著者: 上山裕二 医療法人倚山会 田岡病院 救急科

監修: 箕輪良行 みさと健和病院 救急総合診療研修顧問



  1. 急性エタノール中毒患者には外傷が隠れていることがあるので、詳細にチェックすることが強く推奨される(推奨度1)
  1. アルコール血中濃度が低いにも関わらずGCSが14点以下である場合には、意識障害の原因としてアルコール以外のものを検索することが強く推奨される(推奨度1)
オーダー内の薬剤用量は日本医科大学付属病院 薬剤部 部長 伊勢雄也 以下、林太祐、渡邉裕次、井ノ口岳洋、梅田将光による疑義照会のプロセスを実施、疑義照会の対象については著者の方による再確認を実施しております。
※薬剤中分類、用法、同効薬、診療報酬は、エルゼビアが独自に作成した薬剤情報であり、 著者により作成された情報ではありません。
著者のCOI(Conflicts of Interest)開示:
上山裕二 : 特に申告事項無し[2022年]
監修:箕輪良行 : 未申告[2022年]

  1. 定期レビューを行った(変更なし)。


  1. エタノール中毒とは、エタノールを大量に摂取することにより、酩酊、歩行障害、もしくは昏睡などの中毒症状を来した状態である。
  1. 急性エタノール中毒は、血中のエタノール濃度が上昇し、脳が麻痺し現れる症状である。主な症状は脱抑制作用、協調運動障害、記憶障害、昏睡などといった中枢神経症状と、血管拡張+二次性の脱水による低血圧と頻脈である。また低体温やさまざまな代謝障害(低血糖、乳酸アシドーシス、低カリウム血症、低マグネシウム血症、低カルシウム血症、低リン酸血症)になりやすい。頻度は地域によって異なるものの、15~40%の救急外来受診患者にエタノールが同定されたという報告がある[1]
  1. 急性エタノール中毒は、病歴と身体所見からほとんどの場合、鑑別疾患として挙げることができる。



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Abstract/Text This study reports breath-analyzer readings and self-reports as measures of alcohol-related admission to the emergency room of San Francisco General Hospital. A 20% probability sample of patients admitted during a 60-day period was breath analyzed and interviewed. Interviews and breath samples were obtained on 75% of the sample of 2,516 patients. Twice the proportion of injury patients compared to noninjury patients had positive admission breath samples and reported drinking prior to the event. Alcohol involvement reached 41% for self-reports among injured men and over half of both men and women injured in fights or assaults reported drinking prior to the event. Self-reported alcohol use was found to be a valid measure of alcohol consumption when compared to breath-analyzer readings for the same individuals. Emergency room patients may be more likely than others to provide accurate reports of alcohol consumption if they feel that disclosure of amount and timing of drinking prior to an injury or illness could be important in their care. The data suggest that self-reports when used in conjunction with a quantifiable estimate of blood alcohol may be an appropriate method of ascertaining alcohol's involvement in emergency room cases.

PMID 2927129
A B Lowenfels, T T Miller
Alcohol and trauma.
Ann Emerg Med. 1984 Nov;13(11):1056-60.
Abstract/Text Available evidence implicates alcohol consumption as a major risk factor for almost all types of injury. An exceptionally strong relationship is noted between alcohol and motor vehicle accidents--particularly single-vehicle crashes. Recognition of the association between alcohol and trauma is important not only for proper care and for treatment of the underlying alcoholism, but to stimulate enactment of preventive measures aimed at reducing the risk of alcohol-associated injuries.

PMID 6148908
S C Chen, F Y Lin, K J Chang
Body region prevalence of injury in alcohol- and non-alcohol-related traffic injuries.
J Trauma. 1999 Nov;47(5):881-4.
Abstract/Text OBJECTIVE: To explore the relationship between alcohol use and body region of injury in patients injured in traffic collisions.
MATERIALS AND METHODS: A prospective study of 381 patients involved in traffic collisions over the past 4 months. These patients were categorized as either using alcohol or not using alcohol on the day of the accident. Eighty of 381 patients (21%) had detectable blood alcohol concentrations. Age, sex, location of injury, helmet use, clinical diagnosis, Injury Severity Score, Glasgow Coma Scale score, and blood alcohol concentrations were collected for each patient. Blood alcohol concentrations were measured by the radioactive energy attenuation method.
RESULTS: The incidence of head, face, chest, abdomen, and extremity injury in patients with alcohol use was 39%, 56%, 13%, 15%, and 55%, respectively, and 26%, 32%, 15%, 12%, and 63% in those without alcohol use, respectively. The differences in the incidence of head and facial injuries were significant between these two groups (p<0.05). Mean blood alcohol concentrations in head, face, chest, abdomen, and extremity injury were 171, 204, 215, 231, and 163 mg/dL, respectively.
CONCLUSION: More injuries to the head and facial areas compared with other body parts were found in patients with alcohol use. However, alcohol level did not seem to influence the region of the body injured.

PMID 10568716
L M Gentilello, D M Donovan, C W Dunn, F P Rivara
Alcohol interventions in trauma centers. Current practice and future directions.
JAMA. 1995 Oct 4;274(13):1043-8.
Abstract/Text Nearly half of all trauma beds are occupied by patients who were injured while under the influence of alcohol. Alcoholism plays such a significant role in trauma that efforts to reduce injury recurrence are unlikely to be successful if it remains untreated. An injury requiring hospitalization creates a unique opportunity to intervene and to motivate patients to alter their drinking behavior, thereby making trauma centers ideal sites to implement an alcohol screening, intervention, and referral program. However, despite emphasis on injury control and prevention, little has been done to incorporate alcohol intervention programs into care of the injured patient. Effective means of intervention exist that are consistent with the time, financial, and staffing constraints of trauma centers, and they should be implemented.

PMID 7563455
S Galbraith, W R Murray, A R Patel, R Knill-Jones
The relationship between alcohol and head injury and its effect on the conscious level.
Br J Surg. 1976 Feb;63(2):128-30.
Abstract/Text The incidence of head injury has risen in recent years and now accounts for almost one-third of acute male surgical admissions to the Western Infirmary, Glasgow. A prospective study has established that in Glasgow alcohol is a major associated factor, 62% of males and 27% of females having detectable levels in the blood (greater than 5 mg/100 ml); in these patients the mean level was 193 mg/100 ml in men and 165 mg/100 ml in women. The alcohol level was significantly higher in patients who had had 'a fall under the influence', or had been the victims of an assault, than in those involved in traffic or other accidents. This suggests that alcohol may be an important contributroy cause of head injuries in this city. Depression of the conscious level occurred at blood alcohol levels aroung 200 mg/100 ml, but a significant number of patients in coma had a serious head injury.

PMID 1252711









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