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Alcohol IntoxicationAPPROACH

TOXICOLOGY AND BEHAVIORAL · 19 SECTIONS

⚲

597 items

☷ Legend

⚲

Resuscitation and Universal Approaches9▾

Chest and Cardiovascular12▾

Respiratory11▾

Abdominal and Gastrointestinal24▾

Renal and Urinary7▾

Neurologic11▾

Back and Neck8▾

Women's Health, Pregnancy, and GU11▾

Infectious Disease and Fever Syndromes11▾

Allergy and Dermatology7▾

Musculoskeletal and Extremities14▾

Trauma and Wounds14▾

ENT, Eye, Dental10▾

Endocrine, Metabolic, and Abnormal Labs9▾

Toxicology and Behavioral14▾

Undifferentiated Overdose Opioid Toxicity Opioid Withdrawal Alcohol Intoxication Alcohol Withdrawal Stimulant Toxicity Pediatric Ingestion Carbon Monoxide Exposure Inhalational Or Chemical Exposure Suicidal Ideation And Self Harm Risk Assessment Acute Psychosis And Mania Symptoms Anxiety And Panic Symptoms Capacity Assessment And Safe Disposition Behavioral Escalation And Restraint Considerations

Pediatrics16▾

Environmental and Exposure4▾

01History/hx59

Presentation context

›Exposure and timeline

›Time last known well

›Time of first symptoms

›Time of last alcohol intake

›Type of alcohol

›Estimated amount

›Pattern of use

›Binge pattern

›Daily heavy use pattern

›Co-ingestion possibility

›Opioids

›Benzodiazepines

›Stimulants

›Cannabis

›Sedating antihistamines

›GHB

›Acetaminophen

›Salicylates

›Toxic alcohols

›Methanol

›Ethylene glycol

›Isopropanol

›Intent

›Accidental intoxication

›Self harm intent

›Unsafe use context

›Associated symptoms

02Alarm Features/alarm35

Immediate threats

›Resuscitation triggers

›Airway threat

›GCS 8 or less

›Recurrent vomiting with poor airway reflexes

›Stridor

›Inability to maintain oxygenation

›Breathing threat

›RR under 10

›SpO2 under 92 percent on room air

›Persistent hypoventilation

›Circulation threat

›SBP under 90 mmHg

›HR over 130

›Ongoing major bleeding

›Neurologic threat

›New focal deficit

›Seizure

›Persistent coma not explained by ethanol alone

›Temperature threat

›Hypothermia under 35 C

›Hyperthermia over 40 C

High risk patterns suggesting alternate diagnosis

›Disproportionate findings

›Severe acidosis on blood gas

›Elevated anion gap metabolic acidosis

›Osmolar gap elevation

›Marked hypoglycemia

03Medications/meds23

Medication and substance inventory

›Current agents affecting mentation

›Opioids

›Benzodiazepines

›Z drugs

›Antipsychotics

›Antidepressants

›Antihistamines

›Gabapentinoids

›Muscle relaxants

›High risk interactions

›Alcohol plus opioids

›Alcohol plus benzodiazepines

›Alcohol plus sedating antihistamines

›Toxicology relevant prescribed drugs

