Correlation between blood alcohol concentration (BAC), breath alcohol concentration (BrAC) and psychomotor evaluation in a clinical monitored study of alcohol intake in Brazil.

BACKGROUND: Policies that establish maximum blood alcohol concentrations (BACs) or breath alcohol concentration (BrACs) for drivers while driving can reduce traffic accidents by approximately 20%. In Brazil, the National Transit Council (CONTRAN) considers positive BAC and/or BrAC tests or signs of psychomotor capacity alterations as evaluated by a police authority to be an administrative infraction or even a crime. The observed clinical symptoms of alcohol intoxication based on a subject's appearance may not necessarily reflect the quantified BAC and/or BrAC. This study compared the clinical symptoms identified by a medical authority (M) and a non-medical authority (NM) with BAC and BrAC measurements. METHODS: Brazilian health volunteers (n = 15) drank ethanol (40% v/v) and, at scheduled times, the subjects underwent blood draws for BAC analysis, were tested for BrAC analysis, and underwent psychomotor alteration assessments performed by M and NM. RESULTS: Concentration-time profiles of the BACs and BrACs of the volunteer subjects were generated. The BAC values reached a peak at 60 min and subsequently decreased with time. The average BrAC values decreased with time after ingestion. During the evaluations, M was able to identify a lack of static equilibrium until 240 min and a lack of dynamic equilibrium until 120 min. A lack of upper limb motor coordination was observed until 90 min, and a lack of coordination in the lower limbs was observed only during the first hour. Regarding the tests performed by NM, the signs related to the subjects' appearances were observed more frequently, until 60 min. The other analyzed symptoms were not identified. Naturally, the signs reported by both M and NM disappeared with time. CONCLUSION: The evaluations of psychomotor changes performed by Brazilian M were superior to those performed by NM. However, independent of the examiner, at the alcohol concentrations reached in this study, the psychomotor alteration evaluations were ineffective compared with the BAC and BrAC results.

Identification and initial management of intoxication by alcohol and other drugs in the pediatric emergency room.

OBJECTIVE: To review the screening, diagnosis, evaluation, and treatment of intoxication by alcohol and other drugs in children and adolescents in the emergency scenario. DATA SOURCE: This was a narrative literature review. DATA SUMMARY: The detection of this problem in the emergency room can be a challenge, especially when its assessment is not standardized. The intentional and episodic use of large amounts of psychoactive substances by adolescents is a usual occurrence, and unintentional intoxication is more common in children younger than 12 years. The clinical picture in adolescents and children differs from that in adults and some particularities are important in the emergency scenario. After management of the acute condition, interventions targeting the adolescent at risk may be effective. CONCLUSION: The diagnosis and treatment of intoxication by alcohol and other drugs in adolescents and children in the emergency scenario requires a systematic evaluation of the use of these drugs. There are few specific treatments for intoxication, and the management comprehends support measures and management of related clinical complications.

Identification and initial management of intoxication by alcohol and other drugs in the pediatric emergency room / Identificação e manejo inicial de intoxicações por álcool e outras drogas na sala de emergência pediátrica

Abstract Objective: To review the screening, diagnosis, evaluation, and treatment of intoxication by alcohol and other drugs in children and adolescents in the emergency scenario. Data source: This was a narrative literature review. Data summary: The detection of this problem in the emergency room can be a challenge, especially when its assessment is not standardized. The intentional and episodic use of large amounts of psychoactive substances by adolescents is a usual occurrence, and unintentional intoxication is more common in children younger than 12 years. The clinical picture in adolescents and children differs from that in adults and some particularities are important in the emergency scenario. After management of the acute condition, interventions targeting the adolescent at risk may be effective. Conclusion: The diagnosis and treatment of intoxication by alcohol and other drugs in adolescents and children in the emergency scenario requires a systematic evaluation of the use of these drugs. There are few specific treatments for intoxication, and the management comprehends support measures and management of related clinical complications.

Resumo Objetivo: Revisar o rastreamento, o diagnóstico, a abordagem e o tratamento das intoxicações por álcool e outras drogas de crianças e adolescentes no contexto de emergência. Fontes dos dados: Foi feita uma revisão narrativa da literatura. Sumário dos achados: A detecção desse problema na sala de emergência pode ser um desafio, especialmente quando sua avaliação não é padronizada. O uso intencional e em grandes quantidades episódicas de substâncias psicoativas é o padrão em adolescentes e a intoxicação não intencional é mais comum em crianças menores de 12 anos. O quadro clínico em adolescentes e em crianças difere dos adultos e algumas particularidades são importantes no contexto de emergência. Após o manejo do quadro agudo, intervenções com vistas ao adolescente de risco podem ser efetivas. Conclusão: O diagnóstico e o tratamento das intoxicações por álcool e outras drogas em adolescentes e crianças em emergência requer uma avaliação sistemática do uso dessas drogas. Há poucos tratamentos específicos para intoxicação e o manejo é de apoio e das complicações clínicas relacionadas.

