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

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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

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Chronic Ethanol Abuse

Gastrointestinal Manifestations

• Elevation of Hepatic Transaminases with Hepatocellular Injury (see Drug-Induced Hepatotoxicity, [[Drug-Induced Hepatotoxicity]])
  • Alcoholic Hepatitis (see Alcoholic Hepatitis, [[Alcoholic Hepatitis]])
• Acute Pancreatitis (see Acute Pancreatitis, [[Acute Pancreatitis]])
• Increased Risk of Hepatic Encephalopathy (see Hepatic Encephalopathy, [[Hepatic Encephalopathy]])

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

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Ethanol Withdrawal

Clinical

• Delirium (see Delirium, [[Delirium]])

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

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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]