›Insulin and secretagogues

›Anticoagulants

›Beta blockers

›Calcium channel blockers

›TCAs

›Recent changes

›New prescription within 7 days

›Missed doses

›Overuse or double dosing

04Diet/diet10

Intake and contributors

›Recent intake

›Poor oral intake

›Prolonged fasting

›Dehydration risk

›Alcohol related nutrition risk

›Malnutrition risk

›Wernicke risk pattern

›Caffeine and energy drinks

›Co-use with alcohol

›Palpitations risk context

05Review of Systems/ros28

System screen to detect alternate diagnoses

›Neurologic

›Headache

›Visual changes

›Weakness

›Numbness

›Seizure

›Cardiopulmonary

›Chest pain

›Dyspnea

›Palpitations

›Cough

›GI

›Abdominal pain

›Hematemesis

›Melena

›Persistent vomiting

›Infectious

›Fever

›Rigors

›Dysuria

›Endocrine and metabolic

›Polyuria

›Polydipsia

›Weight loss

›Trauma

›Neck pain

›Back pain

06Collateral History and Family History/chafh16

Collateral and reliability

›Collateral sources

›EMS report

›Police report

›Friends

›Family

›Shelter staff

›Reliability considerations

›Witnessed ingestion

›Witnessed trauma

›Access to other substances

Family history relevant to altered mental status

›Neurologic history

›Seizure disorders

›Early stroke

›Cardiac history

›Sudden cardiac death under 50 years

›Inherited arrhythmia syndromes

07Risk Factors/rf27

Patient factors increasing severity or complications

›Alcohol use disorder risk

›Daily heavy use

›Prior severe withdrawal

›Aspiration and airway risk

›Active vomiting

›Reduced gag reflex

›Bleeding and trauma risk

›Anticoagulation

›Frequent falls

›Metabolic vulnerability

›Diabetes mellitus

›Chronic kidney disease

›Chronic liver disease

›Special populations

›Pregnancy

›Older adult

›Adolescents

›Immunocompromised

Exposure risks

›Co-ingestion risk

›Access to sedatives

›Access to opioids

›Access to antifreeze

›Access to windshield washer fluid

›Environmental risks

›Hypothermia exposure

›Drowning risk

08Differential Diagnosis/ddx54

Life threatening

›Cannot miss causes of depressed consciousness

›Hypoglycemia

›Diaphoresis

›Seizure

›Opioid toxicity

›Bradypnea

›Miosis

›Intracranial hemorrhage

›Anticoagulation

›Focal deficit

›Severe traumatic brain injury

›Signs of head trauma

›Persistent low GCS

›Sepsis

›Fever or hypothermia

›Hypotension

›Toxic alcohol ingestion

›Anion gap metabolic acidosis

›Visual symptoms

›Carbon monoxide poisoning

›Multiple affected

›Headache with exposure

›Diabetic ketoacidosis

›Tachypnea

›Ketone elevation

Common

›Common causes

09Past Medical History/pmh20

Relevant conditions and prior events

›Substance and psychiatric history

›Alcohol use disorder (F10.20)