Intoxicación alcohólica / Alcohol intoxication

Resumen:La intoxicación se considera como una manifestación patológica definida por los signos y síntomas que secundarios a la acción de una o varias dosis de un agente tóxico y su evolución puede llevar al sujeto a un estado irreversible e incluso a la muerte. Cada año mueren alrededor de un millón de personas a consecuencia de diversos envenenamientos. La intoxicación alcohólica es causada por alcoholes, compuestos orgánicos que se derivan de los hidrocarburos y están formados por grupos hidroxilos. El etanol es el alcohol que con más frecuencia produce intoxicaciones ya que es el más común y el que más al alcance de la población se encuentra, este produce múltiples alteraciones a nivel del sistema nervioso y de otros sistemas del organismo.

Abstract:Intoxication is considered a pathological manifestation defined by the signs and symptoms secondary to the action of one or more doses of a toxic agent and its evolution may lead to an irreversible subject to state and even to death.Every year about a million people as a result of various poisonings. Alcohol intoxication is caused by alcohols, organic compounds derived hydrocarbons and consist of hydroxyl groups. Ethanol is the alcohol intoxication occurs more frequently because it is the most common and the most accessible to the population is, this results in multiple abnormalities in the nervous system and other body systems.

Prevalence and risk of potentially adverse drug interactions in the treatment of acute alcohol poisoning

ABSTRACT The aim of this paper is to determine the profile of acute alcohol poisoning and to estimate the risk of potentially adverse drug interactions (ADIs) in patients intoxicated by alcohol when attended in emergency care at hospital. A descriptive serial cross-sectional study was performed with 4,271 individuals intoxicated by alcohol, from January 2009 to July 2011. Possible correlations were measured by Pearson's chi-square test. The data show high consumption in the population, especially in males between 25 and 59 years. The main circumstances for poisoning were alcohol misuse (96.3%). After treatment complete recovery from the signs or symptoms of the poisoning was observed in 96.88% cases; and death in 0.70%. The demonstration of potential risk for ADIs in medical care included 300 medical records which contained a history of acute alcohol poisoning. Possible drug-drug interactions (44.2%) and drug-alcohol interactions (55.8%) were demonstrated in 60.60% of analyzed medical records. Among these cases, 3%, 92.4% and 4.6% were classified as mild, moderate and severe, respectively. The measurement of ADIs aims to prevent clinical complications in medical care for alcohol misuse disorders.

RESUMO O objetivo deste trabalho foi definir o perfil de intoxicação alcoólica aguda e estimar o risco de interações medicamentosas adversas (IMAs) potenciais em pacientes com intoxicação alcoólica atendidos na emergência hospitalar. Um estudo descritivo, serial, de corte transversal foi realizado com 4.271 indivíduos com intoxicação alcoólica, de janeiro 2009 a julho 2011. Correlações foram medidas pelo teste qui-quadrado. Os dados mostram alto consumo na população estudada, especialmente em homens de 25 a 59 anos. A principal circunstância de intoxicação foi o abuso (96,3%). Após tratamento, cura foi observada em 96,88% dos casos e morte em 0,7%. O risco de IMAs potenciais no atendimento médico incluiu 300 prontuários médicos com histórico de intoxicação alcoólica aguda. Possíveis interações medicamentosas (44,2%) e interações fármaco-álcool (55,8%) foram observadas em 60,6% dos prontuários analisados. Entre elas, 3%, 92,4% e 4,6% foram classificadas como leve, moderada e grave, respectivamente. A medição das IMAs visa a prevenir complicações clínicas no atendimento dos agravos devido ao abuso de álcool.

Disentangling contributions of bar attendance, drinking, and other factors to elevated acute alcohol problems on the U.S.-Mexico border.

