Alcohol Intoxication

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What is alcohol intoxication?

Alcohol intoxication, also known as drunkenness, ethanol intoxication or alcohol poisoning, is the state of inebriation following acute alcohol consumption, or consumption of large amounts of alcohol within a short period of time. A large amount for men is equivalent to five or more drinks in two hours, and for women it’s four or more drinks within the same time frame.

Ethanol, or ethyl alcohol, is found in commercial alcoholic beverages and is most commonly associated with alcohol intoxication. However, other forms of alcohol intoxication resulting from accidental ingestion may also occur. They are described as follows:

• Methanol – It smells like ethanol, but it is found in antifreeze, solvents and fuel. A very small amount of methanol can cause intoxication and death. Like ethanol, methanol is a product of alcohol distillation, and it is sometimes found in alcoholic beverages that are incorrectly brewed at home. Individuals may consume alcoholic beverages tainted with methanol without knowing it, which is why home-distilled spirits are illegal in the United States.
• Ethylene glycol – Colorless and odorless, this type of alcohol is found in antifreeze, inhalants, solvents, hydraulic brake fluids, cosmetics and other consumer products. Ethylene glycol poisoning occurs when it is accidentally or intentionally ingested. Ethylene glycol abuse is common among teens who consume these household products for their sweet taste. Children sometimes accidentally drink it without intending any harm to themselves.
• Isopropanol – A form of alcohol also known as isopropyl alcohol, isopropanol is found in cleaning agents and antiseptics such as rubbing alcohol. Surprisingly, a number of children have been reported to have isopropanol poisoning from drinking or inhaling hand sanitizers, according to data published by the Centers for Disease Control and Prevention (CDC) in 2017. From 2011 to 2014, 70,669 children aged 12 and under were exposed to isopropanol intoxication from hand sanitizers, which often have scents that appeal to young children.

How prevalent is alcohol intoxication?

The rate of alcohol-related emergency-department (ED) visits has increased dramatically over a period of eight years, according to a study released by The National Institutes of Health (NIH). NIH researchers analyzed data from the Nationwide Emergency Department Sample (NEDS), assessing trends in emergency-department (ED) visits related to acute and chronic alcohol consumption among those aged 12 and older. They found that the rate rose by almost 50% from 2006 to 2014, equivalent to an increase from approximately 3 million to 5 million, signaling the negative impact of alcohol use on public health.

Individuals who are frequently hospitalized for alcohol intoxication are more likely to suffer from physical and psychological disorders. In a cohort study of patients visiting the emergency department for acute alcohol intoxication between 2012 and 2016, frequent users – those who went to the ED more than 20 times for acute intoxication in the previous 12 months – had higher rates of comorbidities, such as kidney disease, liver disease, traumatic brain injury, psychosis and bipolar disorder (Klein, Martel, Driver, Reing & Cole, 2018).

Who’s at risk for alcohol intoxication?

Women are more susceptible to alcohol intoxication than men for a number of reasons:

• Women are more likely to have higher blood alcohol concentration (BAC) levels than men when they consume the same amount of alcohol, because they have less dehydrogenase, an enzyme that metabolizes alcohol.
• Women are more easily intoxicated right before their period due to changes in hormone levels
• Women are likely to have higher percentages of body fat, a factor associated with higher BACs

Factors other than gender also affect the rate of alcohol intoxication, which may include the following:

• Percentage of alcohol in the beverage(s)
• Amount of alcohol ingested
• Individual body weight
• Individual hydration
• Level of tolerance
• Amount of food eaten before or during alcohol consumption
• Any drugs, prescribed or illicit, mixed with alcohol

Signs of alcohol intoxication

Nausea and vomiting
Alcohol is an irritant, and when it’s ingested in large amounts, it upsets the stomach and forces the body to throw up. In the long run, alcohol poisoning can lead to gastritis, a health condition characterized by irritation, inflammation and erosion of the stomach lining. Symptoms of gastritis include burning aches and pain in the abdominal area, dark stools, vomiting of blood, upset stomach between meals or at night, indigestion and loss of appetite.