›Prior withdrawal seizures

›Prior delirium tremens

›Opioid use disorder

›Medical comorbidities

›Diabetes mellitus

›Epilepsy

›Coronary artery disease

›Chronic liver disease

›Chronic kidney disease

›Prior injuries and complications

›Prior intracranial hemorrhage

›Prior aspiration pneumonia

Procedures and devices

›Relevant procedures

›Bariatric surgery

›GI bleeding interventions

›Implanted devices

›Pacemaker

›ICD

10Physical Exam/exam52

Initial survey and vitals interpretation

›ABCDE focused exam

›Airway

›Gurgling

›Vomitus in airway

›Breathing

›Work of breathing

›Hypoventilation pattern

›Circulation

›Skin perfusion

›Capillary refill

›Disability

›GCS components

›Pupils

›Exposure

›Temperature

›Hidden trauma

›Vital sign danger patterns

›Hypotension with altered mentation

›Hypoxia with normal mental status baseline

›Fever with altered mentation

Neuro and toxidrome exam

›Neurologic

›Level of consciousness

›Orientation

›Speech

›Gait if safe

›Focal deficits

11Lab Studies/labs44

Core tests and decision logic

›Point of care glucose

›If low, treat immediately without delay

›Recheck after treatment

›Electrolytes and renal function

›Sodium

›Potassium

›Bicarbonate

›Creatinine

›Venous blood gas

›pH

›pCO2 mmHg

›Serum ethanol concentration

›Correlate trend with clinical course

›Poor correlation in tolerant patients

›Anion gap and osmolar gap framework

›If anion gap metabolic acidosis, broaden differential

›If osmolar gap elevated, consider toxic alcohols

›Acetaminophen concentration

›Obtain if overdose possible despite unclear history

›Time of ingestion often unreliable

›Salicylate concentration

›Obtain if tachypnea or tinnitus

›Mixed respiratory alkalosis and metabolic acidosis pattern

›Pregnancy test

›Reproductive age patients

›Guides imaging and medication choices

12Imaging/img32

Scoring Systems

›Neurologic severity tools

›Glasgow Coma Scale

›Tracks depressed consciousness severity

›Guides airway and imaging thresholds

›RASS

›Quantifies agitation and sedation

›Supports sedation titration

›Head injury decision tools when trauma suspected

›Canadian CT Head Rule

›Use in minor head injury with GCS 13 to 15

›Not for anticoagulated with high concern outside criteria

MRI

›MRI brain considerations

›Consider if persistent altered mental status after ethanol clearance

›Consider if focal deficit with nondiagnostic CT

›Contraindications

›Non MRI compatible implanted device

›Metallic foreign body risk

›CT head without contrast

›If new focal deficit

›If persistent low GCS not explained by ethanol alone

›If head trauma with anticoagulation

›If witnessed fall with concerning features

›CT cervical spine

›If midline tenderness

›If high risk mechanism

13Special Tests/spec12

Bedside and procedural diagnostics

›Capnography

›If hypoventilation concern

›If receiving sedatives

›Bedside swallow and airway protection screen

›If oral intake planned in ED

›If recurrent vomiting history

›Serum ketones

›If nausea and vomiting with metabolic acidosis

›Supports alcoholic ketoacidosis vs DKA

›Lumbar puncture triggers

›If fever with persistent altered mental status

›If meningismus or immunocompromise

14ECG/ecg19

ECG use and high risk findings

›Indications in intoxication

›Co-ingestion possibility

›Chest pain

›Syncope

›Abnormal vital signs

›Conduction and toxicity clues

›QRS widening

›TCA or sodium channel blockade concern

›Consider sodium bicarbonate therapy pathway

›QTc prolongation

›Antipsychotics

›Methadone

›Hypokalemia or hypomagnesemia

›Brugada pattern

›Fever induced unmasking

›Sodium channel blocker co-ingestion

›Rhythm concerns

›Atrial fibrillation with rapid ventricular response

›Ventricular ectopy with stimulant co-use

15Assessment/ax29

Working diagnosis and severity

›Acute alcohol intoxication (F10.129)

