Alcoholic Metabolic Emergencies

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Key points

  • Hypoglycemia in the alcohol intoxicated adult is no more common than the rest of the population; children often have hypoglycemia with alcohol overdose.

  • Beer potomania can be treated with simple fluid restriction; isotonic resuscitation should be approached with caution.

  • Alcoholic ketoacidosis may not present with ketonemia.

  • Alcoholic encephalopathy syndromes, such as Wernicke encephalopathy and Korsakoff syndrome, should be treated with 500 mg intravenous thiamine every 8 hours.

Alcohol intoxication

Acute alcohol intoxication, herein referred to as “intoxication,” is defined as the pathologic state produced by the ingestion of alcohol. Blood alcohol levels (BAL) are sometimes used to supplement clinical decision-making in the ED, and a working understanding of the pharmacokinetics of ethanol is helpful in these circumstances. The degree and duration of symptoms of intoxication are governed by the body’s absorption, metabolism, and elimination of alcohol over time. Ethanol is absorbed

Intoxication and the endocrine system

Alcohol can cause clinical abnormalities of endocrine function. Its effects on gonadal function, bone and mineral metabolism derangements, and glucocorticoid secretion rarely result in acute illness requiring ED management.7 However, acute intoxication may result in alterations in glucose metabolism requiring emergency treatment.

Habitual drinkers who consume alcohol in the absence of other nutrition have a theoretical risk of developing hypoglycemia. Fasting states deplete existing glycogen

Hyponatremia: A Consequence of Beer Potomania

First described in a 1971 case series, beer potomania is alcohol-induced hyponatremia found in alcohol users with concomitant poor nutritional supplementation. A large percentage of the patients in that initial case series consumed greater than or equal to 4 L of beer per day in the days preceding hospitalization.11 The lone consumption of large quantities of beer causes total body deficiencies in sodium and protein. Because of the kidney’s inability to match water excretion with the high

Summary

The spectrum of metabolic derangements due to the habitual and recreational use of alcohol is vast. Emergency physicians must be vigilant when treating the intoxicated and altered patient. Many of the disease states previously discussed are curable if managed in a timely fashion. Furthermore, many of the conditions discussed within this article are preventable with abstinence from alcohol; as physicians, we should always attempt to engage our patients in discussions regarding health maintenance

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