Dawaa Reference

Clinical reference

Acute Alcohol Intoxication

Treatment options, dosing, cautions and Egyptian brands from the shipped Dawaa Reference card.

Evidence status

Checked against the sources named below

Sources3 sources

Ethanol Toxicity - StatPearls - NCBI Bookshelf (NBK557381) - https://www.ncbi.nlm.nih.gov/books/NBK557381/ · MSF Essential Drugs 2024 (THIAMINE = VITAMIN B1 injectable monograph) - msf-essential-drugs-2024.txt · ICPC-3 (WONCA International Classification of Primary Care, 3rd edition) class PS13 - condition scope only, no dose

Verified against2 documents
  • Ethanol Toxicity - StatPearls (NBK557381), treatment section - thiamine recommended, no amount stated
  • MSF Essential Drugs 2024, THIAMINE = VITAMIN B1 injectable - 100 mg IM or IV 3 times daily for 3 to 5 days

Verified date2026-09

Presentation reference

Is it this?

Reference only, to read alongside your own examination.

Symptoms — what the patient reports (3)

  • Complains of nausea, vomiting and diarrhoea [diarrhoea · nausea · vomiting]
  • At low blood levels: relaxation, talkativeness, clumsy fine movements
  • Double vision and amnesia once blood alcohol climbs [double vision · memory loss]

Signs — what you find (8)

  • Slurred speech, clumsiness, nystagmus and memory loss support the diagnosis [memory loss · nystagmus · slurred speech]
  • Judgement and coordination become impaired as the level rises
  • Unsteady gait with slurred speech and mood or behaviour change [slurred speech]
  • Low body temperature, dysarthria and nystagmus at higher levels [hypothermia · nystagmus · slurred speech]
  • Above 0.4%, breathing is depressed and coma or death can follow [coma]
  • Skin signs include telangiectasia, spider naevi, palmar erythema and muscle wasting [muscle wasting · redness · telangiectasia]
  • Tolerance can leave a heavy drinker alert and steady at levels that would floor others
  • Re-examine: injuries may surface only as the intoxication wears off

Tests (7)

  • Full electrolyte panel plus liver function tests
  • Metabolic upsets include lactic acidosis and low glucose, potassium, magnesium, calcium and phosphate
  • ECG, since alcohol can set off atrial and ventricular tachydysrhythmias
  • Repeat the ECG if an arrhythmia is found; most settle as alcohol clears
  • Holiday heart syndrome, a new arrhythmia such as atrial fibrillation after a binge
  • Brain CT where the mental state is altered and no full history is obtainable
  • Psychiatric assessment, repeated when lucid, if suicidal talk or gestures occur

If not this — what else fits (6)

  • Head trauma, sepsis or central nervous system infection
  • Seizure, or poisoning by something other than ethanol
  • Too hot or too cold, thyroid disturbance, hypoxia, metabolic derangement
  • Non-beverage alcohol - cologne, cough syrup, isopropyl
  • Wernicke encephalopathy or hepatic encephalopathy, once drinking is established
  • Any of these can sit alongside the intoxication rather than replace it

Scores

  • CAGE questionnaire — Is this drinking a problem?

SourceStatPearls "Ethanol Toxicity" - disease-level clinical article

Presentation findings are traced to the source above.

Rx: Thiamine, if the picture is Wernicke's encephalopathy or delirium tremens | Main treatment

THIAMINE, IF THE PICTURE IS WERNICKE'S ENCEPHALOPATHY OR DELIRIUM TREMENS

1

THIAMINE

Thiamine, if the picture is Wernicke's encephalopathy or delirium tremens

1st line

Strength100 mg

Forminjection

Adult dose and duration

100 mg by intramuscular injection, or by very slow intravenous injection over 30 minutes, 3 times daily x 3 to 5 days

Paediatric dose

No source on file states a thiamine dose for a child with acute alcohol intoxication. MSF's paediatric thiamine amounts are written for infantile beriberi, which is a different illness, so none of them is printed here. A child who has drunk alcohol is referred.

Dose source

MSF Essential Drugs 2024 (THIAMINE = VITAMIN B1 injectable monograph, delirium tremens and Wernicke's encephalopathy)

Why

The Ethanol Toxicity article recommends routine thiamine for a patient with alcohol use disorder, especially where the mental status is altered, and states no amount; it reasons that occult thiamine deficiency and Wernicke encephalopathy are hard to detect and carry a high mortality, so the balance favours giving it. The amount comes from MSF, whose thiamine monograph doses exactly that picture. The two sources are named separately because they answer different questions - one says give it, the other says how much.

Cautions
  • Egypt's register lists no single-ingredient thiamine preparation, injectable or oral. Vitamin B1 appears only inside B-complex ampoules and tablets whose thiamine content the register does not state, so read the ampoule's own label before giving the amount above.
  • Anaphylaxis and hypotension are reported with intravenous thiamine. The monograph requires a very slow intravenous injection over 30 minutes; the intramuscular route avoids that risk.
  • Check a point-of-care glucose. Many patients with alcohol use disorder have depleted glycogen stores, and the Ethanol Toxicity article treats hypoglycaemia before replenishing vitamins such as thiamine.
  • Thiamine treats the deficiency, not the intoxication. A reduced level of consciousness still needs emergency assessment.
Egyptian brands

No Egyptian brand matched — prescribe by generic name.

MAIN TREATMENT

2

OBSERVATION, AIRWAY AND GLUCOSE (REFERRAL & ADVICE)

1st line
Adult dose and duration

Acute impairment from alcohol use presenting with disinhibition, poor coordination, or reduced consciousness; mild intoxication is observed until sober, while significant impairment of consciousness or suspected co-ingestion needs emergency assessment, since there is no specific antidote. - Refer, with advice

Paediatric dose

A child who has drunk alcohol follows the same pathway: recognise and refer. The thiamine amount printed above is an adult amount and no source states one for a child in this illness.

Dose source

No dose - observation, airway protection and glucose, then referral

Why

Acute impairment from alcohol use presenting with disinhibition, poor coordination, or reduced consciousness; mild intoxication is observed until sober, while significant impairment of consciousness or suspected co-ingestion needs emergency assessment, since there is no specific antidote.

Cautions
  • Rare in Egyptian primary care.
  • Ethanol itself has no antidote. Thiamine is given for the deficiency that goes with alcohol dependence, not to reverse the intoxication; the rest of the management is observation, airway protection and glucose.
  • RED FLAG - A reduced level of consciousness or an inability to protect the airway (aspiration risk) is an emergency. Refer also for signs of head injury or hypoglycaemia coexisting with the intoxication, or suspected co-ingestion of another drug.

Prices are indicative (dataset snapshot 2026-06); verify with the pharmacy.