›Mild

›Ambulatory with minimal assistance

›Protecting airway

›Moderate

›Significant ataxia

›Requires close observation

›Severe

›Depressed consciousness

›Airway risk

›Key alternate diagnoses to exclude

›Hypoglycemia

›Point of care glucose result supports

›Persistent symptoms despite correction prompts reassessment

›Head injury

›Trauma evidence supports

›Anticoagulation increases risk

›Polysubstance intoxication

›Mixed toxidrome supports

›Unexpected course supports

Complications and uncertainty

›Complications to monitor for

›Aspiration

›Hypothermia

›Rhabdomyolysis

›Alcoholic ketoacidosis

›If course atypical, expand evaluation

16Plan/plan69

Approach to the critical patient

›First 5 minutes

›Monitoring

›Cardiac monitor

›Pulse oximetry

›Capnography if hypoventilation risk

›IV access

›At least 1 large bore IV if moderate or severe

›2 large bore IV if shock or major trauma concern

›Glucose

›Immediate point of care glucose

›If low, dextrose immediately

›Oxygenation and ventilation

›Supplemental oxygen if SpO2 under 92 percent

›Bag valve mask ventilation if hypoventilation

›Airway escalation

›If GCS 8 or less, prepare for airway management

›If recurrent vomiting with poor reflexes, prepare for airway management

Differential Management

›!Alcohol intoxication→›!Hypoglycemia→›Traumatic brain injury (moderate-severe)→

Targeted therapies

›Hypoglycemia treatment

›Dextrose IV

›Adult D50W 25 g IV

›If ongoing risk, D10W infusion titrated to euglycemia

›Thiamine timing

17Disposition/dispo28

Level of care and criteria

›ICU criteria

›Intubated or impending airway failure

›Refractory hypoventilation

›Hemodynamic instability

›Severe metabolic acidosis

›Recurrent seizures

›Inpatient admission criteria

›Aspiration pneumonia suspicion with hypoxia

›Significant traumatic injury

›Persistent altered mental status after ethanol clearance window

›Alcoholic ketoacidosis requiring ongoing therapy

›High risk withdrawal expected

›Prior delirium tremens

›Prior withdrawal seizures

›Observation pathway criteria

›Moderate intoxication needing serial exams

›Uncertain co-ingestion with stable vitals

›Mild trauma needing monitoring

›Discharge criteria

›Clinically sober

›Normal conversation

›Ambulates safely

›Vital signs stable

›Airway protected

›No evidence of serious alternate diagnosis

›Safe discharge plan

›Reliable supervision

18Discharge Instructions/di25

Copy discharge instructions

›Diagnosis

›Alcohol intoxication

›Symptoms improved with observation and supportive care

›Medications

›Avoid alcohol with sedating medications

›Avoid driving or operating machinery today

›Activity

›Rest today

›No driving today

›Hydration and nutrition

›Drink water or oral rehydration fluids

›Eat when able

›Follow up

›Primary care follow up within 1 week

›Substance use treatment resources local protocol dependent

›Return to ED now for

›Trouble breathing

›Repeated vomiting

›Chest pain

›New confusion

›Fainting

›Seizure

›Severe headache

›Weakness or numbness

›Any new injury concerns

19References/r15

Guidelines and core resources

›NICE guideline CG100 Alcohol use disorders diagnosis and management of physical complications 2010 updated

›Includes Wernicke encephalopathy management principles

›Local protocol adaptation often required

›Royal College of Physicians Alcohol use disorders acute care guidance 2010s local protocol dependent

›Supports thiamine use in malnutrition risk

›Emphasizes complications screening

›American Academy of Clinical Toxicology core principles of toxic alcohol evaluation 2002 to 2015 era statements

›Supports osmolar gap and anion gap framework limitations

›Emphasizes early antidote when suspected

›American Heart Association ACLS guidelines 2020

›Airway and ventilation priorities in altered mental status

›Cardiac arrest and bradycardia pathways if deterioration

›CDC clinical guidance on carbon monoxide poisoning updated periodically

›Exposure history and pulse oximetry limitations

›Hyperbaric oxygen criteria local protocol dependent

Evidence & Review

Reviewed by SymptomDx Medical Team · Last reviewed February 24, 2026

SymptomDx is an educational tool for medical professionals. It does not replace clinical judgment. Verify all clinical data and drug dosages with authoritative sources.

