Clinical signs of alcohol intoxication and importance of blood alcohol concentration testing in alcohol dependence

The goal of the study was to find out if and what is a difference between clinical signs of alcohol intoxication (AI) and a detected blood alcohol concentration (BAC) among the patients with syndrome of alcohol dependence.

The relation between BAC and clinical assessment of AI is a complicated issue. People with dependence form a special group due to their altered tolerance to alcohol.

Clinical, prospective study of 1,277 patients seeking treatment for alcohol-related problems. The average age was 43.1 (SD ± 11.8) years, 74 % males. Alcohol dependence and diagnosis of AI was done by a psychiatrist during a standard examination. This was followed by a laboratory testing for the presence of alcohol in the exhaled air calculated into BAC. The clinical and laboratory findings were compared in a descriptive and statistical way under codes Y 91 and Y 90 in accordance with the ICD-10/WHO diagnostic criteria.

The clinical signs of AI were found in 275 (22 %) patients. Of these, 57 (21 %) showed no presence of alcohol in blood laboratory testing. Alcohol was found in blood in 383 (30 %) patients, of whom 165 (43 %) did not show the clinical signs of AI. 21 % had no clinical signs of AI at BAC ≥ 2 ‰.

Our findings showed that there was a substantial discrepancy between the clinical signs of AI and the detected BAC in people with dependence. These differences do not seem to result from insufficient diagnostic skills of the physicians but they are rather due to the non-specific nature of the signs, which can be of different etiology. Therefore, an enhanced diagnostic alertness and routine laboratory testing for the presence of alcohol is important, especially in the emergency and addiction medicine (Fig. 2, Ref. 19).