investigations depend on clinical presentation and severity.

Laboratory Investigations

• Blood glucose

• Blood alcohol concentration where available

• Electrolytes

• Renal function tests

• Liver function tests where indicated

• Full blood count

• Toxicology screening when other substances are suspected

Additional Assessment

• Assessment of airway breathing and circulation

• Assessment for trauma especially head injury

• Mental status examination

• Assessment of suicide risk where indicated

Management

Treatment Goals

• Maintain airway breathing and circulation

• Prevent complications

• Treat associated medical problems

• Ensure patient safety

Non-Pharmacological Management

Management is mainly supportive and depends on severity.

• Ensure airway protection

• Monitor vital signs and level of consciousness

• Place unconscious patients in the recovery position where appropriate

• Provide oxygen if hypoxic

• Prevent aspiration

• Treat injuries related to falls or accidents

• Provide reassurance and a safe environment

• Monitor for withdrawal symptoms in individuals with alcohol dependence

• Provide counselling and referral for alcohol use assessment after recovery

Pharmacological Management

Treatment is symptomatic and depends on clinical presentation.

Supportive measures may include:

• Intravenous fluids when clinically indicated

• Correction of hypoglycaemia

• Correction of electrolyte abnormalities

• Thiamine supplementation in patients at risk of nutritional deficiency or alcohol dependence before glucose administration where possible

Patients with severe intoxication, respiratory depression, coma, or complications require urgent medical management and monitoring.

Referral Criteria

Refer to the next level of care if:

• Reduced level of consciousness

• Respiratory depression

• Suspected alcohol poisoning

• Severe agitation or behavioural disturbance

• Significant trauma

• Recurrent intoxication episodes

• Suspected alcohol dependence

• Coexisting psychiatric illness

• Need for detoxification or rehabilitation services

Complications

• Aspiration pneumonia

• Respiratory depression

• Coma

• Hypoglycaemia

• Hypothermia

• Trauma and injuries

• Alcohol withdrawal after intoxication resolves

• Death

Prevention

• Public education on harmful alcohol use

• Screening for hazardous drinking

• Brief interventions in healthcare settings

• Alcohol dependence treatment services

• Prevention of drinking and driving

• Community awareness programmes

Prognosis

Most cases of mild to moderate alcohol intoxication resolve with supportive care. Severe intoxication can be life-threatening, especially when associated with respiratory depression, aspiration, trauma, or use of other sedating substances.

Patient Education

• Avoid excessive alcohol consumption

• Avoid combining alcohol with sedatives or other drugs

• Do not drive or operate machinery after drinking alcohol

• Seek medical attention for confusion, unconsciousness, difficulty breathing, or seizures

• Individuals with repeated intoxication should be assessed for Alcohol Use Disorder