Clinical Features

Symptoms and signs of ethanol intoxication include slurred speech, nystagmus, disinhibited behavior, central nervous system depression, and decreased motor coordination and control. A lowering of usual blood pressure or even hypotension may occur secondary to ethanol-mediated decrease in total peripheral resistance or as a result of volume loss. Reflex tachycardia may also be observed. When hypotension is present, causes other than ethanol intoxication must be considered. Morbidity and mortality in association with acute intoxication are predominantly the result of accidental injuries, often motor vehicle collisions, related to ethanol-induced deficits in judgment or physical capabilities.

Because of the phenomenon of tolerance, blood alcohol levels correlate poorly with degree of intoxication. While death from respiratory depression may occur in unhabituated individuals at concentrations of 400 to 500 mg/dL, it is not uncommon for some alcoholics to appear minimally intoxicated if at all at blood concentrations as high as 400 mg/dL.5 Although most states have adopted 100 or 80 mg/dL as the legal definition of intoxication for the purposes of driving a motor vehicle, there is considerable evidence to suggest that impairment may be seen with levels as low as 5 mg/dL, especially in unhabituated individuals.

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