During alcoholic coma onset, the patient shows signs of acute alcoholism: diplopia (double vision), dysarthria (can not pronounce words), cerebellar ataxia (drunk walking, jerky language), vertigo (dizziness), agitation with hallucinations and delusions.
Coma is installed at a blood alcohol level of 3-4 g per thousand, with face congestion and conjunctivitis, tachycardia, ethanol halitosis (mouth odor).
Subsequently, the phenomenon of collapse appear: pallor, sweating, hypotension, cyanosis with extremities cooling, then coma, with disappearance of reflexes, with convulsions.
If alcohol level is greater than 4-5 grams per thousand the death will occur.
In suicide attempts, alcohol is often associated with barbiturates or other sedatives. This etiology is suspected in a comatose patient which has ethanol halitosis, but with very severe circulatory and respiratory disturbances.
Differential diagnostic problems arise in mixed coma (head trauma with ethanol, ethanol with stroke especially hemorrhagic).
Alcoholic coma treatment
Gastric lavage is indicated only initially (because ethanol penetrates quickly into the bloodstream – after 2-3 hours after ingestion) and only in superficial stages of coma (in deep coma appears the risk of tracheobronchial aspiration).
Protection from cold – there are heat losses which favors pulmonary complications.
Is administered 5% glucose (2-3 liters / day) + saline solution + potassium chloride + vitamin B1, B6, possibly triiodothyronine for rapid degradation of alcohol.
At the agitated patients psychotropic medication should be avoided, as this may increase CNS depression, particularly the respiratory and vasomotor centers.
In deep coma (grade 3 or 4) initial treatment consists in the administration of 300-400 ml of glucose 33%.