GROUP 2

Abiera, Jenny Lyn , Aripal, Venus  

Edessa , Baylon, Thrxia Mae
Jennifer ,
Barambangan, HaniyahBarcebal ,
Floger Faye R. , Carduza, Ruben
Jr. , Cinco, Dan Eldred ,
Comendador, Maiu Liwen B. ,
Estrella, Emma Eliza G. , Genson,
Milton A. , Hadjiula, Al Ameen ,
Kismundo, Jelourd Olaer ,
Madrones, Lian Lou O. , Oking,
Marie Kuan Yin ,
Pangangaan, Nymar E. , Peli,
Vincent Anthony G. , Reyes,
Antonio Miguel , Reyes, Shari
Ann L. , Roces, Ritzmer Jay C. ,
HISTORY OF PRESENT ILLNESS
• Jacob
• 14 year old boy
• Night PTC, ER visit due to alcohol intoxication. Advised to have follow
up check up hence consultation at OPD
 Living with his mom. Not comfortable talking to parents about
HOME alcohol use, getting into trouble

EDUCATION Currently enrolled in school. Missed school once because of hangover

ACTIVIES Usually hangs out with friends having drinks at parties

Drinks 3-4 bottles of beer and rum and coke, 1-2x a month for 6 months
DRUG/ALCOHOL with friends to relax and feel better about himself. No report of illicit drug use

SEXUAL Did not disclose his/her sexual activities

SELF HARM Avoids going with friends who drive while intoxicated. Does not drink and drive

No experience of any black outs during drinking however admits

SAFETY it happened to someone he knows. Never been in danger of driving or
riding a car with someone driving while drunk.
ETIOLOGY
• Underlying problems often family related e.g divorce of parents
• Experimenting
• Problems in human relationship e.g friends or girlfriend/boyfriend.
• Alcoholic parents
• Alcoholic group of friends
• Lower socioeconomic living
• Under educated regarding alcohol abuse
PATHOPHYSIOLOGY
ETHANOL

Impaired
gluconeogenesis HYPOGLYCEMIA
 CLINICAL PRESENTATION
(Adolescent Alcohol Intoxication)
Alcohol acts primarily
• Central nervous system (CNS) depressant
• Produces
Euphoria
Grogginess
Talkativeness
Impaired short-term memory; and
an increased pain threshold
• Causes vasodilation and hypothermia
centrally mediated
At very high serum levels
• Respiratory depression occurs
• Diuretic effect
• Its inhibitory effect on pituitary antidiuretic hormone release.
• The gastrointestinal (GI) complications of alcohol use
• occur from a single large ingestion
• most common is acute erosive gastritis
• manifesting as epigastric pain, anorexia, vomiting, and heme-positive stools
• Less frequently
• vomiting and mid-abdominal pain
• caused by acute alcoholic pancreatitis
• diagnosis is confirmed by the finding of elevated serum amylase and lipase levels
• Moderate alcohol consumption:
• Women: 1 drink/day
• Men: 2 drinks per day

• Alcohol Binge drinking: >4-5 drinks on a single occasion, generally

under a 2hr period & elevating blood alcohol concentration (BAC) levels
to >= 0.08

• Chronic heavy alcohol consumption:

• Women: >7 drinks/week
• Men: >14 drinks/week

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4046814/
Alcohol Overdose Syndrome
• suspected in any teenager who appears disoriented, lethargic, or
comatose
• distinctive aroma of alcohol may assist in diagnosis
• confirmation by analysis of blood is recommended
• At levels >200 mg/ dL, the adolescent is at risk of death
• and levels >500 mg/dL (median lethal dose)
• are usually associated with a fatal outcome

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4046814/
DIAGNOSTIC WORKUP:

CRAFFT or AUDIT (Alcohol Use Disorders Identification Test)

perform well in a clinical setting as techniques to identify alcohol use
disorders. A score of ≥8 on the AUDIT questionnaire identifies people who
drink excessively and who would benefit from reducing or ceasing
drinking.
CRAFFT

Nelson’s Textbook of Pediatrics 21’st Edition Chapter 140 page 1047

AUDIT

Nelson’s Textbook of Pediatrics Chapter 140 Page 1049

LABORATORY
• Serum gamma-glutamyl transferase and aspartate transaminase-
elevated levels may reflect recent use of alcohol

• Random blood sugar- decreased levels may indicate

hypoglycemic state
LEARNING GAPS
History of present illness
• Data regarding first ER visit the night before OPD consultation such as chief
complaint, initial state of the patient
• Past medical history
• Family history and social history (considering illicit drug use)

Physical Examination
• Physical examination upon arrival to the ER
DIFFERENTIAL DIAGNOSIS
 ALCOHOL USE DISORDER
RULE-IN
MALE SEX
DSM5 diagnostic criteria for AUD:
( + )Recurrent use resulting in a failure to fulfill
major role obligations at work, school, or home:
• The patient verbalized, “I missed the 1st period
of class” everytime after drinking; “I don’t
know when to stop drinking, alcohol is not a
big deal, feel relaxed when drinking”
RULE-OUT
DSM5 diagnostic criteria for AUD:
( - )Recurrent alcohol use in situation in which it is
physically hazardous. (the patient don’t ride or drive a
friend’s car if they are drunk)
( - ) Continues alcohol use despite having persistent or
recurrent social interpersonal problems caused or
exacerbated by the effects of alcohol.
The patient is willing to stop drinking: 5/10
 YOUNG ANTISOCIAL SUBTYPE
21.1% of alcoholics fall into this subtype. Tends to start drinking at the youngest age and
also develops an alcohol dependence at the earliest age.

RULE-IN RULE-OUT
MALE SEX Cravings for alcohol
14 years old Using alcohol in dangerous or hazardous situations
Controlling use of alcohol, such that its use results Developing the symptoms of physical dependence as a
in negative consequences in numerous aspects of result of alcohol use (tolerance or both tolerance and
life withdrawal)
Spending significant amounts of time using or Experiencing significant distress or dysfunction as a
trying to get alcohol or recovering from alcohol result of use of alcohol
use
HYPOGLYCEMIA
• We still cannot fully rule this out
because of the learning gaps.
 MANAGEMENT/TREATMENT
Alcohol Overdose Artificial Ventilatory Support
Syndrome Must be provided until the liver can eliminate sufficient amounts of alcohol
from the body usually 20hrs to reduce 400mg/dL- zero (0).

Dialysis ( alcohol blood level >400mg/dL)

Follow up Acute Group Counseling

Treatment Individualized Counseling
Multifamily Intervention

Nelson’s Textbook of Pediatrics 21st Edition pp.1049