Alcoholic is a primarily a depressant to central nervous system. Following a single dose, peak levels are reached in about one hour, persist for two hours and then decline gradually. After consumption appreciable quantity of alcohol there is release of inhibitions resulting in a state of exhilaration and euphoria. Further doses of alcohol produce progressively, dizziness, slurred speech, ataxia, termors, confusion, nausea, vomiting and increase impairment of mental faculties until stupor and coma supervene. Physical examination at this stage reveals the skin to be hot and flushed or pale and sweating, deep reflexes are exaggerated with bilateral extensor planters, pupils and dilated, breathing is stertorous and pulse is full and bounding. Death occurs uncommonly from respiratory or circulatory failure.

    DIAGNOSIS.

    In the presence of a flushed face, semi coma or coma and the odour of alcohol, the diagnosis of alcohol intoxication is easy. However, when confronted with a comatose patient, it is advisable not to ascribe the loss of consciousness to alcohol until all the possibilities have been ruled out by appropriate examination and investigations. When coma persist for more then 24 hours, possibility of mixed poisoning, complicating head injury, subdural haematoma or cerebral stroke should be strongly considered.

    MANAGEMENT.

    Most of the patients with mild to moderate degree of intoxication usually 'sleep it off' and require no special treatment. When stupor or coma has supervened, general principles of management are similar to those described under 'barbiturate poisoning'. Violent delirium should be controlled with injection chlorpromazine or diazepam but not with barbiturates because of their synergistic effect with alcohol.

    The stomach should be emptied and lavaged with tap water to remove unabsorbed alcohol. Administration of insulin and glucose or analeptic drugs is of little practical value. In the presence of deep coma, forced dieresis should be tried.

    酒精首先是一種中樞神經(jīng)系統(tǒng)的抑制劑。在一次劑量之后，大約一小時(shí)內(nèi)達(dá)到峰值水平，持續(xù)兩小時(shí)，然后逐漸跌落。在攝入相當(dāng)數(shù)量的酒精之后，會(huì)釋放壓抑，導(dǎo)致興奮和狂喜的狀態(tài)。更多劑量的酒精會(huì)逐漸產(chǎn)生頭昏眼花、口齒不清、動(dòng)作失調(diào)、藥物副作用、意識(shí)模糊、惡心、嘔吐并且增加腦力官能的損害，直到昏迷和昏睡不醒的意外發(fā)生。這一階段的身體檢查顯示皮膚發(fā)熱、發(fā)紅或者蒼白、出汗，擴(kuò)大的深層反射帶有雙趾伸肌僵直、瞳孔擴(kuò)大、鼾聲呼吸以及脈搏飽滿而跳躍。罕有因呼吸或循環(huán)系統(tǒng)衰竭的死亡發(fā)生。

    診斷

    在出現(xiàn)滿臉通紅、半昏迷或昏迷狀態(tài)以及酒精氣味的時(shí)候，診斷酒精中毒是很容易的。然而，面對(duì)昏睡的病人時(shí)，在所有的可能性均通過適當(dāng)?shù)臋z查和調(diào)查排除之前，建議不要馬上將意識(shí)的喪失歸咎于酒精。當(dāng)持續(xù)昏迷超過 24 小時(shí)時(shí)，應(yīng)該充分考慮混合中毒、復(fù)雜的顱腦損傷、硬膜下血腫或者腦中風(fēng)的可能性。

    處理

    大多數(shù)輕度到中度中毒的患者通常"睡它一場(chǎng)"就行，無須特殊地處理。當(dāng)意外發(fā)生昏迷或者昏睡的情況時(shí)，一般的處理原則類似于在'巴比妥類中毒'情況下描述的原則。應(yīng)該采取注射氯丙嗪或者安定來控制暴力譫妄，但是不要采用巴比妥酸鹽，因?yàn)樗鼈兒途凭�有協(xié)同效應(yīng)。

    應(yīng)該把胃倒空并且用自來水沖洗，以除去未被吸收的酒精。管理胰島素和葡萄糖或者興奮劑藥物有一點(diǎn)點(diǎn)實(shí)用價(jià)值。在存在深度昏迷的時(shí)候，應(yīng)該嘗試強(qiáng)制分開。