Stupor
In a drunken stupor, the individual’s consciousness is subdued and becomes unresponsive to environmental stimuli with the exception of extreme stimulation such as loud noises, pain, bright lights and shock. The individual might appear conscious (i.e., the person’s eyes can follow objects) but he or she is mentally impaired and almost unconscious. Persistent patterns of heavy drinking leading to alcohol intoxication can have serious consequences, such as alcohol-induced psychosis, a condition characterized by an individual’s break from reality. The person may experience cognitive delusions, hallucinations, mood changes, and erratic behavior.

Slurred speech, swaying and staggering
The supplementary motor area of the brain is associated with movement, posture and coordination, and it is the same region of the brain responsible for language processing and speech production. When the body reaches a blood alcohol concentration level of 0.08%, this area of the brain is more affected than other parts of the brain, which explains why an intoxicated person sways, staggers, and slurs his or her words. Alcohol disrupts the signals in this region of the brain, slowing down voluntary motor control and reducing reaction time, which proves to be hazardous when one is operating a vehicle or other heavy machinery.

Bloodshot eyes/dilated pupils
Alcohol swells up the blood vessels in the eyes and distorts one’s vision. Short-term effects of alcohol intoxication on the optic nerves include increased sensitivity to light, headaches, involuntary rapid eye movement, slower pupil reaction (e.g., dilated pupils), and disrupted optical functioning resulting in double/blurred vision. Long-term alcohol consumption can lead to toxic amblyopia, also known as nutritional optic neuropathy, which is the gradual deterioration of vision characterized by vision-blurring and dimness. Toxic amblyopia, a condition resulting from a toxic reaction to alcohol or other toxic substances in the optic nerve, can develop over days to weeks, depending on usage and length of use.

Alcohol-induced aggression
Alcohol and aggression have been strongly linked, but not everyone who drinks gets aggressive. Aggression during alcohol intoxication depends on individual and contextual factors (Kuypers, Verkes, van den Brink, van Amsterdam & Ramaekers, 2018). Biological traits in individuals may predict alcohol induced aggression and impulsivity, according to the National Institute on Alcohol Abuse and Alcoholism (NIAAA). In addition to individual genetic and personality traits, chronic alcohol use, prior experiences of violence, expectations of alcohol’s effects, and early childhood environmental conditions – especially discrimination and social exclusion – contribute to the likelihood of aggression during intoxication (Beck & Heinz, 2013).

Sweating
Perspiration can occur after a person drinks too much alcohol. Sweating from alcohol intoxication results from the build up of toxins in the body when the liver cannot metabolize the excess amount of alcohol in the body. On average, the liver safely metabolizes one standard drink per hour; anything beyond that raises the blood alcohol concentration (BAC) more quickly. After drinking alcohol, people feel warm because alcohol changes the body’s temperature, enlarging the blood vessels and giving a flushed appearance (e.g., a flushed face and skin). Enlarged blood vessels triggers the sweat glands, and though the body may feel warmer, in reality the body’s temperature is dropping as heat produced by the vital organs moves from the body’s core to the skin’s surface via dilated blood vessels.

References

1 Beck, A., & Heinz, A. (2013). Alcohol-related aggression-social and neurobiological factors. Deutsches Arzteblatt international, 110(42), 711–715. doi:10.3238/arztebl.2013.0711

2 Klein, L. R., Martel, M. L., Driver, B. E., Reing, M., & Cole, J. B. (2018). Emergency Department Frequent Users for Acute Alcohol Intoxication. The western journal of emergency medicine, 19(2), 398–402. doi:10.5811/westjem.2017.10.35052

3 Kuypers KPC, Verkes RJ, van den Brink W, van Amsterdam JGC & Ramaekers JG. (2018). Intoxicated aggression: do alcohol and stimulants cause dose-related aggression? A review. European Neuropsychopharmacology. https://doi.org/

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