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Source: Doering PL, Li RM. Substance-Related Disorders: Alcohol, Nicotine, and Caffeine. In: DiPiro JT, Talbert RL, Yee GC, Matzke GR, Wells BG, Posey LM, eds. Pharmacotherapy: A Pathophysiologic Approach. 8th ed. Accessed June 11, 2012.

  • Acute detoxification and withdrawal after chronic alcohol abuse a serious condition that can require hospitalization and adjunctive pharmacotherapy. Death may ensue if blood alcohol concentration (BAC) high enough.

  • Alcohol absorption begins in stomach within 5–10 minutes of ingestion.
  • Peak concentrations usually achieved 30–90 minutes after finishing last drink.
  • Alcohol metabolized by alcohol dehydrogenase to acetaldehyde, which is further metabolized to carbon dioxide and water by aldehyde dehydrogenase.
  • There is 14 g of alcohol in 12 oz of beer, 4 oz of wine, or 1.5 oz (one shot) of 80-proof whiskey. This amount increases BAC by 20–25 mg/dL (4.3–5.4 mmol/L) in healthy 70-kg man. Deaths from alcohol intoxication generally occur when BACs >500 mg/dL (87–109 mmol/L).
  • Alcohol withdrawal includes 2 main components:
  • History of cessation or reduction in heavy and prolonged alcohol use
  • Presence of two or more of symptoms of alcohol withdrawal.

  • Slightly more than half of Americans (approximately 129 million people) aged 12 or older reported being current drinkers of alcohol in a 2008 survey.
    • 23.3% (58.1 million) participated in binge drinking.
    • 6.9% reported heavy drinking.

Signs and Symptoms

  • Signs and symptoms of alcohol intoxication:
    • Slurred speech
    • Ataxia
    • Incoordination
    • Sedation
    • Nystagmus
    • Impaired judgment
    • Unconsciousness
    • Nausea
    • Vomiting
    • Respiratory depression
    • Coma
  • Signs and symptoms of alcohol withdrawal:
    • Tachycardia
    • Diaphoresis
    • Hyperthermia
    • Hallucinations
    • Delirium
    • Seizures
  • Table 1 relates effects of alcohol to BAC.

Table 1. Specific Effects of Alcohol Related to Blood Alcohol Concentration

Laboratory Tests

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