eMedicine Specialties > Pediatrics: Cardiac Disease and Critical Care Medicine > Toxicology

Toxicity, Ethanol: Treatment & Medication

Author: Elizabeth Brothers, MD, Resident Physician, Department of Emergency Medicine, State University of New York Downstate Medical Center
Coauthor(s): Christopher I Doty, MD, FACEP, FAAEM, Assistant Professor of Emergency Medicine, Residency Program Director, Department of Emergency Medicine, Kings County Hospital Center, State University of New York Downstate Medical Center
Contributor Information and Disclosures

Updated: Oct 14, 2009

Treatment

Medical Care

The mainstay of medical treatment of patients with ethanol toxicity is supportive care. Many modalities for treating ethanol intoxication and enhancing ethanol clearance have been attempted. In general, a conservative approach is recommended.

Hypoglycemia and respiratory depression are the 2 most immediate life-threatening complications that result from ethanol intoxication in children.

  • Initial care
    • Assess the airway. If necessary, secure the airway with an endotracheal (ET) tube if the patient is not maintaining good ventilation or if a significant risk of aspiration is observed. Provide respiratory support and mechanical ventilation if needed.
    • Obtain intravenous (IV) access and replace any fluid deficit or use a maintenance fluid infusion. Use plasma expanders and vasopressors to treat hypotension, if present.
    • Ensure that the patient maintains a normal body temperature.
    • Quickly correct hypoglycemia. In children, 2-4 mL/kg of 25% dextrose solution is usually administered. A maintenance infusion of dextrose-containing IV fluids is often required. Correct any electrolyte abnormalities found with laboratory studies. Routine empiric electrolyte replacement is not helpful; only documented electrolytic abnormalities should be corrected.
    • If the ingestion occurred within 1 hour of presentation, placing a nasogastric tube and evacuating the stomach contents can be helpful.
    • In patients with chronic ethanol abuse, administer thiamine 100 mg IV/intramuscularly (IM) to prevent neurologic injury.
  • Additional care: If other substances have been co-ingested, initiate specific treatment for those substances, if available. For instance, naloxone can be used to reverse respiratory depression if opiate co-ingestion is suspected.
  • Other treatments
    • The administration of medications to cause emesis is not recommended because of the rapid onset of CNS depression and risk of aspiration.
    • The administration of activated charcoal is not recommended for isolated alcohol ingestions because it does not bind hydrocarbons or alcohols. If the clinician suspects a concomitant ingestion of other toxic products, activated charcoal may be effective in absorbing these toxins.
    • Forced diuresis is not helpful because 90% of ethanol metabolism occurs in the liver, and only 10% of the ethanol load is secreted in the urine.
    • GABA-receptor antagonists such as naloxone and flumazenil have little effect on the CNS or respiratory depression caused by ethanol; their use is not recommended in isolated ethanol intoxication.
    • The effects of insulin, glucose, caffeine, and several other medications have been studied, but none consistently increases ethanol metabolism or alleviate CNS depression.
    • Glucose administration is important in patients who are hypoglycemic as a result of ethanol intoxication; however, this treatment does not clear ethanol from the blood.
    • Fructose infusion can increase the ethanol clearance by 25%. However, the use of fructose is not recommended because significant adverse effects may occur. For instance, fructose infusion can cause lactic acidosis, severe osmotic diuresis, and GI symptoms; therefore, it is not routinely used in the treatment of ethanol intoxication.
    • Hemodialysis efficiently clears ethanol from the blood but is an invasive procedure; thus, its use is not routinely recommended. Hemodialysis can be used in patients whose clinical condition is deteriorating or in patients whose CNS depression, respiratory depression, or hypotension is refractory to standard therapy.
    • Patients who have impaired hepatic function may require dialysis to clear an ethanol load.

Surgical Care

  • No surgical modalities are used for the treatment of ethanol intoxication.

Consultations

  • Contact the regional or local poison control center for treatment guidance and reporting purposes.
  • Consider consulting social services personnel in all cases of ethanol intoxication in children.
  • Patients who chronically abuse alcohol may have serious nutritional deficiencies and may require a consultation with a nutritionist.

Diet

  • If no specific electrolyte abnormalities are present, the patient should maintain a healthy well-balanced diet.
  • All electrolytic disturbances should be corrected before their discharge from the hospital.

Activity

  • No activity restrictions are indicated.

Medication

Vitamin and electrolyte replacement is recommended only for specific deficits detected by means of laboratory testing. Thiamine replacement is an exception because it is the only vitamin for which routine administration is recommended and it has been proved useful in patients with chronic alcohol abuse. Thiamine is given to prevent Wernicke syndrome.

