Treatment of Ethanol Poisoning

Acute Poisoning

1. Airway protection - if necessary, provide ventilator support.
2. Correction of hypoglycemia - give 250 mL of 10% glucose IV fluids. If hypoglycemia persists, give 50 mL of 50% dextrose, titrated to requirement and monitored by blood glucose.
3. Correction of hypotension - by IV fluids.
4. Ondansetron and naltrexone are better than any other medications (for nausea/vomiting and as opioid antagonist adjunct).
5. If the person does not regain consciousness even after dextrose/glucose infusion, this indicates cerebral edema due to irreversible neuronal damage, or poisoning by another drug/medicine - treat accordingly.
6. Chronic addicts - give intravenous thiamine 50 mg in 50-100 mL IV fluid (to prevent Wernicke's encephalopathy).
7. Hemodialysis - is 3-4 times more effective than all the above treatments to eliminate ethanol.

Chronic Poisoning

1. Treatment of Withdrawal:

• Carbamazepine - effective, including for Delirium tremens (DTs).
• Chlormethiazole - popularly used in western countries in reducing doses over a week, but has potential for addiction.
• Clonidine - 60-80 mg/h IV.
• Gamma-hydroxybutyric acid (GHB) - 50 mg/kg orally.
• Vitamins - E, C, and beta-carotene as supplementation.

2. Aversion Therapy (Deaddiction / Conditioned Reflex Treatment):

• Aim is to wean off addiction gradually (detoxification process).
• The most common drug used for deaddiction is disulfiram (tetraethylthiuram / ethylthiurame).
• Disulfiram interferes with the oxidative metabolism of ethanol at the acetaldehyde stage, causing acetaldehyde accumulation, which produces unpleasant symptoms when the patient consumes alcohol.
• This aversive reaction gradually leads the patient to avoid alcohol entirely.

• Hypoglycemia and hypotension are the two main acute metabolic emergencies.
• Thiamine is mandatory in chronic alcoholics before giving glucose (to prevent precipitating Wernicke's).
• Hemodialysis is the most effective method of elimination.
• Disulfiram is the classic drug for aversion therapy in chronic alcoholism.