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Referral and warning signs
When to refer
Refer to Hospital (H) if: Significant CNS depression (coma), Respiratory depression, Hypotension, Hypothermia, Hypoglycemia, Seizures, Suspected head injury or other trauma, Suspected co-ingestion.
Red flags
- Coma (GCS ≤ 8)
- Respiratory depression (RR < 10/min or shallow)
- Hypotension
- Hypothermia (<35°C)
- Hypoglycemia
- Signs of trauma
Signs and symptoms
- Smell of alcohol on breath
- Slurred speech (dysarthria)
- Uninhibited behaviour
- Altered cognition and perception
- Impaired judgment, poor coordination (ataxia)
- Nausea and vomiting
- Excessive sweating (diaphoresis)
- Dilated pupils (variable)
- Hypoglycemia (especially children, malnourished)
- Hypothermia
- Stupor, Coma
- Respiratory depression (slow, shallow breathing)
- Hypotension, Thready pulse (in severe cases)
Risk factors
- Deliberate excessive consumption (binge drinking)
- Accidental ingestion (esp. children)
- Rapid consumption
- Low body weight
- Lack of tolerance (naive users)
Diagnosis
Clinical assessment
Based on history of recent large alcohol intake and clinical signs of intoxication. Crucial to rule out other causes of altered mental status, especially head injury and hypoglycemia.
Investigations
- Point-of-care Blood Glucose: ESSENTIAL
- Blood Alcohol Concentration (BAC) / Breathalyzer (if available)
- Consider: Electrolytes, ABG (if severe respiratory depression), Trauma workup (CT Head if injury suspected), Lumbar Puncture (if meningitis suspected).
Diagnostic criteria
Clinical presentation consistent with alcohol intoxication +/- Measured elevated BAC, after excluding other life-threatening causes.
Management
Non-pharmacological management
- Airway management (recovery position, intubation if GCS<8 or aspiration risk).
- Breathing support (oxygen, assisted ventilation if needed).
- Circulation support (IV fluids for dehydration/hypotension).
- Temperature management (rewarming for hypothermia).
- Observation until clinically sober.
Pharmacological treatment
- IV Dextrose (Adult: 50% 20-50ml; Child: 10% 5ml/kg) if hypoglycemic or glucose cannot be checked.
- Thiamine 100 mg IV/IM BEFORE or with glucose if chronic use or malnutrition suspected.
- Supportive care only; no specific antidote.
Monitoring
Frequent monitoring of vital signs, GCS, respiratory status, blood glucose.
Complications
- Aspiration pneumonia
- Respiratory arrest
- Hypoglycemia
- Hypothermia
- Trauma
- Wernicke's encephalopathy precipitation (if thiamine given after glucose)
- Death
Prevention
- Moderation in alcohol consumption
- Avoidance of binge drinking
- Safe storage away from children
Patient education
- Dangers of excessive alcohol consumption.
- Risks of binge drinking.
- Avoid driving while intoxicated.
Uganda-specific notes
Common presentation. Always check glucose. Consider co-ingestion or methanol poisoning if illicit brew involved. Thiamine essential if malnutrition/chronic use suspected.
References
- Uganda Clinical Guidelines (UCG) 2023
Chapter 1, Section 1.3.12.1