Alcohol intoxication/drunkeness

Other names Drunkenness, ethanol intoxication.

Alcohol intoxication, also known in overdose as alcohol poisoning,commonly described as drunkenness or inebriation.

Drunkenness is the behavior and physical effects caused by a recent consumption of alcohol.

Ethanol is the main psychoactive component of alcoholic beverages, and other physiological symptoms may arise from the activity of acetaldehyde, a metabolite of alcohol.

These effects may not arise until hours after ingestion and may contribute to the hangover condition.

Symptoms of intoxication at lower doses may include mild sedation and poor coordination, whereas with higher doses, there may be slurred speech, trouble walking, and vomiting.

Extreme doses of alcohol may result in a respiratory depression, coma, or death.

Complications may include seizures, aspiration pneumonia, injuries including suicide, and low blood sugar.

Alcohol intoxication can lead to alcohol-related crime with perpetrators more likely to be intoxicated than victims.

Alcohol intoxication can begin after two or more alcoholic drinks.

Alcohol has abuse risk factors include a social situation where heavy drinking is common and a person having an impulsive personality.

Diagnosis is usually based on the history of events and physical examination.

Legally, alcohol intoxication is often defined as a blood alcohol concentration (BAC) of greater than 25–80 mg/dL or 0.025–0.080%.

This can be measured by blood or breath testing.

Alcohol is broken down in the human body at a rate of about 15 mg/dL per hour, depending on an individual’s metabolic rate.

Management of alcohol intoxication involves supportive care: maintaining recovery position, keeping the person warm, and making sure breathing is sufficient.

Gastric lavage and activated charcoal have not been found to be useful in alcohol intoxication.

Some effects of alcohol intoxication, such as euphoria and lowered social inhibition promote alcohol’s desirability.

Alcohol is metabolized by a normal liver at the rate of about 8 grams of pure ethanol per hour (8 grams or 10 mL (0.34 US fl oz).

Livers with hepatitis, cirrhosis, gall bladder disease, and cancer are likely to result in a slower rate of metabolism.

Ethanol is metabolized to acetaldehyde by alcohol dehydrogenase (ADH), which is found in many tissues, including the gastric mucosa. 

Acetaldehyde is metabolized to acetate by acetaldehyde dehydrogenase (ALDH), which is found predominantly in liver mitochondria. 

Acetate is used by the muscle cells to produce acetyl-CoA using the enzyme acetyl-CoA synthetase, and the acetyl-CoA is then used in the citric acid cycle.

As drinking increases, individuals become sleepy or fall into a stupor. 

After a very high level of consumption the respiratory system becomes depressed and the person could stop breathing. 

Comatose patients may aspirate their vomit, resulting in vomitus in the lungs, which may cause pneumonia.

CNS depression and impaired motor coordination along with poor judgment increase the risks of accidental injury.

About one-third of alcohol-related deaths are due to accidents and another 14% are from intentional injury.

Alcohol causes respiratory failure and accidents caused by its effects on the central nervous system, and  significant metabolic derangements. 

Hypoglycemia occurs due to ethanol’s inhibition of gluconeogenesis, especially in children, and may cause lactic acidosis, ketoacidosis, and acute kidney injury. 

Metabolic acidosis is compounded by respiratory failure. 

Patients may also present with hypothermia.

Alcohol affects many neurotransmitter systems in the brain.

Molecular pharmacology studies have shown that alcohol has facilitatory, and  inhibitory effects on a number of systems.

Among the neurotransmitter systems with enhanced functions are: GABAA, 5-HT3 receptor agonism responsible for GABAergic (GABAA receptor PAM), glycinergic, and cholinergic effects nicotinic acetylcholine receptors.

Alcohol is also converted into phosphatidylethanol, a lipid metabolite, which binds to and regulates ion channels, resulting in neurotransmitter and neuropeptide systems changes leading to behavioral or symptomatic effects of alcohol intoxication.

The order in which different types of alcoholic beverages are consumed does not have any effect on alcohol intoxication.

Many of the effects of activating GABAA receptors have the same effects as that of ethanol consumption: include anxiolytic, anticonvulsant, sedative, and hypnotic effects, cognitive impairment, and motor incoordination.

GABAA receptors containing the δ-subunit have been shown to be located exterior to the synapse and are involved with tonic inhibition rather than its γ-subunit counterpart.

The δ-subunit has been shown to be able to form the allosteric binding site which makes GABAA receptors containing the δ-subunit more sensitive to ethanol concentrations, even to moderate social ethanol consumption levels/

GABAA receptors that contain both δ and β3-subunits display increased sensitivity to ethanol.

Location of GABAA receptors within the synapse may also contribute to ethanol sensitivity.

Alcohol intoxication is described as a mental and behavioural disorder, with definitive diagnosis relying on a blood test for alcohol, usually performed as part of a toxicology screen. 

Law enforcement officers in the United States and other countries often use breathalyzer units and field sobriety tests as more convenient and rapid alternatives to blood tests.

To determine whether someone is intoxicated by alcohol by some means other than a blood-alcohol test, it is necessary to rule out other conditions such as hypoglycemia, stroke, usage of other intoxicants, mental health issues, etc.

Acute alcohol intoxication can mimic other acute neurological disorders or is frequently combined with other recreational drugs that complicate diagnosis and treatment.


Acute alcohol poisoning is a medical emergency due to the risk of death from respiratory depression or aspiration of vomit if vomiting occurs while the person is unresponsive. 

Emergency treatment: stabilizing and maintain an open airway and sufficient breathing while waiting for the alcohol to metabolize. 

Removing any vomit or, if the person is unconscious or has impaired gag reflex, intubation of the trachea.

Other measures may include:

Administer the vitamin thiamine to prevent Wernicke–Korsakoff syndrome.

Hemodialysis if the blood concentration is very high at >130  mmol/L (>600 mg/dL)

Provide oxygen therapy as needed via nasal cannula or non-rebreather mask.

Administration of intravenous fluids in cases involving hypoglycemia and electrolyte imbalance.

The medication metadoxine may speed the breakdown of alcohol, is approved in a number of countries in Europe, as well as India and Brazil.

Additional medication may be indicated for treatment of nausea, tremor, and anxiety.

Alcohol intoxication is prevalent in populations treated for trauma, and particularly in the age group of people aged within their 18th – 24th years.

The acute confusional state caused by alcohol withdrawal, is known as delirium tremens.

People having drunk heavily for several days or weeks may have withdrawal symptoms after the acute intoxication has subsided.

The  liver detoxifies the blood of alcohol over a period of time that depends on the initial level and the patient’s overall physical condition. 

An abnormal liver will take longer but still succeeds, provided the alcohol does not cause liver failure.

Patients who persistently consume a dangerous amount of alcohol can develop memory blackouts and idiosyncratic intoxication or pathological drunkenness symptoms.

Long-term consumption of excessive amounts of alcohol can cause liver damage and have other deleterious health effects.

Alcohol intoxication is a risk factor in some cases of catastrophic injury.

Alcohol use is also associated with unsafe sex.

In the United States, it is a criminal offense for a person to be drunk while driving a motorized vehicle, except in Wisconsin, where it is only a fine for the first offense.

In some countries, it is an offense to serve alcohol to an already-intoxicated person,

The blood alcohol content (BAC) for legal operation of a vehicle is typically measured as a percentage of a unit volume of blood: In the United States  it is .08%.

The United States Federal Aviation Administration prohibits crew members from performing their duties within eight hours of consuming an alcoholic beverage, while under the influence of alcohol, or with a BAC greater than 0.04%.

In the United States public intoxication is a crime.

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