letter to editor - Unusually High Ethanol Levels in Two Emergency

Published: Journal of Analytical Toxicology, Volume 20, Number 4, July/August 1996, pp. 272.

Unusually High Ethanol Levels in Two Emergency Medicine Patients
D.J. Wells, Jr. and M.T. Barnhill, Jr.

To the Editor:
The blood ethanol concentration associated with overdose fatalities has been reported in the literature as 0.45% or higher. However, there have been reports of survival at higher concentrations. Individual metabolic response to alcohol is variable; greater tolerance has been observed in subjects with a history of chronic ethanol abuse (1). We recently reviewed the medical records at a local tertiary care hospital and trauma center and encountered two reports of patients who survived after achieving serum alcohol concentrations greater than 600 mg/dL.

Patient 1 was a 42-year-old male found unconscious with “obvious signs of ethanol abuse.” A family member found him lying in bed, foaming at the mouth, and convulsing. Upon examination, his pupils were dilated and sluggish. He exhibited periods of apnea and was intubated. The serum ethanol level on presentation was 648 mg/dL using an instrumental enzymatic method. He rapidly regained consciousness, and was extubated the following day, but was retained an additional day for observation after spiking a temperature of 101.2°F. He was then discharged after being strongly advised to seek counseling for his drinking problem. The family stated that the patient had a history of heavy drinking.

Patient 2 was a 35-year-old female who was seen staggering and slumping to the ground. She was transported to the hospital by ambulance and was unresponsive upon arrival. There was a strong ethanol odor to her breath. A serum ethanol concentration of 653 mg/dL was reported upon admission. She was seen by the trauma service and cleared of any major physical injury. The patient was initially unresponsive to deep pain, but later awoke and became combative. She was physically restrained and placed on intraveneous fluids; her serum alcohol was determined every 4 h. The next day she was alert and cooperative. Examination by a psychiatrist was requested by the medical service after the patient stated that she wished she were dead. She was not judged to be suicidal, but stated during the psychiatric interview that she had drunk 12 beers per day, “more or less”, since she was 11 years old. She developed withdrawal symptoms the following day and was treated with a tranquilizer. After her condition normalized, she left the hospital the following day without a medical release.

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