154 - Ethanol and Opioid Intoxication and Withdrawal

their lifetimes. Mild to moderate consumption (up to one drink/day for women and two drinks/day for men) has been shown to have beneficial cardiovascular effects, including a decreased risk of myocardial infarction and stroke, as well as overall decreased mortality (Box 154.1). Despite these possibly beneficial effects of alcohol, it has been found to be a top 10 cause of preventable deaths among all age groups in the United States. Additionally, approximately 9% of adults meet the diagnostic criteria for alcohol abuse and alcoholism. This maladaptive behavior can lead to numerous individual medical complications and societal problems, including motor vehicle collisions, assaults, homicide, suicide, and domestic violence. An estimated 7.6 million emergency department (ED) visits per year are for alcohol-related diseases and diagnoses. Alcohol withdrawal is seen in the ED in various forms and stages, including early withdrawal, hallucinosis, seizures, and fully developed delirium tremens (DT). DT, a severe withdrawal syndrome defined by the presence of tremors, seizures, and delirium, develops in 5% of patients who develop symptoms of alcohol withdrawal and itself carries a 5% to 15% risk of mortality. Among patients admitted to the hospital with a diagnosis of alcohol withdrawal, the following clinical features have been found to be associated with an increased risk of death: underlying liver disease, the need for endotracheal intubation, hyperthermia, persistent tachycardia, and the use of physical restraints.