Vitamins

Vitamins are organic substances required in small amounts for various metabolic processes. In the body, vitamins may be synthesized in small or insufficient amounts or not at all; thus, supplementation may be required. Vitamins are used in patients with suspected chronic ethanol abuse to prevent serious neurologic complications. If feasible, thiamine should be administered prior to glucose load to reduce risk of Wernicke encephalopathy.


Thiamine (Vitamin B1)

An essential coenzyme of carbohydrate metabolism. Given to all patients with suspected chronic alcohol abuse. Only drug used in patients with ethanol intoxication without a documented deficit. Used in treatment and prevention of Wernicke syndrome.

Adult

100 mg/d IV/IM

Pediatric

Administer as in adults

May enhance effect of neuromuscular blockade

Pregnancy

A - Fetal risk not revealed in controlled studies in humans

Precautions

Pregnancy category C if dose exceeds RDA; some patients have warm stinging sensation during injection; angioedema anecdotally reported; sensitivity reactions possible (intradermal test-dose recommended if sensitivity suspected); deaths (ie, cardiovascular collapse) have resulted from repeated IV use

More on Toxicity, Ethanol

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Treatment & Medication: Toxicity, Ethanol
Follow-up: Toxicity, Ethanol
Multimedia: Toxicity, Ethanol
References
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Further Reading

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Keywords

ethanol, ethanol toxicity, alcohol intoxication, ethanol intoxication, drunkenness, inebriation, ethyl alcohol intoxication, alcohol overdose, ethanol poisoning, alcohol poisoning, drinking, psychoactive drug, hypoglycemia, alcohol abuse, hypoglycemia, hypoglycemic seizures, trauma risk, over-the-counter medication, alcoholism, respiratory depression, hypoxia, urticaria, hypothermia, myocardial depression, diuresis, acute pancreatitis, lactic acidosis, congestive heart failure, pulmonary edema, arrhythmia, cardiovascular collapse, sudden death, cardiomyopathy, obesity

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Contributor Information and Disclosures

Author

Elizabeth Brothers, MD, Resident Physician, Department of Emergency Medicine, State University of New York Downstate Medical Center
Elizabeth Brothers, MD is a member of the following medical societies: American College of Emergency Physicians, Emergency Medicine Residents Association, and Sigma Xi
Disclosure: Nothing to disclose.

Coauthor(s)

Christopher I Doty, MD, FACEP, FAAEM, Assistant Professor of Emergency Medicine, Residency Program Director, Department of Emergency Medicine, Kings County Hospital Center, State University of New York Downstate Medical Center
Christopher I Doty, MD, FACEP, FAAEM is a member of the following medical societies: American Academy of Emergency Medicine, American College of Emergency Physicians, American Medical Association, Council of Emergency Medicine Residency Directors, and Society for Academic Emergency Medicine
Disclosure: Nothing to disclose.

Medical Editor

Halim Hennes, MD, MS, Pediatric Emergency Medicine Research Director, Professor, Departments of Pediatrics and Emergency Medicine, Medical College of Wisconsin
Halim Hennes, MD is a member of the following medical societies: American Academy of Pediatrics
Disclosure: Nothing to disclose.

Pharmacy Editor

Mary L Windle, PharmD, Adjunct Assistant Professor, University of Nebraska Medical Center College of Pharmacy, Pharmacy Editor, eMedicine
Disclosure: Pfizer Inc Stock Investment from financial planner; Avanir Pharma Stock Investment from financial planner ; WebMD Salary and stock Employment and investment from financial planner

Managing Editor

Jeffrey R Tucker, MD, Assistant Professor, Department of Pediatrics, Division of Emergency Medicine, University of Connecticut and Connecticut Children's Medical Center
Jeffrey R Tucker, MD is a member of the following medical societies: American Academy of Clinical Toxicology, American Academy of Pediatrics, and Massachusetts Medical Society
Disclosure: Merck Salary Employment

CME Editor

Paul D Petry, DO, FACOP, FAAP, Consulting Staff, Freeman Pediatric Care, Freeman Health System
Paul D Petry, DO, FACOP, FAAP is a member of the following medical societies: American Academy of Osteopathy, American Academy of Pediatrics, American College of Osteopathic Pediatricians, and American Osteopathic Association
Disclosure: Nothing to disclose.

Chief Editor

Timothy E Corden, MD, Associate Professor of Pediatrics, Co-Director, Policy Core, Injury Research Center, Medical College of Wisconsin; Associate Director, PICU, Children's Hospital of Wisconsin
Timothy E Corden, MD is a member of the following medical societies: American Academy of Pediatrics, Phi Beta Kappa, Society of Critical Care Medicine, and Wisconsin Medical Society
Disclosure: Nothing to disclose.

 
 
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