II. Signs: Clinical Sobriety
- Eating drinking
- Walking without Ataxia, unsteady gait
- Baseline mental status
- Appropriate decision making
III. Labs
-
Blood Alcohol Level
- Legal limit in all U.S. states: 0.08% (80 mg/dl)
- Rate of Alcohol metabolization
- Non-chronic drinkers: 0.02 g/dl/h (20 mg/dl/h)
- Blood Alcohol 0.16% (160 mg/dl) will require 4 hours to fall below 0.08% (80 mg/dl)
- Chronic heavy drinkers: 0.03 g/dl/h (30 mg/dl/h)
- Blood Alcohol 0.16% (160 mg/dl) will require 3 hours to fall below 0.08% (80 mg/dl)
- Non-chronic drinkers: 0.02 g/dl/h (20 mg/dl/h)
IV. Precautions
-
Blood Alcohol correlates poorly with signs of Intoxication
- At a given Blood Alcohol Level, chronic drinkers appear less intoxicated than occasional drinkers
- Signs of Intoxication may occur at Blood Alcohol Levels well below limits
- Intoxication may be be compounded by coingested substances
- Other recreational drugs may result in greater Impairment than the BAL implies
-
Blood Alcohol Level does not need to be drawn to document sobriety for discharge
- Sobriety for discharge (not driving) may be determined clinically
- If Blood Alcohol Level is obtained, patient is considered intoxicated above 0.08%
- Consider limiting Blood Alcohol to cases where cause of Intoxication is unclear
- Waiting for Blood Alcohol to fall to legal limit in chronic drinkers may result in Alcohol Withdrawal
V. Management: Disposition
- Document the functional abilities and limitations of the patient (see exam above)
- A legal Blood Alcohol alone is not sufficient to declare sobriety
- As noted above, Clinical Sobriety may be determined solely on clinical examination
- Clinical Sobriety by examination
- Discharge home
- Continued Intoxication
- Injury prior to presentation, neurologic changes or need for serial examination when sober
- Continued observation
- Improving, alert, clinical stability and no concern for missed clinical findings
- Continued observation OR
- Discharge to sober, responsible adult who remain with the patient until sober OR
- Transfer to detox center
- Injury prior to presentation, neurologic changes or need for serial examination when sober
- Leaving Against Medical Advice (AMA)
- Evaluate Clinical Sobriety and decision making capacity
- If intact decision making capacity, the patient may not be held
- Patients who had other ingestion requiring reversal (e.g. Opioid Overdose) they may be held to observe for recurrence
- If discharged Against Medical Advice, consider notifying police of concerns regarding intoxicated patient
VI. References
- Delaney, Ashoo, Henry and Swaminathan in Herbert (2015) EM:Rap 15(8): 5-7