Alcohol IntoxicationAPPROACH

TOXICOLOGY AND BEHAVIORAL · 19 SECTIONS

⚲

597 items

☷ Legend

⚲

Resuscitation and Universal Approaches9▾

Chest and Cardiovascular12▾

Respiratory11▾

Abdominal and Gastrointestinal24▾

Renal and Urinary7▾

Neurologic11▾

Back and Neck8▾

Women's Health, Pregnancy, and GU11▾

Infectious Disease and Fever Syndromes11▾

Allergy and Dermatology7▾

Musculoskeletal and Extremities14▾

Trauma and Wounds14▾

ENT, Eye, Dental10▾

Endocrine, Metabolic, and Abnormal Labs9▾

Toxicology and Behavioral14▾

Pediatrics16▾

Environmental and Exposure4▾

01History/hx59

Presentation context

›Exposure and timeline

›Time last known well

›Time of first symptoms

›Time of last alcohol intake

›Type of alcohol

›Estimated amount

›Pattern of use

›Binge pattern

›Daily heavy use pattern

›Co-ingestion possibility

›Opioids

›Benzodiazepines

›Stimulants

›Cannabis

›Sedating antihistamines

›GHB

›Acetaminophen

›Salicylates

›Toxic alcohols

›Methanol

›Ethylene glycol

›Isopropanol

›Intent

›Accidental intoxication

›Self harm intent

›Unsafe use context

›Associated symptoms

02Alarm Features/alarm35

Immediate threats

›Resuscitation triggers

›Airway threat

›GCS 8 or less

›Recurrent vomiting with poor airway reflexes

›Stridor

›Inability to maintain oxygenation

›Breathing threat

›RR under 10

›SpO2 under 92 percent on room air

›Persistent hypoventilation

›Circulation threat

›SBP under 90 mmHg

›HR over 130

›Ongoing major bleeding

›Neurologic threat

›New focal deficit

›Seizure

›Persistent coma not explained by ethanol alone

›Temperature threat

›Hypothermia under 35 C

›Hyperthermia over 40 C

High risk patterns suggesting alternate diagnosis

›Disproportionate findings

›Severe acidosis on blood gas

›Elevated anion gap metabolic acidosis

›Osmolar gap elevation

›Marked hypoglycemia

03Medications/meds23

Medication and substance inventory

›Current agents affecting mentation

›Opioids

›Benzodiazepines

›Z drugs

›Antipsychotics

›Antidepressants

›Antihistamines

›Gabapentinoids

›Muscle relaxants

›High risk interactions

›Alcohol plus opioids

›Alcohol plus benzodiazepines

›Alcohol plus sedating antihistamines

›Toxicology relevant prescribed drugs

›Insulin and secretagogues

›Anticoagulants

›Beta blockers

›Calcium channel blockers

›TCAs

›Recent changes

›New prescription within 7 days

›Missed doses

›Overuse or double dosing

04Diet/diet10

Intake and contributors

›Recent intake

›Poor oral intake

›Prolonged fasting

›Dehydration risk

›Alcohol related nutrition risk

›Malnutrition risk

›Wernicke risk pattern

›Caffeine and energy drinks

›Co-use with alcohol

›Palpitations risk context

05Review of Systems/ros28

System screen to detect alternate diagnoses

›Neurologic

›Headache

›Visual changes

›Weakness

›Numbness

›Seizure

›Cardiopulmonary

›Chest pain

›Dyspnea

›Palpitations

›Cough

›GI

›Abdominal pain

›Hematemesis

›Melena

›Persistent vomiting

›Infectious

›Fever

›Rigors

›Dysuria

›Endocrine and metabolic

›Polyuria

›Polydipsia

›Weight loss

›Trauma

›Neck pain

›Back pain

06Collateral History and Family History/chafh16

Collateral and reliability

›Collateral sources

›EMS report

›Police report

›Friends

›Family

›Shelter staff

›Reliability considerations

›Witnessed ingestion

›Witnessed trauma

›Access to other substances

Family history relevant to altered mental status

›Neurologic history

›Seizure disorders

›Early stroke

›Cardiac history

›Sudden cardiac death under 50 years

›Inherited arrhythmia syndromes

07Risk Factors/rf27

Patient factors increasing severity or complications

›Alcohol use disorder risk

›Daily heavy use

›Prior severe withdrawal

›Aspiration and airway risk

›Active vomiting

›Reduced gag reflex

›Bleeding and trauma risk

›Anticoagulation

›Frequent falls

›Metabolic vulnerability

›Diabetes mellitus

›Chronic kidney disease

›Chronic liver disease

›Special populations

›Pregnancy

›Older adult

›Adolescents

›Immunocompromised

Exposure risks

›Co-ingestion risk

›Access to sedatives

›Access to opioids

›Access to antifreeze

›Access to windshield washer fluid

›Environmental risks

›Hypothermia exposure

›Drowning risk

08Differential Diagnosis/ddx54

Life threatening

›Cannot miss causes of depressed consciousness

›Hypoglycemia

›Diaphoresis

›Seizure

›Opioid toxicity

›Bradypnea

›Miosis

›Intracranial hemorrhage

›Anticoagulation

›Focal deficit

›Severe traumatic brain injury

›Signs of head trauma

›Persistent low GCS

›Sepsis

›Fever or hypothermia

›Hypotension

›Toxic alcohol ingestion

›Anion gap metabolic acidosis

›Visual symptoms

›Carbon monoxide poisoning

›Multiple affected

›Headache with exposure

›Diabetic ketoacidosis

›Tachypnea

›Ketone elevation

Common

›Common causes

09Past Medical History/pmh20

Relevant conditions and prior events

›Substance and psychiatric history

›Alcohol use disorder (F10.20)

