Dubowski's stages of alcohol influence and clinical signs and symptoms of drunkenness in relation to a person's blood-alcohol concentration-Historical background.

This article traces the origin of various charts and tables delineating the stages of alcohol influence in relation to the clinical signs and symptoms of drunkenness and a person's blood-alcohol concentration (BAC). In forensic science and legal medicine, the most widely used such table was created by Professor Kurt M. Dubowski (University of Oklahoma). The first version of the Dubowski alcohol table was published in 1957, and minor modifications appeared in various articles and book chapters until the final version was published in 2012. Seven stages of alcohol influence were identified including subclinical (sobriety), euphoria, excitement, confusion, stupor, alcoholic coma and death. The BAC causing death was initially reported as 0.45+ g%, although the latest version cited a mean and median BAC of 0.36 g% with a 90% range from 0.21 g% to 0.50 g%. An important feature of the Dubowski alcohol table was the overlapping ranges of BAC for each of the stages of alcohol influence. This was done to reflect variations in the physiological effects of ethanol on the nervous system between different individuals. Information gleaned from the Dubowski table is not intended to apply to any specific individual but more generally for a population of social drinkers, not regular heavy drinkers or alcoholics. Under real-world conditions, much will depend on a person's age, race, gender, pattern of drinking, habituation to alcohol and the development of central nervous tolerance. The impairment effects of ethanol also depend to some extent on whether observations are made on the rising or declining phase of the blood-alcohol curve (Mellanby effect). There will always be some individuals who do not exhibit the expected behavioral impairment effects of ethanol, such as regular heavy drinkers and those suffering from an alcohol use disorder.

Alcohol-Related Metabolic Emergencies.

Patients with alcohol use disorders are commonly identified and managed in the emergency department. Although the alcohol-intoxicated patient has a high risk for significant injury and diseases, the majority will be allowed to sober in the emergency department and can be discharged without incident. However, there are metabolic derangements in these patients, such as alcoholic ketoacidosis, Wernicke-Korsakoff, and potomania that very commonly present similar to intoxication and can be misdiagnosed by emergency clinicians.

Impact of the COVID-19 pandemic on emergency department alcohol intoxication presentations and positive screens for problem drinking.

Our aim was to assess the changes in patients presenting with acute alcohol intoxications or positive screens for problem drinking during the COVID-19 pandemic compared to before the pandemic in a seven-hospital health system. A retrospective chart review of emergency department (ED) visits from seven hospitals in the Washington, DC/Baltimore, and MD area from January 2019 to June 2021 is provided. The health system utilizes a validated system for Screening, Brief Intervention, and Referral to Treatment (SBIRT) for ED patients. We evaluated trends in patients who had a positive SBIRT screen for problem drinking (AUDIT-C score ≥ 3 in women, 4 in men), alcohol misuse (≥5), and those presenting with acute alcohol intoxication before March 2020 and during the early COVID pandemic period. There were 510 648 patients who were screened, ranging from ages of 16 to 95 years during the study period. There was an overall increase in patients who screened positive for problem drinking, alcohol misuse, and acute intoxications. While there was an overall decrease in the total number of ED visits during the start of the pandemic, which later increased near prepandemic levels, alcohol-related presentations as a percentage of total visits increased during the early pandemic period. There was an overall decrease in ED visits during the COVID-19 pandemic study period; problem drinking and acute intoxication presentation held steady, leading to an overall increase in proportion compared to pre-COVID-19 levels. Future research should focus on lessons learned during this time and should navigate the postpandemic care of patients with AUD. There was an increase in the proportion of ED visits for alcohol intoxications and positive screens for problem drinking during the COVID-19 pandemic in our seven-hospital system.

Detection of Alcohol Intoxication Using Voice Features: A Controlled Laboratory Study.

