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Alcohol intoxication delirium — Clinical Guidelines

Overview

Alcohol intoxication delirium is a severe complication characterized by acute confusion and altered mental status secondary to excessive alcohol consumption, affecting various age groups including pediatric patients 1 10.

Diagnosis

Clinical Presentation: Confusion, disorientation, agitation, or stupor 1 10.

Laboratory Tests: Blood alcohol concentration (BAC) measurement is crucial for diagnosis 9 10.

Additional Assessments: Glasgow Coma Score (GCS) can aid in assessing severity 7.

Toxicology Screen: Often includes BAC to confirm intoxication 10.

Management

Supportive Care: Airway protection, hydration (oral or IV if necessary), and monitoring vital signs 6.

Intravenous Fluids: Use cautiously; evidence varies, consult guidelines 6.

Vitamin Supplementation: Consider testing for and treating vitamin deficiencies, particularly B12 8.

Environmental Control: Safe environment to prevent injury; consider specialized units like 'drunk tanks' in some contexts 5.

Special Populations

Pediatrics: Growing concern with increasing cases in pediatric emergency departments 1.

Elderly: Higher risk of delirium and complications; careful monitoring required 10.

Comorbidities: Presence of underlying conditions may exacerbate symptoms; individualized care needed 10.

Key Recommendations

Measure Blood Alcohol Concentration (BAC) for definitive diagnosis and management planning (Evidence: Strong 9 10).

Provide Supportive Care Including Airway Management and Hydration to address immediate physiological needs (Evidence: Moderate 6).

Consider Vitamin Deficiency Screening in intoxicated patients, especially B12, due to potential deficiencies (Evidence: Weak 8).

Implement Policies Encouraging EMS Utilization to ensure timely medical intervention without fear of legal repercussions (Evidence: Moderate 2 4).

References

1 Castro-Rodríguez C, Lorente-Romero J, Rivas-García A, García-Loygorri CF, Vázquez-López P, Marañón R. Acute Alcohol Intoxication in Pediatric Emergencies. Pediatric emergency care 2022. link 2 Roberts S, Murugesan A, Tolson J, Patanwala AE, Rice AD, Beskind D et al.. Can Emergency Medical Services Utilization Rates Be Used to Measure the Success of An Alcohol Amnesty Policy?. Prehospital emergency care 2021. link 3 Sanvisens A, Sanjeevan I, Zuluaga P, Túnez A, de Francisco A, Papaseit E et al.. Five-Year Incidence of Hospital-Based Emergencies Related to Acute Recreational Intoxication in Minors. Alcoholism, clinical and experimental research 2019. link 4 Monahan BV, Nable JV, WinklerPrins V. Implementation of an Alcohol Medical Amnesty Policy at an Urban University With a Collegiate-Based Emergency Medical Services Agency. The Journal of adolescent health : official publication of the Society for Adolescent Medicine 2019. link 5 . 'Drunk tanks' discussed. Emergency nurse : the journal of the RCN Accident and Emergency Nursing Association 2014. link 6 Hindmarch PN, Land S, Wright J. Emergency physicians' opinions on the use of intravenous fluids to treat patients intoxicated with ethanol (alcohol): attitudes of emergency medicine physicians in the North East of England toward the use of intravenous fluids to treat individuals intoxicated with ethanol (alcohol) attending the emergency department compared with the scientific evidence. European journal of emergency medicine : official journal of the European Society for Emergency Medicine 2012. link 7 Binner C, Selinski S, Barysch MJ, Pölcher C, Schormann W, Hermes M et al.. Munich Oktoberfest experience: remarkable impact of sex and age in ethanol intoxication. Archives of toxicology 2008. link 8 Li SF, Jacob J, Feng J, Kulkarni M. Vitamin deficiencies in acutely intoxicated patients in the ED. The American journal of emergency medicine 2008. link 9 Denney RC. The Intoximeter 3000 and the four minute fallacy. Medicine, science, and the law 1998. link 10 Malcolm JB, Benjamin B, Sorbie AL, Auchterlonie IA. Alcohol intoxication, an underdiagnosed problem?. Archives of disease in childhood 1985. link 11 Shults SD, Layne NR. Age and BAC when arrested for drunken driving and public drunkenness. Journal of studies on alcohol 1979. link 12 Cameron D, Spence MT, Drewery J. Rate of onset of drunkeness. A preliminary study. Journal of studies on alcohol 1978. link 13 Smart RG. Effects of two liquor store strikes on drunkenness, impaired driving and traffic accidents. Journal of studies on alcohol 1977. link 14 Hayslip B, Kapusinski D, Darbes A, Zeh R. Evaluation of driving-while-intoxicated programs; some methodological considerations. Journal of studies on alcohol 1976. link

Alcohol intoxication delirium