# Acute Alcohol Intoxication - Category: chronic - Review status: reviewed (every claim checked against a document named on this page) - 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 date: 2026-09 ## Verified against - 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 ## Treatment metadata - Thiamine — 100 mg — injection - Observation, airway and glucose (Referral & Advice) ## Complete treatment card ```text ACUTE ALCOHOL INTOXICATION 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 Review status: REVIEWED against 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 (2026-09) 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 Score CAGE questionnaire - Is this drinking a problem? Source StatPearls "Ethanol Toxicity" - disease-level clinical article Status 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 [1st line] Adult 100 mg by intramuscular injection, or by very slow intravenous injection over 30 minutes, 3 times daily x 3 to 5 days Peds 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. 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. Caution 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. Egypt no Egyptian brand matched - prescribe by generic name MAIN TREATMENT 2. OBSERVATION, AIRWAY AND GLUCOSE (REFERRAL & ADVICE) [1st line] Adult 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 Peds 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. 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. Caution 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. ``` --- Dawaa Reference is a reference for prescribers, not a medical device, and does not replace clinical judgement. [Privacy policy](/privacy)