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tox_ethanol

ethanol intoxication/poisoning

the drunk alcoholic in the ED

Mx in ED

  • strongly consider investigating for other causes or associated conditions:
    • vital signs including temperature and neuro obs
    • finger prick blood glucose
    • breathalyzer to document BAC
    • IV access and bloods for FBE, U&E, LFTs, lipase, CRP, ethanol and others as indicated
    • Group and hold / crossmatch / clotting profile if suspect major trauma or GIT bleed
    • targeted investigations:
      • CT brain if decreased GCS and suspicion of head injury or focal neurologic signs
      • trauma investigations (eg. CT Cx spine, CXR) if suspicion of trauma
      • serum ammonia if hepatic flap, etc
      • sepsis workup if high CRP, fever, hypothermia or other suspicion of sepsis
      • ECG especially if possible co-ingestants or chest pain
      • CXR if possible aspiration, sepsis or trauma
      • serum paracetamol if possible suicidal intent or self-poisoning
      • serum CK if possible rhabdomyolysis from prolonged collapse on ground
  • adequate visual examination particularly looking for evidence of trauma, focal neurology and hepatic encephalopathy
  • PR exam if suggestion of GIT bleed (eg. history dark stools, hypotension, or raised urea)
  • bladder scan to exclude urinary retention especially if in pain or agitated
  • supportive care
  • manage airway if excessively sedated
  • whilst in hospital, place on an alcohol withdrawal chart and prescribe 10-20mg oral diazepam 2-6hrly APP up to 60mg/d if GCS is not depressed.
    • do not discharge patient with diazepam - it is only for use whilst in hospital.
  • all patients should be given iv thiamine ASAP (NOT oral as this is not absorbed well in alcoholics)
  • when appropriate, offer information and referral for addiction medicine (drug and alcohol) to aid detoxification.
tox_ethanol.txt · Last modified: 2021/02/23 13:09 by gary1