Emergency Medicine, Fondazione Policlinico Universitario A. Gemelli IRCCS, Università Cattolica del Sacro Cuore, Rome, Italy.
Eur Rev Med Pharmacol Sci. 2020 Sep;24(17):9121-9128. doi: 10.26355/eurrev_202009_22859.
Acute alcohol intoxication is actually a common admission cause in the Emergency Department and represents an increasing public health burden, in particular among adolescents. It involves possible and significant illness and injury, which can quickly get worse and may need to be managed in the emergency room.
We conducted a narrative review of the literature regarding the effectiveness of first aid role of the Emergency Department setting.
This review included eighteen studies about alcohol intoxication management in the Emergency Department; most of all highlights the emerging phenomenon in Europe and around the world of acute alcohol intoxication management in first aid. The treatment of acute alcohol intoxication depends on general clinical conditions of the patient, vital signs, hemodynamic stability, cognitive state, alcohol-related complications, which are closely related to the blood alcohol concentration. At the same time, symptoms could be extremely variable due to individual differences in alcohol metabolism. In case of mild-moderate intoxication (blood alcohol concentration < 1 g/L), no drugs are necessary. In case of severe intoxication (blood alcohol concentration > 1 g/L), it is necessary to support with intravenous fluids, treat hypoglycemia, hypotension, hypothermia and electrolyte imbalance, administer complex B and C vitamins and accelerate alcohol elimination from blood with metadoxine. Unlike adults, adolescents are more exposed to the toxic effect of alcohol (because of their immature hepatic alcohol dehydrogenase activity), and then, acute alcohol-related complications are more frequent and dangerous in young people than in adult population. In many cases, patients affected by acute alcohol intoxication referring to an Emergency Department have mild-moderate transitory symptoms that do not require the use of drugs; they can benefit from a clinical observation, with a clinical course often completed within 24 hours with a favorable outcome. Clinical observation with vital signs control is necessary also to evaluate the possible development of the alcohol withdrawal syndrome (that involves a specific treatment) and to evaluate also possible pathological complications of the organism, above all acute liver damage.
Patients affected by acute alcohol intoxication are the best candidates to apply the rules of the Temporary Observation Unit in the Emergency Department, because of a clinical course often completed within 24 hours, a favorable outcome and without the need for hospitalization. In many cases, hospitalization could be not necessary, but the patient affected by Alcohol Use Disorder must be referred to an Alcohol Addiction Unit for the follow-up, to reduce the risk of alcohol relapse and complications related to alcohol abuse, and financial costs of hospitalization.
急性酒精中毒实际上是急诊科常见的入院原因，尤其在青少年中，这构成了日益严重的公共卫生负担。它可能导致严重的疾病和伤害，这些问题会迅速恶化，可能需要在急诊室进行治疗。
我们对急诊科急救作用的相关文献进行了叙述性综述。
该综述纳入了 18 项关于急诊科酒精中毒管理的研究；其中大多数都强调了在欧洲和世界各地出现的急性酒精中毒急救管理新现象。急性酒精中毒的治疗取决于患者的一般临床状况、生命体征、血流动力学稳定性、认知状态、酒精相关并发症，这些都与血液酒精浓度密切相关。同时，由于个体间酒精代谢的差异，症状可能会有极大的不同。在轻度至中度中毒（血液酒精浓度<1g/L）的情况下，不需要使用药物。在重度中毒（血液酒精浓度>1g/L）的情况下，需要静脉补液支持，治疗低血糖、低血压、低体温和电解质失衡，给予复合 B 族和 C 族维生素，并使用美他多辛加速血液中酒精的消除。与成年人不同，青少年更容易受到酒精的毒性影响（因为他们的肝内酒精脱氢酶活性不成熟），因此，年轻人的急性酒精相关并发症比成年人群更频繁、更危险。在许多情况下，到急诊科就诊的急性酒精中毒患者有轻度至中度的短暂症状，不需要使用药物；他们可以受益于临床观察，通常在 24 小时内完成临床病程，结果良好。有必要进行生命体征控制的临床观察，以评估酒精戒断综合征（需要特定治疗）的可能发展，评估机体的可能病理性并发症，尤其是急性肝损伤。
急性酒精中毒患者是急诊科临时观察单元规则的最佳适用者，因为其临床病程通常在 24 小时内完成，结果良好，且无需住院。在许多情况下，住院可能是不必要的，但必须将患有酒精使用障碍的患者转至酒精成瘾单位进行随访，以降低酒精复发和与滥用酒精相关的并发症的风险，并降低住院的经济成本。
