Physician Diagnosis

The doctor will assess the person suspected of alcohol intoxication to answer the following medical questions and provide the appropriate care. Friends or family who accompany a drunken person (or person suspected to be intoxicated) to the hospital can provide invaluable information regarding recent events as well as past medical history.

• Does the blood alcohol concentration (BAC) correspond to the physical exam and the person’s apparent degree of intoxication?
  
  
  • Most importantly, in a lethargic, drunken person, a doctor may be more interested in how low the BAC is rather than how high it is. This is because the lower the BAC, the less likely that alcohol explains the abnormal drowsiness.
    
    
  • The dilemma: If the BAC is found to be inappropriately low for the apparent degree of intoxication (for example, a BAC of 150 in a person who is deeply lethargic), then the doctor must look elsewhere for an explanation. Conversely, a BAC of 300 may perfectly explain a stuporous state while masking a coexisting, serious, life-threatening condition.
  
  
• Is there any evidence of serious physical injury?
  
  
  • In people with mild-to-moderate intoxication, the physical exam alone may often be sufficient to exclude serious physical injuries or at least permit a later reassessment.
    
    
  • The existence or extent of a head injury may be difficult or impossible to assess in a lethargic, intoxicated person. Important information about the person's medical history and recent activities is often lacking, and the person usually is in no condition to talk coherently.
    
    
  • It is entirely possible to have a serious, life-threatening, internal head injury (from a fall, car accident, baseball bat) with no cuts or bleeding in the head. So, deeply lethargic or comatose, intoxicated people should undergo CT scans of their head. A plain skull x-ray is of little value and may actually do harm if the absence of a skull fracture lulls the doctor into thinking there is no head injury. A plain skull x-ray only assesses for a cracked skull. CT scans visualize bleeding in the brain.
  
  
• Are any medical conditions contributing to the person’s condition?
  
  
  • The assessment of medical conditions in an intoxicated person can be quite complex, as the two often coexist. The doctor will need to assess the status of the person's chronic medical illnesses plus any acute illnesses and injuries. Diagnosis and further investigation of these possibilities are guided by available medical history, physical exam, and results of standard blood tests.
    
    
  • The doctor will check (to rule out) common conditions that mimic those of alcohol intoxication, such as head injuries (usually with internal bleeding), hypoglycemia (low blood sugar), seizure disorders, and the influence of illicit drugs (marijuana, cocaine, amphetamines, and opiates). Common opiates are heroin and codeine. In addition, psychiatric conditions, especially depression and alcohol abuse, frequently coexist. Until the alcohol wears off, it can be exceedingly difficult for the doctor to separate the effects of each.
    
    
  • The doctor will look for specific conditions. For example, if there is fever, the doctor might consider meningitis, pneumonia, or some other serious infection that might be causing a change of mental status. If the blood pressure is extremely low, the doctor will look for internal bleeding.
    
    
  • In addition, the doctor will be looking for evidence of chronic alcohol abuse, such as red spots on the skin (called spider angiomas), an enlarged liver, or yellow eyes or skin (jaundice, caused by damage to the liver).