Acute alcohol intoxication is a common problem which has become more prevalent with the rise in alcohol consumption particularly by the young and women, both of whom have a lower tolerance of this popular social poison.
Whilst there may be some small health benefits from modest alcohol consumption as part of a healthy diet and lifestyle, the adverse effects of excessive alcohol intake both in the short and long terms are well documented. This section deals with the nutritional care of those who are intoxicated.
For those who think that they may be drinking excessively in the long term please see the section on “Alcohol misuse” at NHS Direct www.nhsdirect.nhs.uk/articles/article.aspx?articleId=10
Severe intoxication may require medical treatment if the following problems are present:
Many of those with alcohol excess will benefit from:
For those who are going to go out drinking it is prudent to eat a good-size balanced meal several hours beforehand, which will help to reduce the immediate adverse nutritional effects of alcohol.
Acute alcohol intoxication will typically produce unsteadiness, slurring of speech and mild confusion. However the same picture may also result from severe deficiency of vitamin B1 - thiamine, which if not corrected can lead to permanent brain damage. This is unlikely to happen as a result of a few episodes of intoxication and is more likely to occur in those who have been drinking regularly, especially large amounts of beer, are eating poorly and frequently miss meals are underweight or are otherwise unwell.
The syndrome of severe vitamin B1 – thiamine deficiency is termed Wernicke’s Encephalopathy, WE, which is impossible to differentiate from acute alcohol intoxication. The persistence of confusion, unsteadiness or double vision 24-48 hours after ceasing drinking means that Wernicke’s Encephalopathy is a real possibility, which should be assessed by an experienced doctor. See Acute Thiamine Deficiency.
Important facts about alcohol-induced vitamin B1 deficiency:
Wernicke’s Encephalopathy is often not recognised in life and studies have shown that as many as 90% of cases are only diagnosed at post-mortem. Additionally repeated episodes of WE can lead to even more serious brain damage, Korsakoff’s Psychosis, which is characterised by a loss of memory for both recent and new events which the sufferer tries to cover by confabulating. Such individuals are alert and orientated and thus initially appear quite normal. As a rule they are unemployed/unemployable and have broken relationships.
In view of the above the current widely accepted practice, nationally and internationally, is to administer parenteral (usually intravenous) replacement therapy to all high-risk patients undergoing treatment of alcohol withdrawal syndrome in inpatient settings, especially if they show signs of chronic malnutrition. Such a situation is preventable by the prompt treatment of alcohol-induced vitamin B1 deficiency as well as alcohol abstention and attention to a better diet.
Sustained regular excessive drinking even without obvious nutritional deficiencies developing is associated with brain shrinkage and loss of intellectual and neurological function, which is not always reversible.
Medical intervention to aid alcohol withdrawal using drug treatment and psychological support is available from the NHS and is of benefit. Attention to the person’s nutritional state is likely to be relevant and oral thiamine 100 mg three times daily with Vitamin B Compound Strong three times daily is often appropriate for those in primary care for as long as there is the possibility of malnutrition.
Folate supplements may also be required and those with macrocytosis on their Full Blood Count should have their folate status checked.
Maintenance with thiamine 50 mg one daily and Vitamin B Compound Strong two daily is also reasonable and may need to be continued indefinitely in those who continue to drink. www.cks.library.nhs.uk/alcohol_problem_drinking/view_whole_topic_review
The Royal College of Physicians Report on Alcohol: Guidelines for Managing Wernicke’s Encephalopathy in the Accident and Emergency Department. Thomson AD, Cook CCH, Touquet R, Henry JA. Alcohol and Alcoholism Vol 37, No. 6, pp513-521, 2002. See report here.
All doctors involved in the acute care of emergency patients should read the entire article.
Sgouros X et al. Evaluation of a Clinical Screening Instrument to Identify State of Thiamine Deficiency in Inpatient with Severe Alcohol Dependence Syndrome. Alcohol and Alcoholism Vol 39, No.3, pp227-232, 2004. http://alcalc.oxfordjournals.org/cgi/content/full/39/3/227#TBL3