Alcohol, trauma, or underlying medical condition?
The legal limit of blood alcohol content is set by the US Department of Motor Vehicles at 0.08%. However, not everyone presents the same way clinically, as different individuals have different tolerance levels depending on their level of regular alcohol use. Even the liver eliminates alcohol from the body at different rates as someone develops a tolerance for alcohol. There are many medical issues that can mimic alcohol intoxication. The list includes low blood sugar, stroke, seizures, encephalitis/meningitis, sepsis, kidney failure, different forms of encephalopathy, drug intoxication, electrolyte imbalances, hypothyroidism, hypothermia, vitamin deficiencies, multiple sclerosis, adrenal diseases, low oxygen levels, CO2 poisoning, dementia, psychiatric disease, and traumatic brain injury/concussion. So, it is important to understand how healthcare providers go about differentiating what is causing the patient’s symptoms.
It is essential that first responders and the emergency department staff do a very thorough assessment of these clients in order to determine what is causing his/her symptoms. Impaired cognition, altered mental status, slurred words, aggressive or bizarre behavior, confusion or unresponsiveness can all indicate a profoundly serious problem. Therefore, the clinician needs to consider many possibilities, even if the client smells like alcohol and intoxication seems likely. It is very important that alcohol level, blood glucose, and other labs are checked, signs, symptoms and vital signs are assessed, and a head CT is obtained if head trauma is suspected. A positive alcohol level does not necessarily mean other problems cannot be or are not present.
It is especially critical to identify patients with traumatic brain injury who also have high blood alcohol content as these patients have been shown to have increased in-hospital mortality compared to those who are not intoxicated. This could be due to the brain injury not being detected, either because of the alcohol intoxication or how the alcohol affects the brain. In these cases, if head trauma is suspected, a CT of the brain is the best initial imaging to obtain. This test can miss some injuries but will readily identify those injuries which are amenable to emergent neurosurgical interventions such as hematomas or hemorrhages. (Bennett & Fairbrother, 2017)
What does this have to do with criminal cases?
Both alcohol use and traumatic brain injury can be associated with criminal activity. Therefore, a review of the defendant’s medical records by an expert will assist in understanding their condition and determine if underlying medical conditions played a role in their behavior.
Bennett, J., & Fairbrother, H. (2017, August 30). emDocs. (A. Koyfman, & B. Long, Editors) Retrieved April 19, 2020, from emdocs.net: http://www.emdocs.net/alcohol-intoxication-mimics-ed-ddx-approach-management/
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