BACKGROUND: Levels of drinking are unusually elevated among young adults on the U.S.-Mexico border, and this elevation can be largely explained by young border residents' unusually high frequency of bar attendance. However, this explanation complicates interpretation of high alcohol problem rates that have also been observed in this group. Because bar environments can lower the threshold for many types of problems, the extent to which elevated alcohol problems among young border residents can be attributed to drinking per se-versus this common drinking context-is not clear. METHODS: Data were collected from multistage cluster samples of adult Mexican Americans on and off the U.S.-Mexico border (current drinker N = 1,351). After developing structural models of acute alcohol problems, estimates were subjected to path decompositions to disentangle the common and distinct contributions of drinking and bar attendance to problem disparities on and off the border. Additionally, models were estimated under varying degrees of adjustment to gauge the sensitivity of the results to sociodemographic, social-cognitive, and environmental sources of confounding. RESULTS: Consistent with previous findings for both drinking and other problem measures, acute alcohol problems were particularly elevated among young adults on the border. This elevation was entirely explained by a single common pathway involving bar attendance frequency and drinking. Bar attendance did not predict acute alcohol problems independently of drinking, and its effect was not moderated by border proximity or age. The common indirect effect and its component effects (of border youth on bar attendance, of bar attendance on drinking, and of drinking on problems) were surprisingly robust to adjustment for confounding in all parts of the model (e.g., fully adjusted indirect effect: b = 0.11, SE = 0.04, p < 0.01). CONCLUSIONS: Bar attendance and associated increases in drinking play a key, unique role in the high levels of acute alcohol problems among the border's young adult population that cannot be entirely explained by sociodemographic or social-cognitive characteristics of young border residents, by contextual effects of bars on problems, or by broader neighborhood factors. Bar attendance in particular may represent an early modifiable risk factor that can be targeted to reduce alcohol problem disparities in the region.

Environmental characteristics associated with alcohol intoxication among patrons in Brazilian nightclubs.

INTRODUCTION: Few studies have investigated the association between environmental factors and patrons' binge drinking in nightclubs, and such studies are rare in developing countries. OBJECTIVE: To identify environmental factors associated with binge drinking among patrons in nightclubs in São Paulo, Brazil, using a mixed-methods design. METHOD: The study used a two-stage cluster sampling survey design. Two levels of data were collected: observational data and portal survey data. Individual-level data were collected by a portal survey of 2422 subjects at the entrance and 1822 subjects at the exit of 31 nightclubs. Weighted multilevel analysis was used to investigate the association between patrons' binge drinking (as measured by breath alcohol concentration ≥0.38 mg L(-1) ) at nightclub exit, with environmental-level variables collected through observation and controlled for individual-level data. RESULTS: Pre-drinking was the variable most strongly associated with binge drinking BrAC levels when exiting the venue [adjusted odds ratio (aOR) = 5.98, 95% confidence interval (CI) [4.37, 8.17], P < 0.001). The environmental variables significantly associated with binge drinking were 'all you can drink' service (aOR = 2.44, 95% CI [1.03, 0.79]; P = 0.043), two or more dance floors (aOR = 1.92, 95% CI [1.16, 3.18]; P = 0.011), and higher sound levels (aOR = 1.04 per each decibel increased, 95% CI [1.01, 1.08]; P = 0.048). Data triangulation showed an association between lower alcohol intoxication and ketamine use in three LGBT nightclubs. DISCUSSION: Pre-drinking showed that individual-level characteristics could be more important in binge drinking than the venues' environmental characteristics. Previous studies failed to include pre-drinking in environmental analysis. CONCLUSION: Environmental control interventions, isolated from individual-level approaches, may have limited efficacy in the prevention of alcohol abuse in nightclubs.

An unexpected clinical course in a 29-day-old infant with ethanol exposure.

Ethanol exposure can affect all pediatric age groups but occurs most commonly in ambulatory children and adolescents. Infants are less likely to ingest ethanol because they have limited ability to explore their environments. However, ethanol exposures in infants can occur. We report the case of a 29-day-old (3.5 kg) baby girl who presented with a blood alcohol level of 301 mg/dL after ingesting formula that had been prepared with gin. To our knowledge, she is the youngest reported child with such an elevated ethanol level in the medical literature. Despite her markedly elevated blood alcohol level, she had an unexpectedly mild clinical course, exhibiting subtle neurologic symptoms but no hypothermia, hypoglycemia, or cardiorespiratory impairment. This case demonstrates that the ethanol-exposed infant may lack typical or clear symptoms of acute intoxication. Therefore, the clinician must have a low threshold for pursuing blood alcohol testing in infants and young children with altered mental status. A prompt diagnosis of ethanol exposure is important for ensuring the health and safety of the child.

Guía de Práctica Clínica para la detección temprana, diagnóstico y tratamiento de la fase aguda de intoxicación de pacientes con abuso o dependencia del alcohol: para profesionales de la salud / Clinical Practice Guideline for the early detection, diagnosis and treatment of the acute phase of intoxication of patients with alcohol abuse or dependence: for health professionals

Detección temprana, diagnóstico y tratamiento de la fase aguda de desintoxicación de pacientes adultos con abuso o dependencia del alcohol. La presente guía dará recomendaciones para la detección temprana, diagnóstico y manejo de pacientes adultos en fase aguda con abuso, dependencia o abstinencia de alcohol, por parte de médicos generales, médicos especialistas, psicólogos y enfermeros, en los diferentes niveles de atención, con énfasis en atención primaria.