›Prior withdrawal seizures

›Prior delirium tremens

›Opioid use disorder

›Medical comorbidities

›Diabetes mellitus

›Epilepsy

›Coronary artery disease

›Chronic liver disease

›Chronic kidney disease

›Prior injuries and complications

›Prior intracranial hemorrhage

›Prior aspiration pneumonia

Procedures and devices

›Relevant procedures

›Bariatric surgery

›GI bleeding interventions

›Implanted devices

›Pacemaker

›ICD

10Physical Exam/exam52

Initial survey and vitals interpretation

›ABCDE focused exam

›Airway

›Gurgling

›Vomitus in airway

›Breathing

›Work of breathing

›Hypoventilation pattern

›Circulation

›Skin perfusion

›Capillary refill

›Disability

›GCS components

›Pupils

›Exposure

›Temperature

›Hidden trauma

›Vital sign danger patterns

›Hypotension with altered mentation

›Hypoxia with normal mental status baseline

›Fever with altered mentation

Neuro and toxidrome exam

›Neurologic

›Level of consciousness

›Orientation

›Speech

›Gait if safe

›Focal deficits

11Lab Studies/labs44

Core tests and decision logic

›Point of care glucose

›If low, treat immediately without delay

›Recheck after treatment

›Electrolytes and renal function

›Sodium

›Potassium

›Bicarbonate

›Creatinine

›Venous blood gas

›pH

›pCO2 mmHg

›Serum ethanol concentration

›Correlate trend with clinical course

›Poor correlation in tolerant patients

›Anion gap and osmolar gap framework

›If anion gap metabolic acidosis, broaden differential

›If osmolar gap elevated, consider toxic alcohols

›Acetaminophen concentration

›Obtain if overdose possible despite unclear history

›Time of ingestion often unreliable

›Salicylate concentration

›Obtain if tachypnea or tinnitus

›Mixed respiratory alkalosis and metabolic acidosis pattern

›Pregnancy test

›Reproductive age patients

›Guides imaging and medication choices

12Imaging/img32

Scoring Systems

›Neurologic severity tools

›Glasgow Coma Scale

›Tracks depressed consciousness severity

›Guides airway and imaging thresholds

›RASS

›Quantifies agitation and sedation

›Supports sedation titration

›Head injury decision tools when trauma suspected

›Canadian CT Head Rule

›Use in minor head injury with GCS 13 to 15

›Not for anticoagulated with high concern outside criteria

MRI

›MRI brain considerations

›Consider if persistent altered mental status after ethanol clearance

›Consider if focal deficit with nondiagnostic CT

›Contraindications

›Non MRI compatible implanted device

›Metallic foreign body risk

›CT head without contrast

›If new focal deficit

›If persistent low GCS not explained by ethanol alone

›If head trauma with anticoagulation

›If witnessed fall with concerning features

›CT cervical spine

›If midline tenderness

›If high risk mechanism

13Special Tests/spec12

Bedside and procedural diagnostics

›Capnography

›If hypoventilation concern

›If receiving sedatives

›Bedside swallow and airway protection screen

›If oral intake planned in ED

›If recurrent vomiting history

›Serum ketones

›If nausea and vomiting with metabolic acidosis

›Supports alcoholic ketoacidosis vs DKA

›Lumbar puncture triggers

›If fever with persistent altered mental status

›If meningismus or immunocompromise

14ECG/ecg19

ECG use and high risk findings

›Indications in intoxication

›Co-ingestion possibility

›Chest pain

›Syncope

›Abnormal vital signs

›Conduction and toxicity clues

›QRS widening

›TCA or sodium channel blockade concern

›Consider sodium bicarbonate therapy pathway

›QTc prolongation

›Antipsychotics

›Methadone

›Hypokalemia or hypomagnesemia

›Brugada pattern

›Fever induced unmasking

›Sodium channel blocker co-ingestion

›Rhythm concerns

›Atrial fibrillation with rapid ventricular response

›Ventricular ectopy with stimulant co-use

15Assessment/ax29

Working diagnosis and severity

›Acute alcohol intoxication (F10.129)