OBJECTIVE: Devices such as mobile phones and smart speakers could be useful to remotely identify voice alterations associated with alcohol intoxication that could be used to deliver just-in-time interventions, but data to support such approaches for the English language are lacking. In this controlled laboratory study, we compare how well English spectrographic voice features identify alcohol intoxication. METHOD: A total of 18 participants (72% male, ages 21-62 years) read a randomly assigned tongue twister before drinking and each hour for up to 7 hours after drinking a weight-based dose of alcohol. Vocal segments were cleaned and split into 1-second windows. We built support vector machine models for detecting alcohol intoxication, defined as breath alcohol concentration > .08%, comparing the baseline voice spectrographic signature to each subsequent timepoint and examined accuracy with 95% confidence intervals (CIs). RESULTS: Alcohol intoxication was predicted with an accuracy of 98% (95% CI [97.1, 98.6]); mean sensitivity = .98; specificity = .97; positive predictive value = .97; and negative predictive value = .98. CONCLUSIONS: In this small, controlled laboratory study, voice spectrographic signatures collected from brief recorded English segments were useful in identifying alcohol intoxication. Larger studies using varied voice samples are needed to validate and expand models.

Bottle mix-up: Ethanol intoxication in an infant.

Alcohol intoxication is a common ingestion in pediatrics with close to 10,000 reports to poison control centers annually. Hypoglycemia, neurological depression (ataxia, coma, nystagmus, etc.) and unstable vitals (hypothermia, hypotension, bradycardia, and respiratory depression) are common presentations. The patient is a 3 month old female who was brought into the Emergency Department (ED) for one day of decreased oral intake and inconsolability. Vital signs were reassuring. Physical exam revealed gaze preference to the right with inability to look left, dysconjugate gaze, and hypotonia. Work-up including CT of the head, and urinalysis was unremarkable. Urine drug screen was found to be positive for ethanol with follow up serum ethanol at 162 mg/dL. With conservative management the patient returned to her baseline. On follow-up with her pediatrician, it was elicited that the mother inadvertently used a water bottle of vodka to mix the patient's formula. This case adds to the paucity of literature of abnormal presentations of alcohol intoxication in an infant.

The establishment of a population-specific reference value for the ruler drop test for the clinical assessment of reaction time.

BACKGROUND: Reaction time (RT) is the interval between a stimulus and an appropriate voluntary response in an individual. Alcohol is known to result in delayed RT. In Sri Lanka, an alleged drunken driver is legally subjected to a medico-legal examination to confirm or exclude impairment. The guideline for examining a drunk person in Sri Lanka includes the ruler drop test (RDT) as a test of RT. RDT is a simple test of visual reaction time in which the subject attempts to stop a falling ruler, and the height fallen is used to determine the time taken to react to the event. However, a formal study has yet to be carried out to establish population-specific reference values to interpret RDT results. METHODS: A cross-sectional descriptive study was conducted using 903 adults ≥18 years. A nonparametric approach was applied for deriving the reference values based on an inter-percentile interval. RESULTS: The study population consisted of 56.6% females, and the mean age of the participants was 41.6 years. Most (95%) of the study population could catch the ruler at or less than 40.0 cm of average height. The average height on RDT increased from younger to older age groups. However, subgrouping based on other variables, including sex, age, and alcohol consumption, did not show any statistically significant difference. CONCLUSIONS: The population-specific cut-off limit to identify alcohol intoxication by RDT in a Sri Lankan adult is 'average height' >40 cm.

Identification and management of acute alcohol intoxication.

