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.

酒精首先是一种中枢神经系统的抑制剂。在一次剂量之后，大约一小时内达到峰值水平，持续两小时，然后逐渐跌落。在摄入相当数量的酒精之后，会释放压抑，导致兴奋和狂喜的状态。更多剂量的酒精会逐渐产生头昏眼花、口齿不清、动作失调、药物副作用、意识模糊、恶心、呕吐并且增加脑力官能的损害，直到昏迷和昏睡不醒的意外发生。这一阶段的身体检查显示皮肤发热、发红或者苍白、出汗，扩大的深层反射带有双趾伸肌僵直、瞳孔扩大、鼾声呼吸以及脉搏饱满而跳跃。罕有因呼吸或循环系统衰竭的死亡发生。

诊断

在出现满脸通红、半昏迷或昏迷状态以及酒精气味的时候，诊断酒精中毒是很容易的。然而，面对昏睡的病人时，在所有的可能性均通过适当的检查和调查排除之前，建议不要马上将意识的丧失归咎于酒精。当持续昏迷超过 24 小时时，应该充分考虑混合中毒、复杂的颅脑损伤、硬膜下血肿或者脑中风的可能性。

处理

大多数轻度到中度中毒的患者通常"睡它一场"就行，无须特殊地处理。当意外发生昏迷或者昏睡的情况时，一般的处理原则类似于在'巴比妥类中毒'情况下描述的原则。应该采取注射氯丙嗪或者安定来控制暴力谵妄，但是不要采用巴比妥酸盐，因为它们和酒精有协同效应。

应该把胃倒空并且用自来水冲洗，以除去未被吸收的酒精。管理胰岛素和葡萄糖或者兴奋剂药物有一点点实用价值。在存在深度昏迷的时候，应该尝试强制分开。