Ethanol

Mechanism of Toxicity

Enhances effects of GABA

• Induces release of serotonin and dopamine

Effects

CNS Depressant

• Respiratory depression and coma at high levels

Wernicke Encephalopathy

• Confusion, ataxia, ophthalmoplegia

Treated with glucose and thiamine

Hepatitis/Liver Failure

Alcohol Withdrawal

Can be life threatening, onset with abstinence of alcohol 

Symptoms/Signs:

• Anxiety/Agitation

• Psychosis

• Tachycardia

• Tremor/Tongue fasciculations

• Seizures (risk peaks approximately 24 hours after cessation)

Treatment of withdrawal

• Benzodiazepines

• Thiamine/Folate/Glucose (Wernicke's Encephalopathy, folate deficiency)

• Electrolyte management

• Other agents: Dexmedetomidine, barbiturates, antipsychotics

Alcohol Use Disorder

Individuals who engage in risky or hazardous drinking behavior

Treatments

• Behavioral counseling

•  Acamprosate (improves abstinence)

•  Naltrexone (decreased consumption)

  Lower-level evidence:

• Disulfiram (promotes reaction to alcohol consumption)

• Topiramate (decreased consumption)

• Ondansetron (decreased consumption)