Acute alcohol intoxication (AAI) is a harmful clinical condition, potentially life-threatening, secondary to the intake of large amounts of alcohol. Clinical manifestations of AAI are characterized by behavioural and neurological symptoms, even if its effects involve several organs and apparatus. Moreover, severe alcohol intoxication can produce a global neurological impairment leading to autonomic dysfunction, respiratory depression, coma and cardiac arrest. The evaluation of blood alcohol concentrations (BAC) is useful to confirm the suspicion of intoxication, both for clinical and legal reasons. Most of patients with AAI are referred to Emergency Departments due to behavioural, social, traumatic or clinical complications. Patient's stabilization is the first step in the management of AAI, in order to support vital functions and to prevent complications. Metadoxine represents a useful drug to increase ethanol metabolism and elimination. Given that AAI could represent a sentinel event of chronic alcohol abuse, patients presenting with acute intoxication should be screened for the presence of an underlying alcohol use disorder and referred to and an alcohol addiction unit to start a multidisciplinary treatment to achieve long term alcohol abstinence. The present review will focus on clinical features, diagnostic criteria and treatment strategies of AAI.

Evaluating the influence of alcohol intoxication on the pre-hospital identification of severe head injury: a multi-center, cohort study.

OBJECTIVE: To determine the influence of intoxication on the pre-hospital recognition of severely head-injured patients by Emergency Medical Services (EMS) professionals and to investigate the relationship between suspected alcohol intoxication and severe head injury. METHODS: This multi-center, retrospective, cohort study included trauma patients, aged ≥ 16 years, transported by an ambulance of the Regional Ambulance Facility Utrecht to any emergency department in the participating trauma regions. RESULTS: Between January 1, 2015 and December 31, 2017, 19,206 patients were included, of whom 1167 (6.0%) were suspected to have a severe head injury in the field, and 623 (3.2%) were diagnosed with such an injury at the hospital. These injuries were less frequently recognized in patients with a GCS ≥ 13 than in patients with a GCS < 13 (25.0% vs. 76.2%). Patients suspected to be intoxicated had a higher chance to suffer from severe head injury (OR 1.42, 95%-CI 1.22-1.65) and were recognized slightly more often (45.3% vs. 40.2%). CONCLUSION: Severe head injuries are difficult to recognize in the field, especially in patients without a decreased GCS. Suspicion of alcohol intoxication did not seem to influence pre-hospital injury recognition, as it possibly makes a severe head injury harder to recognize and simultaneously raises caution for a severe injury.

Confectionary containing alcohol and their effect on breath analyzer results: a preliminary study.

Breath analyzers are commonly used to test alcohol intoxication, most often to detect elevated systemic levels of ethanol by employees during working hours or drink-driving drivers. Many scientific studies describe the effect of inhaled ethanol vapors in the ambient air or the application of mouthwash before the breath test. This preliminary study interprets false positivity of the breath test after consumption over-the-counter confectionery.

An Intelligent Online Drunk Driving Detection System Based on Multi-Sensor Fusion Technology.

Since drunk driving poses a significant threat to road traffic safety, there is an increasing demand for the performance and dependability of online drunk driving detection devices for automobiles. However, the majority of current detection devices only contain a single sensor, resulting in a low degree of detection accuracy, erroneous judgments, and car locking. In order to solve the problem, this study firstly designed a sensor array based on the gas diffusion model and the characteristics of a car steering wheel. Secondly, the data fusion algorithm is proposed according to the data characteristics of the sensor array on the steering wheel. The support matrix is used to improve the data consistency of the single sensor data, and then the adaptive weighted fusion algorithm is used for multiple sensors. Finally, in order to verify the reliability of the system, an online intelligent detection device for drunk driving based on multi-sensor fusion was developed, and three people using different combinations of drunk driving simulation experiments were conducted. According to the test results, a drunk person in the passenger seat will not cause the system to make a drunk driving determination. When more than 50 mL of alcohol is consumed and the driver is seated in the driver's seat, the online intelligent detection of drunk driving can accurately identify drunk driving, and the car will lock itself as soon as a real-time online voice prompt is heard. This study enhances and complements theories relating to data fusion for online automobile drunk driving detection, allowing for the online identification of drivers who have been drinking and the locking of their vehicles to prevent drunk driving. It provides technical support for enhancing the accuracy of online systems that detect drunk driving in automobiles.