Guía de práctica clínica (GPC) para la detección temprana, diagnóstico y tratamiento de la fase aguda de intoxicación de pacientes con abuso o dependencia del alcohol / Clinical Practice Guideline for the early detection, diagnosis and treatment of the acute phase of intoxication of patients with alcohol abuse or dependence

La guía busca contestar las siguientes preguntas clínicas elaborando recomendaciones basadas en evidencia, En pacientes mayores de 18 años con abuso o dependencia del alcohol, ¿cuáles son los criterios clínicos más importantes para predecir el desarrollo de un síndrome de abstinencia? En pacientes mayores de 18 años con abuso o dependencia del alcohol, ¿cuáles son los factores de riesgo para el desarrollo de encefalopatía de Wernicke? En pacientes mayores de 18 años con síndrome de abstinencia, ¿cuáles son los factores de riesgo más importantes para evaluar la probabilidad de que se presente un delirium tremens? En personas mayores de 18 años con abuso o dependencia del alcohol que presentan intoxicación.

Awareness of legal blood alcohol concentration limits amongst respondents of a national roadside survey for alcohol and traffic behaviours in Brazil.

BACKGROUND: In Brazil the legal blood alcohol content (BAC) allowed for driving was changed to zero in 2008. If the BAC found is above 0.6g/L, drivers may be arrested. However, there are limited data on drivers' awareness of such limits. METHODS: Drivers from 27 major metropolitan areas (n=3397) were randomly asked to participate in roadside survey from 12 a.m. to 12 p.m. on Fridays and Saturdays. They were breathalized by highway patrol officers, and after consent interviewers collected data on drinking behaviours, knowledge about the law, and breath tests results. RESULTS: The mean age was 37.3±11.3 years; 94.3% were male and 26.5% had some college education. When asked about the BAC that could result in arrest, 34.5% of the subjects claimed to know it. However, only 23.5% (8.1% of the total sample) provided correct answers. Factors associated with the right answers were: male gender (p=0.04; OR=2.08; CI=1.01-4.27); higher education (p<0.0001); negative BAC or self-report of driving under the influence (DUI) (p=0.02); higher family income (p=0.01) and non-professional driving (p=0.041). Age was not statistically different between groups. After multivariate analysis, male gender (p=0.002), higher education (p<0.0001) and negative BAC or DUI (p=0.046) remained in the model. CONCLUSIONS: The knowledge that BAC levels over 0.6g/L may result in arrest is sparse amongst Brazilian drivers, notably amongst women, the less educated and those who drink and drive. Educational programmes targeted at those specific groups may be necessary in order to increase awareness about the legal BAC limit and its consequences.

Muertes por intoxicación accidental aguda por alcohol y drogas de abuso en Costa Rica entre 2006 y 2010 / Accidental poisoning deaths acute alcohol and drug abuse in Costa Rica between 2006 and 2010

En este artículo se presenta el análisis de 15642 autopsias realizadas en el Departamento de Medicina Legal de Costa Rica entre los años 2006 a 2010, de las cuales se extrajeron aquellas cuyas causa de muerte fue una intoxicación accidental (sobredosis) por alcohol o drogas de abuso. Se encontraron 210 casos que arrojaron el siguiente perfil de las víctimas: sexo masculino, edad entre 30 y 59 años, habitantes de Guanacaste o San José, que fallece los fines de semana o a fin y principio de año, de una intoxicación aguda por alcohol si es costarricense o nicaragüense o de una intoxicación por cocaína o heroína si se trata de un norteamericano o europeo. Asimismo se demostró que en el período en estudio ha habido un aumento significativo de la tasa de mortalidad por esta causa...

[Impact of a drink-driving detection program to prevent traffic accidents (Villa Clara Province, Cuba)]. / Impacto de un programa de detección de conductores bajo los efectos del alcohol en la prevención de accidentes de tráfico (provincia de Villa Clara [Cuba]).

OBJECTIVE: To determine the effectiveness of a method to reduce road traffic accidents and their consequences in the province of Villa Clara (Cuba). DESIGN: From May to October 2003, active surveillance of drink-driving was carried out. Analysis of chronological series was used. RESULTS: A total of 805 (12.46%) drivers were found to be under the effect of alcohol. Traffic accidents, deaths, and injuries decreased by 29.9%, 70.8% and 58.7%, respectively, in comparison with a similar period in 2002. The number of accidents in May, June, July, September and October fell below the historical low. The number of deaths was lowest in May, August and September. The number of injuries in July fell below the historical low. CONCLUSION: The interventions carried out proved useful in preventing traffic accidents and their consequences.

Volumen de trabajos del entrenado Clase 2001-2004

Contiene: estudios de brotes epidémicos, evaluación de un sistema de vigilancia, publicaciones e informes, conferencias científicas.

Volumen de trabajos del entrenado Clase 2001-2004

Contiene: estudios de brotes epidémicos, evaluación de un sistema de vigilancia, publicaciones e informes, conferencias científicas.