Ethanol Infusion for Alcohol Withdrawal Prophylaxis Does Not Cause Intoxication

Abstract

Objective: Alcohol Withdrawal Syndrome (AWS) remains a common problem, especially in trauma and surgical patients. An intravenous ethanol infusion protocol was developed at this institution and previously validated for AWS prophylaxis. One concern with intravenous ethanol has been potential for intoxication and/or side effects. This study was performed on patients receiving AWS prophylaxis with an intravenous ethanol protocol to evaluate for intoxication and the occurrence of any adverse effects.
Methods: We did a retrospective review of all patients in our hospital who received AWS prophylaxis by ethanol infusion between 2008 and 2013. Information collected specific to ethanol infusion included rate of administration, serum ethanol levels, serum sodium level, use of benzodiazepines and anti-emetics, and development of AWS. Intoxication was defined using the Texas limit for blood alcohol content in a driver of .08% (80mg/dL).  The study period began at admission and lasted 7 days.
Results: Ninety-seven patient charts were reviewed.  Average serum ethanol level on admission was 137 mg/dL. Serum ethanol levels increased in 12% of patients after administration of ethanol infusion, and levels generally decreased over time.  Asymptomatic hyponatremia (serum sodium <135) occurred in 60% of patients. Benzodiazepines were administered to 52 patients (54%); of these, only 15 received increases in infusion rates indicating appropriate protocol use. In addition, 32 of the 52 had the ethanol infusion discontinued prior to scheduled protocol wean.
Conclusion: Ethanol infusion for alcohol withdrawal prophylaxis in the hospitalized patient rarely induces alcohol intoxication. However, a majority of patients experience asymptomatic hyponatremia. The high rate of concomitant benzodiazepine use suggests possible low efficacy of the infusion, although low adherence to the protocol could be a contributing factor.