Review of Ethanol Intoxication Sensing Technologies and Techniques.

The field of alcohol intoxication sensing is over 100 years old, spanning the fields of medicine, chemistry, and computer science, aiming to produce the most effective and accurate methods of quantifying intoxication levels. This review presents the development and the current state of alcohol intoxication quantifying devices and techniques, separated into six major categories: estimates, breath alcohol devices, bodily fluid testing, transdermal sensors, mathematical algorithms, and optical techniques. Each of these categories was researched by analyzing their respective performances and drawbacks. We found that the major developments in monitoring ethanol intoxication levels aim at noninvasive transdermal/optical methods for personal monitoring. Many of the "categories" of ethanol intoxication systems overlap with each other with to a varying extent, hence the division of categories is based only on the principal operation of the techniques described in this review. In summary, the gold-standard method for measuring blood ethanol levels is through gas chromatography. Early estimation methods based on mathematical equations are largely popular in forensic fields. Breath alcohol devices are the most common type of alcohol sensors on the market and are generally implemented in law enforcement. Transdermal sensors vary largely in their sensing methodologies, but they mostly follow the principle of electrical sensing or enzymatic reaction rate. Optical devices and methodologies perform well, with some cases outperforming breath alcohol devices in terms of the precision of measurement. Other estimation algorithms consider multimodal approaches and should not be considered alcohol sensing devices, but rather as prospective measurement of the intoxication influence. This review found 38 unique technologies and techniques for measuring alcohol intoxication, which is testament to the acute interest in the innovation of noninvasive technologies for assessing intoxication.

"Alcohol intoxication by proxy on a NICU" - a case report.

BACKGROUND: Ethanol intoxications in newborns are generally due to false preparation of formula with alcoholics or alcohol consumption by the breastfeeding mothers. Rarely, intoxications occur in hospitalized newborns, e.g., from excessive use of alcoholic hand sanitizers. We herein report a strange case of acute ethanol intoxications in our NICU. CASE PRESENTATION: An extremely premature infant (23 0/7 weeks gestational age, birthweight 580 g) suffered from repeated life-threatening events with hemodynamic compromise, apnea, and lactic acidosis while being treated in our neonatal intensive care unit (NICU). Symptomatic treatment with intravenous fluids and, if necessary, intubation and catecholamine therapy led to recovery after several hours each time. The episodes eventually turned out to be severe ethanol intoxications brought about by breast milk contaminated with ethanol. The breast milk was supplied by the infant's mother, who consumed non-trivial amounts of alcohol to build up her strength and make herself produce more milk, which was recommended to her by a family member. Additionally, she supplemented her own mother's milk with cow's milk because she was worried her baby was underserved with her milk. The mother admitted to this in intensive conversations with our team and a professional translator. CONCLUSIONS: This unique case underlines how different cultural dynamics can attribute to life-threatening events in the care of premature infants. It is important for us to emphasize that intensive communication and building a confident relationship with the parents of patients is essential to the work on NICUs. Child safeguarding issues and possibilities of intoxications have to stay in mind even in a supposedly safe space like the NICU.

Design of an Artificial Opal/Photonic Crystal Interface for Alcohol Intoxication Assessment: Capillary Condensation in Pores and Photonic Materials Work Together.

Alcohol intoxication has a dangerous effect on human health and is often associated with a risk of catastrophic injuries and alcohol-related crimes. A demand to address this problem adheres to the design of new sensor systems for the real-time monitoring of exhaled breath. We introduce a new sensor system based on a porous hydrophilic layer of submicron silica particles (SiO2 SMPs) placed on a one-dimensional photonic crystal made of Ta2O5/SiO2 dielectric layers whose operation relies on detecting changes in the position of surface wave resonance during capillary condensation in pores. To make the active layer of SiO2 SMPs, we examine the influence of electrostatic interactions of media, particles, and the surface of the crystal influenced by buoyancy, gravity force, and Stokes drag force in the frame of the dip-coating preparation method. We evaluate the sensing performance toward biomarkers such as acetone, ammonia, ethanol, and isopropanol and test sensor system capabilities for alcohol intoxication assessment. We have found this sensor to respond to all tested analytes in a broad range of concentrations. By processing the sensor signals by principal component analysis, we selectively determined the analytes. We demonstrated the excellent performance of our device for alcohol intoxication assessment in real-time.

