Alcohol intoxication

• Airway protection-intubation and ventilation
• Insert urinary catheter
• NGT for aspiration

• Pharmacological

Give fomepizole

• Load 15 mg/kg IV infusion over 30 min;
• Then 10 mg/kg IV 12 hourly for 4 doses;
• Then increase to 15mg/kg 12 hourly until Ethylene glycol or Methanol levels are <20mg/dL

Give Ethanol

Adults:

Loading dose

• 600 mg/kg IV (i.e, 7.6mL/kg of 10% ethanol (EtOH) solution) or 600–700mg/kg PO/NG using a 95% solution diluted to ≤ 20% with water or juice

Maintenance dose:

• 155 mg/kg/hr depending on alcohol consumption status (lower for non-drinkers) o Oral maintenance: 0.15 mL/kg/hr (IV = 1.4 mL/kg/hr) 10% EtOH

• Chronic alcoholics and hemodialysis patients need increased dose; increased maintenance dose of EtOH by 50%; non-alcohol users may need less.

• Maintain serum ethanol of 100-150mg/dL [21.7-32.55 mmol/L]

Children: Oral loading dose

• 95% EtOH: 0.8–1 mL/kg
• 40% EtOH (80 proof undiluted liquor): 2 mL/kg o 43% EtOH (86 proof undiluted liquor): 1.8 mL/kg

Maintenance dose (orally)

• 43% EtOH: 0.1 mL/kg/hr o 95% EtOH: 0.1 mL/kg/hr IV dose (10% EtOH)
• 10% EtOH = 7.9 g/dL o Loading: 8-10 mL/kg IV; not to exceed 200 mL
• Maintenance: 0.83 mL/kg/hr IV o 10% EtOH = 7.9 g/dL
• 40% EtOH (80 proof undiluted liquor) = 31.6 g/dL
• 43% EtOH (86% proof undiluted liquor) = 34 g/dL
• 95% EtOH (absolute alcohol) = 75 g/dL o Continue maintenance dose until methanol or ethylene glycol levels are below 10 mg/dL

Note:

• Asses for toxic co-ingestion, aspiration pneumonia, head injury,
• Children and adolescent with suicidal ideation-visit psychiatrist

Prevention

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References

1. STG