These are not just drunken stupors

This is the 3855th article of Da Yi Xiao Hu

Lao Liu, who has a history of drinking for many years, could only drink alone at home every day during the epidemic lockdown, which was boring; his wife also noticed that Lao Liu's appetite had greatly decreased, and he would sometimes be irritable and angry, and sometimes look dull and talk to himself. She just thought he was in a bad mood and often comforted him.

After the lockdown was lifted, Lao Liu couldn't wait to invite a few friends to his home for a drink. His friends also brought a lot of fish and meat, and Lao Liu and his wife happily prepared a large table of dishes. When the guests and hosts were eating and chatting, everyone suddenly found that Lao Liu was leaning back in his chair and was drowsy. The few words he said were incoherent. His wife hurriedly helped Lao Liu lie down on the sofa and apologized that he was too excited today and was a little tired after a busy day, so he was easily drunk.

But a careful friend, Lao Zhang, reminded him that Lao Liu had a good appetite today and had eaten a lot of food, but he had not drunk much wine, so he did not look drunk. After this reminder, everyone decided to send Lao Liu to the hospital. Soon, the emergency room doctor came to the conclusion that he had acute hepatic encephalopathy, also known as "hepatic coma."

It turned out that Mr. Liu had developed alcoholic cirrhosis due to long-term excessive drinking and his liver function continued to decline, but he himself was unaware of it. This time, he consumed a large amount of high-protein food and induced acute hepatic encephalopathy. Fortunately, he sought medical treatment in time, otherwise it might have been fatal if it had been delayed.

Generally, the excitement or drowsiness that healthy people experience after being drunk are all alcoholic encephalopathy of varying degrees caused by acute alcohol poisoning. Usually, as the alcohol in the body is gradually metabolized and eliminated, the drunk person will regain consciousness on his own (of course, a few severe cases of alcoholic encephalopathy can also be life-threatening). This is why many people think that being "unconscious" after being drunk is a trivial matter and that a good night's sleep will be fine.

However, people with chronic underlying diseases may develop some acute complications when or after drinking, which may cause changes or loss of consciousness, but are often mistaken for being "drunk" and may delay diagnosis and treatment, which requires our attention. Here are some situations that are particularly easy to confuse.

Acute hepatic encephalopathy

It is mainly seen in patients with acute or chronic liver disease and severe reduction of liver metabolic capacity (such as Lao Liu mentioned above). It often presents a chronic progressive process, with gradually worsening symptoms such as temperament changes, cognitive or consciousness disorders, and "flapping" tremors. It may also cause acute exacerbation under the influence of some factors, or sudden onset of acute hepatic encephalopathy when the original chronic course of the disease is not obvious, resulting in mental or consciousness disorders, or even coma, similar to the symptoms of drunkenness.

Common factors that induce acute hepatic encephalopathy include: large intake of high-protein food in a short period of time, upper gastrointestinal bleeding, large transfusion of stored blood, constipation, large use of diuretics, large drainage of ascites in a short period of time, acute liver failure, etc. In general, the exhaled breath of patients with hepatic encephalopathy will have an "ammonia smell", but this special odor may be masked after drinking or vomiting due to excessive alcohol.

Acute cerebrovascular disease (cerebral embolism/cerebral hemorrhage/subarachnoid hemorrhage) and brain trauma

Some patients with atrial fibrillation, arteriosclerosis, hypertension or cerebral aneurysm, under the stimulation of alcohol, have an accelerated heart rate and a sharp rise in blood pressure. Combined with the combined effects of excitement and agitation, these may induce acute cerebral embolism, cerebral hemorrhage or subarachnoid hemorrhage, and other acute cerebrovascular diseases that can cause acute disturbance of consciousness or even coma.

Under normal circumstances, these emergencies would be taken seriously by witnesses, but if these emergencies occur during or after drinking, they may be ignored as changes in consciousness caused by excessive alcohol, and the best time for treatment will be missed.

Some people who drink too much alcohol may experience blurred vision, unsteady walking, etc., which may cause accidental head impacts and cause craniocerebral trauma, such as traumatic subarachnoid hemorrhage, subdural hemorrhage, skull base fracture, etc. In severe cases, not only will it cause sudden loss of consciousness, but it may even be life-threatening. However, these symptoms are easily masked by drunkenness and delay treatment.

Hypoglycemic encephalopathy

Some people sit down at the table and don't bother to eat their dishes or staple food, but are busy "clinking glasses" and "cheers" with relatives and friends. Drinking a lot of alcohol on an empty stomach will not only accelerate the occurrence of acute alcohol poisoning and aggravate the damage, but it is also likely to cause hypoglycemia due to gluconeogenesis disorders caused by the metabolism of a large amount of alcohol.

If hypoglycemia cannot be supplemented with exogenous glucose in time, it will cause hypoglycemic encephalopathy, which not only causes impaired consciousness, but also directly endangers life due to brain cell damage and necrosis. Hypoglycemic encephalopathy caused by acute alcohol poisoning is particularly easy to be mistaken for a mere manifestation of drunkenness.

Diabetic ketoacidosis/diabetic hyperosmolar encephalopathy

Diabetic ketoacidosis/hyperosmolar encephalopathy is a common endocrine crisis and a common acute complication that threatens the life of diabetic patients. Among the inducing factors, poor diet control, stress (emotional excitement), and dehydration (such as vomiting) are often accompanied by alcohol overdose (poisoning). Therefore, diabetic patients may develop ketoacidosis/hyperosmolar encephalopathy when or after being drunk.

The common manifestations of this group of endocrine crises include: impaired consciousness, vomiting, and exhaled breath with the smell of rotten apples. These manifestations can easily overlap or be masked by the symptoms of drunkenness. If treatment is not timely, it can further cause life-threatening organ failure such as shock.

The above mentioned (but not limited to) acute and severe illnesses that may occur with excessive drinking are difficult to accurately identify outside the hospital, so to avoid risks, our advice is:

1. Drink in moderation and do not drink on an empty stomach.

2. Patients with acute and chronic liver disease should abstain from alcohol; patients with chronic diseases such as cardiovascular and cerebrovascular diseases, diabetes, etc. should try to avoid drinking, or occasionally drink a small amount of low-alcohol wine. Drinking should be avoided especially when the chronic disease is not well controlled.

3. If a person experiences impaired consciousness during or after drinking (especially if he or she suffers from acute or chronic diseases or has fallen or collided), his or her family, friends, and colleagues must pay attention to the person and seek medical attention promptly to rule out serious acute illnesses.

Author: Emergency Department, Shuguang Hospital Affiliated to Shanghai University of Traditional Chinese Medicine

He MiaoDeputy Chief Physician