Severe glycerol intoxication mimicking toxic alcohol ingestion following large volume consumption of vanilla essence.

INTRODUCTION: Patients with ethanol dependence may consume vanilla extract for the high alcohol content. CASE PRESENTATION: A 42-year-old male with ethanol dependence who developed status epilepticus, severe anion gap metabolic acidosis and a hyperosmolar non-ketotic coma after ingestion of 600 mL vanilla essence. He was found to have an osmolar gap of 151 with a marked pseudohypertriglyceridaemia of 96.4 mmol/L (8350 mg/dL), found to be secondary to significantly elevated glycerol levels. The patient required intubation for status epilepticus and dialysis to correct the severe acid-base disturbance and remove excess glycerol. The patient made a full recovery. DISCUSSION: Glycerol is traditionally thought to be a nontoxic alcohol, but this represents a severe case of glycerol toxicity requiring treatment with dialysis. It may represent an emerging or underdiagnosed clinical presentation given availability of high-glycerol products. In the right clinical context, pseudohypertriglyceridaemia and altered mental state may be recognised as glycerol intoxication, avoiding the need for unnecessary investigations.

Acute Alcohol Intoxication in Pediatric Emergencies.

INTRODUCTION: Alcohol intoxication in pediatrics is a growing problem in our environment. The objectives of this study are to define the prevalence of acute alcohol intoxication in the pediatric emergency department (PED) and to describe the associated symptoms and their relationship with potential risk factors. METHODS AND MATERIAL: This cross-sectional study includes patients younger than 16 years with a diagnosis of acute alcohol intoxication between March 2010 and October 2018 in the PED of a tertiary hospital. Patients with concomitant intoxication by other substances were excluded. The association between qualitative variables was determined using the χ 2 or Fisher exact test and quantitative with the Student t , Mann-Whitney U test, and simple linear regression. RESULTS: There were 136 episodes of alcohol intoxication, which represents a prevalence of 24.1/100,000 emergencies. After excluding 10 patients because of positive screening for other drugs, 126 patients with a mean age of 14.5 years (SD, 1.2 years) were included, 57.9% of whom were women. A total of 25.4% of the patients were younger than 14 years. Ethanolemia was determined in 88.9%, and its mean concentration was 195.7 mg/dL (SD, 56.5 mg/dL), with potentially serious levels (>300 mg/dL) being found in 3.6% of the patients. A relationship was found between the Glasgow Coma Scale score and ethanolemia ( B = -12.7; 95% confidence interval, -8.1 to -17.4; P < 0.001), as well as with potassium ( B = -31, 9; 95% confidence interval, -6.6 to -57.3; P = 0.014). No patient had seizures or hypoglycemia. A total of 10.3% of the patients required admission. CONCLUSIONS: Alcohol intoxication is a rare consultation reason in the PED. They usually present with mild and self-limited symptoms, being the decrease in the level of consciousness and hypokalemia the most frequent symptom and analytical alteration.

PECULIARITIES IN PERFORMING MEDICAL EXAMINATION TO ASSESS THE EXTENT OF ALCOHOL INTOXICATION OF DRIVERS ACCORDING TO THE LEGISLATION OF UKRAINE AND SOME OTHER COUNTRIES.

