Ethanol

Indications for Pharmacologic Ethanol Administration

  • Ethylene Glycol Intoxication (see Ethylene Glycol, [[Ethylene Glycol]]): competes with
    • Mechanism: competes with ethylene glycol for alcohol dehydrogenase (alcohol dehydrogenase enzyme has higher affinity for ethanol and becomes saturated at an ethanol level between 13-30 mg/dL), preventing formation of toxic metabolites
      • The half-life of ethylene glycol is prolonged to about 17 hrs in the presence of ethanol infusion
  • Methanol Intoxication (see Methanol, [[Methanol]])
    • Mechanism: competes with methanol for alcohol dehydrogenase (alcohol dehydrogenase enzyme has higher affinity for ethanol and becomes saturated at an ethanol level between 13-30 mg/dL), preventing formation of toxic metabolites

Administration

  • xxx

Adverse Effects

Neurologic Adverse Effects

  • xxx
  • xxx

Other Adverse Effects

  • xxx
  • xxx

Acute Ethanol Intoxication

Diagnosis

Elevated Osmolal Gap (see Serum Osmolality, [[Serum Osmolality]])

  • xxx

Arterial Blood Gas (ABG)

  • xxxx

Ethanol Level

  • Diagnostic

Clinical Manifestations

Neurologic Manifestations

  • Ataxia (see Ataxia, [[Ataxia]])
  • Delirium (see Delirium, [[Delirium]])
  • Loss of Inhibition

Renal Manifestations

Elevated Osmolal Gap with/without Alcoholic Ketoacidosis (AKA) (see Serum Osmolality, [[Serum Osmolality]] and Alcoholic Ketoacidosis, [[Alcoholic Ketoacidosis]])

  • Physiology
  • Clinical

Other Manifestations

  • xxx
  • xxx

Treatment

  • Abstinence from Ethanol

Chronic Ethanol Abuse

Gastrointestinal Manifestations

Hematologic Manifestations

  • Sideroblastic Anemia (see Anemia, [[Anemia]])
  • Thrombocytopenia (see Thrombocytopenia, [[Thrombocytopenia]]): due to impaired platelet production

Neurologic Manifestations

  • xxxx (see xxxx, [[]])
  • xxxx (see xxxx, [[]])

Other Manifestations

  • xxx

Treatment

  • Abstinence from Ethanol

Ethanol Withdrawal

Clinical

Treatment

  • Benzodiazepines (see Benzodiazepines, [[Benzodiazepines]])
    • Chlordiazepoxide (Librium)
    • Diazepam (Valium)
    • Lorazepam (Ativan)
    • Midazolam (Versed)
  • Clonidine (see Clonidine, [[Clonidine]]): adjunct to benzodiazepines
  • Dexmedetomidine (Precedex) (see Dexmedetomidine, [[Dexmedetomidine]]): adjunct to benzodiazepines
    • Decreases benzodiazepine dosing, decreases alcohol withdrawal scoring, and blunts hyperadrenergic cardiovascular responses

References

Ethanol Withdrawal

  • Role of α2-agonists in the treatment of acute alcohol withdrawal. Ann Pharmacother. 2011 May;45(5):649-57 [MEDLINE]
  • Dexmedetomidine as adjunct treatment for severe alcohol withdrawal in the ICU. Ann Intensive Care. 2012 May 23;2(1):12 [MEDLINE]