›Mild

›Ambulatory with minimal assistance

›Protecting airway

›Moderate

›Significant ataxia

›Requires close observation

›Severe

›Depressed consciousness

›Airway risk

›Key alternate diagnoses to exclude

›Hypoglycemia

›Point of care glucose result supports

›Persistent symptoms despite correction prompts reassessment

›Head injury

›Trauma evidence supports

›Anticoagulation increases risk

›Polysubstance intoxication

›Mixed toxidrome supports

›Unexpected course supports

Complications and uncertainty

›Complications to monitor for

›Aspiration

›Hypothermia

›Rhabdomyolysis

›Alcoholic ketoacidosis

›If course atypical, expand evaluation

16Plan/plan69

Approach to the critical patient

›First 5 minutes

›Monitoring

›Cardiac monitor

›Pulse oximetry

›Capnography if hypoventilation risk

›IV access

›At least 1 large bore IV if moderate or severe

›2 large bore IV if shock or major trauma concern

›Glucose

›Immediate point of care glucose

›If low, dextrose immediately

›Oxygenation and ventilation

›Supplemental oxygen if SpO2 under 92 percent

›Bag valve mask ventilation if hypoventilation

›Airway escalation

›If GCS 8 or less, prepare for airway management

›If recurrent vomiting with poor reflexes, prepare for airway management

Differential Management

›!Alcohol intoxication→›!Hypoglycemia→›Traumatic brain injury (moderate-severe)→

Targeted therapies

›Hypoglycemia treatment

›Dextrose IV

›Adult D50W 25 g IV

›If ongoing risk, D10W infusion titrated to euglycemia

›Thiamine timing

17Disposition/dispo28

Level of care and criteria

›ICU criteria

›Intubated or impending airway failure

›Refractory hypoventilation

›Hemodynamic instability

›Severe metabolic acidosis

›Recurrent seizures

›Inpatient admission criteria

›Aspiration pneumonia suspicion with hypoxia

›Significant traumatic injury

›Persistent altered mental status after ethanol clearance window

›Alcoholic ketoacidosis requiring ongoing therapy

›High risk withdrawal expected

›Prior delirium tremens

›Prior withdrawal seizures

›Observation pathway criteria

›Moderate intoxication needing serial exams

›Uncertain co-ingestion with stable vitals

›Mild trauma needing monitoring

›Discharge criteria

›Clinically sober

›Normal conversation

›Ambulates safely

›Vital signs stable

›Airway protected

›No evidence of serious alternate diagnosis

›Safe discharge plan

›Reliable supervision

18Discharge Instructions/di25

Copy discharge instructions

›Diagnosis

›Alcohol intoxication

›Symptoms improved with observation and supportive care

›Medications

›Avoid alcohol with sedating medications

›Avoid driving or operating machinery today

›Activity

›Rest today

›No driving today

›Hydration and nutrition

›Drink water or oral rehydration fluids

›Eat when able

›Follow up

›Primary care follow up within 1 week

›Substance use treatment resources local protocol dependent

›Return to ED now for

›Trouble breathing

›Repeated vomiting

›Chest pain

›New confusion

›Fainting

›Seizure

›Severe headache

›Weakness or numbness

›Any new injury concerns

19References/r15

Guidelines and core resources

›NICE guideline CG100 Alcohol use disorders diagnosis and management of physical complications 2010 updated

›Includes Wernicke encephalopathy management principles

›Local protocol adaptation often required

›Royal College of Physicians Alcohol use disorders acute care guidance 2010s local protocol dependent

›Supports thiamine use in malnutrition risk

›Emphasizes complications screening

›American Academy of Clinical Toxicology core principles of toxic alcohol evaluation 2002 to 2015 era statements

›Supports osmolar gap and anion gap framework limitations

›Emphasizes early antidote when suspected

›American Heart Association ACLS guidelines 2020

›Airway and ventilation priorities in altered mental status

›Cardiac arrest and bradycardia pathways if deterioration

›CDC clinical guidance on carbon monoxide poisoning updated periodically

›Exposure history and pulse oximetry limitations

›Hyperbaric oxygen criteria local protocol dependent

Evidence & Review

Reviewed by SymptomDx Medical Team · Last reviewed February 24, 2026

SymptomDx is an educational tool for medical professionals. It does not replace clinical judgment. Verify all clinical data and drug dosages with authoritative sources.