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Medical Author:

John P. Cunha, DO, FACOEP

John P. Cunha, DO, FACOEP

John P. Cunha, DO, is a U.S. board-certified Emergency Medicine Physician. Dr. Cunha's educational background includes a BS in Biology from Rutgers, the State University of New Jersey, and a DO from the Kansas City University of Medicine and Biosciences in Kansas City, MO. He completed residency training in Emergency Medicine at Newark Beth Israel Medical Center in Newark, New Jersey.

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Medical Editor:

Roxanne Dryden-Edwards, MD

Roxanne Dryden-Edwards, MD

Dr. Roxanne Dryden-Edwards is an adult, child, and adolescent psychiatrist. She is a former Chair of the Committee on Developmental Disabilities for the American Psychiatric Association, Assistant Professor of Psychiatry at Johns Hopkins Hospital in Baltimore, Maryland, and Medical Director of the National Center for Children and Families in Bethesda, Maryland.

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People who drink alcohol to the point that it interferes with their social life, professional life, or health should contact a doctor to discuss the problem. The great difficulty lies in the fact that denial plays a large part in alcoholism. Consequently, alcoholics rarely seek professional help voluntarily.

Often a family member or employer convinces or forces the person with alcoholism to seek medical treatment. Even if an alcoholism sufferer accepts treatment because of pressure from family, an employer, or a medical professional, he or she can benefit from it. Treatment may help this person develop motivation to change the alcohol problem.

Alcohol is involved one in three motor-vehicle fatalities, 50% of drownings, nearly 20% of fire-related deaths, and up to 50% of homicides.

It is imperative that emergency care be sought immediately when alcohol has contributed to an injury. This is very important because someone who is intoxicated may not be able to reliably assess the severity of the injury they have sustained or inflicted. An intoxicated person may, for example, not notice that they have a fractured neck vertebra (broken neck) until it is too late (that is, paralysis has occurred).

Several alcohol-related conditions require immediate evaluation in a hospital's emergency department.

• Alcohol withdrawal requires emergency treatment. When withdrawing from alcohol, a person classically goes through four phases: tremulousness (the shakes), seizures, hallucinations, and delirium tremens (DTs). These stages are described in further detail:
• During the tremulous stage, the person will exhibit a tremor of his or her hands and legs. This can be seen if the person extends his or her hand and tries to hold it still. This symptom is often accompanied by anxiety and restlessness.
• Seizures often follow the tremulous stage. They are commonly generalized seizures during which the entire body shakes uncontrollably and the person loses consciousness. Seizures can occur in people withdrawing from alcohol. If you see someone having a seizure, attempt to lay the person on one side so they don't inhale any vomit or secretions into their lungs. If possible, protect the person's head or other body parts from knocking uncontrollably onto the floor or against other potentially harmful objects. Do not place anything inside the person's mouth while they are having a seizure.
• Hallucinations affect many people undergoing the late stages of major alcohol withdrawal. Visual hallucinations are the most common type of hallucination experienced during alcohol withdrawal. People will classically "see" insects or worms crawling on walls or over their skin. Often this is associated with tactile (feeling) hallucinations in which alcoholics think they feel insects crawling on their skin. This phenomenon is called formication. Auditory (hearing) hallucinations can also occur during withdrawal, although less commonly than the other types of hallucinations.
• The most dangerous stage of alcohol withdrawal is called delirium tremens (DTs). About 5% of people withdrawing from alcohol experience DTs. This condition usually occurs within 72 hours after drinking stops but can occur up to seven to 10 days later. The hallmark of this stage is profound delirium (confusion). People are awake but thoroughly confused. This is accompanied by agitation, delusions, sweating, hallucinations, rapid heart rate, and high blood pressure. This is a true emergency. Studies have shown that death will occur in about 35% of these people if they are not treated promptly. Even with appropriate medical treatment, this condition is associated with a 5%-15% death rate.
• Alcoholic ketoacidosis (AKA) is another condition for which emergency medical treatment should be sought. AKA often starts within two to four days after an alcoholic has stopped consuming alcohol, fluids, and food, often because of gastritis or pancreatitis. Not uncommonly, AKA and alcohol withdrawal syndromes are seen at the same time. AKA is characterized by nausea, vomiting, abdominal pain, dehydration, and an acetone-like odor on the person's breath. This occurs when the alcohol dependent person has become depleted of carbohydrate fuel stores and water. Therefore, the body begins to metabolize ("burn") fat and protein into ketone bodies for energy. Ketone bodies are acids that accumulate in the blood, increasing its acidity and causing the person to feel even sicker, thus perpetuating a vicious cycle.
• Alcoholism is often associated with other psychiatric disorders such as anxiety, depression, and psychosis. This psychiatric illness, often combined with a reduced level of sound judgment while intoxicated, leads to suicides, suicide attempts, and suicidal gestures by people who are alcohol dependent. A person who has attempted suicide or is believed to be in serious or imminent danger of committing suicide should be taken quickly to the emergency department of a hospital.

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