OBJECTIVE: The aim: This study is aimed at conducting a comprehensive analysis of the Ukrainian legislation regulating the alcohol testing procedure for drivers, investigating the practice of its implementation, reviewing international experience in this field, and elaborating proposals for its improvement. PATIENTS AND METHODS: Materials and methods: During the writing of the article, the current legislation of Ukraine is regulated, which regulates the procedure for medical examination to establish the state of intoxication of drivers, namely the Code of Ukraine on Administrative Offenses. This work meets the requirements of the Declaration of Helsinki. Methodology of the study includes general scientific methods (dialectic method, inductive and deductive approaches), special investigative techniques. CONCLUSION: Conclusions: Our study has underlined the necessity to improve the legal regulation for more effective alcohol testing program for drivers in Ukraine. This implies the elaboration of guideline for alcohol testing procedure and its approval by the Ministry of Health of Ukraine; to specify and legislate maximum permissible indicator values of blood alcohol concentration; to set the list of drugs and other substances through regulation; to adopt administrative responsibility for driving while intoxicated with alcohol (from 0.2 ppm to 1.1), and criminal liability for driving under severe alcoholic intoxication (1.1 ppm and above).

Acute alcohol intoxication: a clinical overview.

Abstract: Alcohol is a legal and yet detrimental psychoactive substance, capable of establishing addiction and impacting the physical, mental, social, and economic health of people. Alcohol intake causes a large variety of tissue damages severely impacting the nervous system, digestive and cardiovascular systems and causing oral cavity, oropharyngeal, hypopharyngeal, esophageal, colon-rectal, laryngeal, liver and intrahepatic bile duct, and breast cancers. Alcohol can also play a role in the pathogenesis of diabetes mellitus, cardiomyopathy and hemorrhagic strokes. When drunk during pregnancy it is proved to be responsible for serious damage to fetuses causing a wide range of pathological conditions from miscarriage to Fetal Alcoholic Spectrum Disorder (FASD). Acute ethanol intoxication happens when the amount of alcohol consumed is greater than the disposal capacity of the liver, causing an accumulation of its metabolites displayed by initial dysphoria and disinhibition. Nausea, vomiting, memory loss could happen. Although, it can lead to more serious conditions like impaired speaking, impaired coordination, unstable gait, nystagmus, stupor, or coma. Respiratory depression and death could also happen in such cases. Unfortunately, diagnosis of acute alcohol intoxication is difficult because most of the drinkers deny or minimize their assumption. It is dramatically important to assess when the last intake happened to avoid withdrawal syndrome. Alcohol acute intoxication can be considered a serious harm to health and a relevant issue for healthcare provid-ers working in emergency rooms. Differential diagnosis is crucial to avoid serious outcomes. There is no consensus about therapies for acute intoxication, but supportive and symptomatic treatments were proved effective. The repercussions of alcohol misuse over drinkers' social, familiar, economical and working life enhance the importance of a multidisciplinary approach in such cases.

Virtual Breathalyzer: Towards the Detection of Intoxication Using Motion Sensors of Commercial Wearable Devices.

Driving under the influence of alcohol is a widespread phenomenon in the US where it is considered a major cause of fatal accidents. In this research, we present Virtual Breathalyzer, a novel approach for detecting intoxication from the measurements obtained by the sensors of smartphones and wrist-worn devices. We formalize the problem of intoxication detection as the supervised machine learning task of binary classification (drunk or sober). In order to evaluate our approach, we conducted a field experiment and collected 60 free gait samples from 30 patrons of three bars using a Microsoft Band and Samsung Galaxy S4. We validated our results against an admissible breathalyzer used by the police. A system based on this concept successfully detected intoxication and achieved the following results: 0.97 AUC and 0.04 FPR, given a fixed TPR of 1.0. Our approach can be used to analyze the free gait of drinkers when they walk from the car to the bar and vice versa, using wearable devices which are ubiquitous and more widespread than admissible breathalyzers. This approach can be utilized to alert people, or even a connected car, and prevent people from driving under the influence of alcohol.