This handout is for acute alcohol intoxication. Your care team identified this based on: altered mental status with alcohol on breath or witnessed heavy drinking — acep 2023.
Other reasons your team may use this plan: witnessed binge drinking episode with progressive obtundation — acep 2023; found intoxicated in public setting brought by ems, unable to care for self — acep 2023; self-reported heavy alcohol consumption with vomiting, ataxia, or confusion — nice 2024.
Take these medications exactly as prescribed. Do not stop or change a dose without talking to your provider.
| Medication | Starting dose | How | When | What it does |
|---|---|---|---|---|
| thiamine | 500 mg IV over 30 min | IV | TID for 3 days then 250 mg IV daily for 3-5 days (Wernicke prophylaxis) — NICE 2024 | CRITICAL: Thiamine MUST be given BEFORE glucose. Glucose metabolism consumes thiamine; administering glucose without thiamine can precipitate or worsen Wernicke encephalopathy. High-dose IV thiamine (500 mg) recommended over IM 100 mg as absorption is unreliable in malnourished patients — NICE 2024 CG100 |
Plan: Supportive care: thiamine, folate, MgSO4, banana bag, glucose correction — NICE 2024; ACEP 2023
Use these zones to know what to do based on how you feel.
Call 911 or go to the nearest emergency room right away if you have:
Alcohol use disorder screening (AUDIT-C); brief motivational intervention; referral to addiction medicine/counseling; link to alcohol withdrawal engine if anticipated; social work for housing/safety; thiamine supplementation continued oral (100 mg PO daily) if chronic use — NICE 2024; ACEP 2023; UpToDate 2026
Guideline: NICE CG100 — Alcohol-use disorders: diagnosis and management of physical complications (Wernicke prophylaxis; thiamine before glucose) + Mirijello et al, Eur J Intern Med 2022 + Vonghia et al, Eur J Intern Med 2008 (acute alcohol intoxication reviews) + UpToDate 2026 ethanol intoxication in adults