Acute intoxication

Blood alcohol levels around 50 mg/100 ml cause increased well-being, reduced inhibitions, and reduced efficiency (seldom recognized by the subject). Heavier intoxication causes obvious cognitive impairment, ataxia, slurred speech, and vomiting, with subsequent amnesia.

Coma usually supervenes when blood alcohol reaches about 200-300 mg/ 100 ml. Coma in heavy drinkers may also result from head injury, drug overdose, a recent fit, hypothermia, or hypoglycaemia: this is a well-known clinical pitfall in casualty and in acute psychiatric presentations. The patient may well be a known alcoholic or obviously drunk: but may also have other disorders, such as an intracranial bleeding, that will be fatal if not picked up. Blood alcohol levels over 400 mg/100 ml may be fatal. Milder degrees of intoxication can lead to death indirectly through accidents or inhalation of vomit.

'Pathological intoxication' (mania a potu) is abnormal behaviour following only modest alcohol intake, usually described in brain-damaged people, although there is doubt as to the validity of this concept. It is sometimes used as the basis of a somewhat optimistic defence against criminal charges.

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