Ethanol Poisoning
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þ See also
  - Wernicke's Encephalopathy
  <N-Wernic.TXT>

þ Alcohol-Disulfiram (Antabuse) reaction:
 - Norepinephrine is the vasopressor of choice in severe alcohol- disulfuram
   reactions because disulfuram causes norepinephrine depletion.
 - Pyridoxine hydrochloride (vitamin B6) injected intravenously may be of
   benefit in cases of seizures. Dfaz-Alcalá and Lee:  "Toxicity, Disulfuram"
   in Plantz and Adler's EMedicine, www.emedicine.com/emerg/topic151.htm

þ Reversal of EtOH intoxication?
 - No.
   "Back in town. Here are the references for the lack of efficacy of reversal
   agents in the treatment of alcohol intoxication. (Taken from the discussion
   of an ongoing study.) While flumazenil has theoretical advantages as a
   potential reversal agent for any substance with GABA activity (including
   benzos, ethanol, and GHB).
   "Much effort has been expended in the search for a rapid reversal agent
   useful to emergency physicians in the treatment of acute ethanol
   intoxication. Repeated investigations have demonstrated the ineffectiveness
   of caffeine (1), naloxone (2, 3, 4),  and flumazenil (5).  To date, the
   only treatment known to be effective for the enhancement of serum ethanol
   clearance is hemodialysis (6).  The present study demonstrates that
   intravenous fluid therapy has no role in accelerating the physiologic
   elimination of ethanol."
   "As previously posted, flumazenil has no effect in reversal of clinical
   effects of GHB in humans (7). From a separate prepublication article on
   GHB: "Pretreatment with the GABA antagonist flumazenil antagonized the GHB
   growth hormone secretory effect in humans. However, flumazenil failed to
   reverse clinical effects of GHB intoxication (7)." An ongoing study at
   Allegheny has confirmed the same in rats.
   --James Li, MD, Chief resident, emergency medicine
   Charity Hospital, New Orleans
   Refs:
   (1) Nuotto E. (1982) Coffee and caffeine and alcohol effects on psychomotor
   function. Clin Pharmacol Ther 31, 68-72.
   (2) Mackenzie A. I. (1979) Naloxone in alcohol intoxication. Lancet 1,
   733-736.
   (3) Guerin J. and Friedberg G. (1982) Naloxone and ethanol intoxication. Ann
   Intern Med 97, 932-936.
   (4) Nuotto E. and Palva E. S. (1983) Naloxone fails to counteract heavy
   alcohol intoxication. Lancet 2, 167-170.
   (5) Fluckiger A. et al. (1988) Lack of effect of the benzodiazepine
   antagonist flumazenil and the per-formance of healthy subjects during
   experimentally induced ethanol intoxication. Eur J Clin Pharma-col 34,
   273-276.
   (6) Osborn H. (1994) Ethanol. In Toxicologic Emergencies, 5th ed,  Goldfrank
   L. R. ed,  pp 813-824. Appleton & Lange, Norwalk.
   (7) Gerra G, Caccavari R, Fontanesi B et al. Flumazenil effects on growth
   hormone response to gamma-hydroxybutyric acid. Int Clin Psychopharmacol. 1994
   Sep;9(3):211-5.