Alcohol Intoxication

Age: ‍ years old

Gender: ‍malefemale



HISTORY:

Presents with alcohol intoxication

Alcohol intake: ‍ ‍beerwinespirit drinks in the past ‍ ‍hoursdays

Typical pattern of alcohol consumption: ‍social drinkingbinge drinkingdaily useheavy drinking

Behavioral changes noted by: ‍selffamilyfriendslaw enforcement

Attempts to reduce or stop alcohol consumption: ‍yesno

Presence of tolerance: ‍yesno

Withdrawal symptoms when not drinking: ‍yesno



Associated symptoms: *Try using right-click for negatives*

‍slurred speech

‍incoordination

‍unsteady gait

‍impaired attention

‍decreased level of consciousness

‍aggressiveness

‍mood lability

‍impaired judgment

‍nausea

‍vomiting, ‍ episodes ‍per day, ‍, ‍hematemesis

‍depressed mood

‍suicidal ideation

‍homicidal ideation



Contributing factors:

‍recent stressors

‍social or environmental cues

no history of: ‍liver disease, ‍pancreatitis, ‍gastritis, ‍neurological disorders

no use of: ‍illicit drugs, ‍sedatives





EXAM:

General appearance: ‍well-appearing, ‍apparent distress

Vital signs: ‍normal, BP ‍, HR ‍, RR ‍, SpO2 ‍ %, Temp ‍°

Neck: ‍normal, ‍lymphadenopathy, ‍, c-spine ‍

Heart: ‍RRR, ‍MRG, ‍normal S1 and S2

Lungs: ‍clear bilaterally, ‍abnormal sounds, ‍retractions

Abdomen: ‍soft, ‍non-tender ‍, ‍non-distended, ‍

Extremities: ‍warm, ‍dry, cap refill ‍< 3> 3 sec, pulses ‍intact, ‍edema ‍bilaterally, ‍

Neurologic: cranial nerves ‍intact, strength ‍intact 5/5, sensation ‍intact, reflexes ‍intact 2+, cerebellar function ‍intact, gait ‍steady

Mental status: ‍alert, ‍oriented, speech ‍clear, mood ‍normal, thought ‍organized, ‍suicidal ideation, judgment ‍good





ASSESSMENT:

‍Alcohol intoxication ‍confirmedlikelysuspected

DDx: acute alcohol intoxication, alcohol use disorder, substance use disorder, substance-induced mood disorder, substance-induced anxiety disorder, wernicke-korsakoff syndrome, hepatic encephalopathy, pancreatitis, gastrointestinal bleeding, infections, electrolyte imbalances, dehydration, thiamine deficiency, head trauma, intracranial hemorrhage, sepsis, benzos intoxication, psychiatric disorders





PLAN:

Investigations:

- Blood work: ‍CBC, ‍electrolytes, ‍creatinine, ‍glucose, ‍LFTs, ‍INR, ‍ethanol level

- Urine toxicology screen

- ECG

Treatments:

- Monitor vital signs

- ‍IV fluids

- ‍Thiamine

- ‍Anti-emetics

- ‍Sedatives for agitation

- ‍Multivitamin

Further care:

- Observation until sober

- Referral to addiction services

- Referral to social worker

- Referral to psychologist

- Safe transport home

- Admission if no safe discharge plan

- Follow-up in ‍ ‍daysweeks

- Return if symptoms worsen or if new symptoms develop such as confusion, seizures, or persistent vomiting