Alcohol intoxication
Classification and external resources
The Drunkenness of Noah by Michelangelo
ICD-10	F10.0, T51
ICD-9	305.0, 980
MeSH	D000435

Alcohol intoxication (also known as drunkenness or inebriation) is a physiological state that occurs when a person has a high level of ethanol (alcohol) in his or her blood.

Common symptoms of alcohol intoxication include slurred speech, euphoria, impaired balance, loss of muscle coordination (ataxia), flushed face, vomiting, reddened eyes, reduced inhibition, and erratic behavior. In severe cases, it can cause coma or death.

Toxicologists use the term “alcohol intoxication” to discriminate between alcohol and other toxins.

Acute alcohol intoxication results from a very high level of alcohol in the blood. This term is used by health care providers, often in emergencies.

Pathophysiology[link]

Development of a rational scale to assess the harm of drugs of potential misuse, The Lancet, 2007

Alcohol is metabolized by a normal liver at the rate of about one ounce (one "highball", a normal beer, a regular sized glass of wine) every 90 minutes. An "abnormal" liver with conditions such as hepatitis, cirrhosis, gall bladder disease, and cancer will have a slower rate of metabolism.

Ethanol is metabolised to acetaldehyde by alcohol dehydrogenase (ADH), which is found in many tissues, including the gastric mucosa. Acetaldehyde is metabolised to acetate by acetaldehyde dehydrogenase (ALDH), which is predominantly found in liver mitochondria. Acetate is used by the muscle cells to produce acetyl-CoA using the enzyme acetyl-CoA synthetase, and the acetyl-CoA is then used in the citric acid cycle.^[1] It takes roughly 90 minutes for a healthy liver to metabolize a single ounce, approximately one hour per standard unit.

Ethanol's acute effects are largely due to its nature as a central nervous system depressant, and are dependent on blood alcohol concentrations:

• 20–99 mg/dL - Impaired coordination and euphoria
• 100–199 mg/dL - Ataxia, poor judgement, labile mood
• 200–299 mg/dL - Marked ataxia, slurred speech, poor judgement, labile mood, nausea and vomiting
• 300–399 mg/dL - Stage 1 anaesthesia, memory lapse, labile mood
• 400+ mg/dL - Respiratory failure, coma

As drinking increases, people become sleepy, or fall into a stupor. After a very high level of consumption, the respiratory system becomes depressed and the person will stop breathing. The most important thing for friends who witness someone "passing out" from too much alcohol is to get them emergency medical treatment. Comatose patients may aspirate their vomit (resulting in vomitus in the lungs, which may cause "drowning" and later pneumonia if survived). CNS depression and impaired motor co-ordination along with poor judgement increases the likelihood of accidental injury occurring.^[2] It is estimated that about one third of alcohol-related deaths are due to accidents (32%), and another 14% are from intentional injury.^[3]

In addition to respiratory failure and accidents caused by effects on the central nervous system, alcohol causes significant metabolic derangements. Hypoglycaemia occurs due to ethanol's inhibition of gluconeogenesis, especially in children, and may cause lactic acidosis, ketoacidosis and acute renal failure. Metabolic acidosis is compounded by respiratory failure. Patients may also present with hypothermia.

Pharmacology[link]

In the past alcohol was believed to be a non-specific pharmacological agent, affecting many neurotransmitter systems in the brain.^[4] However, molecular pharmacology studies have shown that alcohol has only a few primary targets. In some systems these effects are facilitatory and in others inhibitory.

Among the neurotransmitter systems with enhanced functions are: GABA_A,^[5] glycine,^[5] serotonin,^[6] nicotinic acetylcholine receptors.^[7]

Among those that are inhibited are: NMDA,^[6] dihydropyridine-sensitive L-type Ca2+ channels^[8] and G-protein-activated inwardly rectifying K+ channels.^[9]

The result of these direct effects are a wave of further indirect effects involving a variety of other neurotransmitter and neuropeptide systems, leading finally to the behavioural or symptomatic effects of alcohol intoxication.^[4]

Diagnosis[link]

Definitive diagnosis relies on a blood test for alcohol, usually performed as part of a toxicology screen.

Law enforcement officers often use breathalyzer units and field sobriety tests as more convenient and rapid alternatives to blood tests. The reliability of field sobriety tests is somewhat questionable, although they are commonly used in various jurisdictions.^{[citation needed]}

There are also various models of breathalyzer units that are available for consumer use. Because these may have varying reliability and may produce different results than the tests used for law-enforcement purposes, the results from such devices should be conservatively interpreted.

Many informal intoxication tests exist, which are generally unreliable and not recommended as deterrents to excessive intoxication or as indicators of the safety of activities such as motor vehicle driving, heavy equipment operation, machine tool use, etc.

For determining whether someone is intoxicated by alcohol by some means other than a blood-alcohol test, it is necessary to rule out out other conditions such as hypoglycemia, stroke, usage of other intoxicants, mental health issues, and so on. It is best if their behavior has been observed while the subject is sober to establish a baseline. Several well known criteria can be used to establish a probable diagnosis. For a physician in the acute treatment setting, acute alcohol intoxication can mimic other acute neurological disorders, or is frequently combined with other recreational drugs that complicate diagnosis and treatment.

Epidemiology[link]

Common causes for excessive alcohol consumption include:

• alcoholism
• depression
• inexperience with the effects of alcohol

Alcohol poisoning[link]

Signs and symptoms[link]

The signs and symptoms of alcohol poisoning include:

• confusion
• vomiting^[10]
• dangerous anger
• seizures (fits)
• slow breathing (fewer than eight breaths a minute)
• pale, bluish skin
• cold and clammy skin^[11]

Management[link]

Emergency treatment for acute alcohol intoxication strives to stabilize the patient and maintain a patent airway and respiration, while waiting for the alcohol to metabolize:^[12] Also:

• Protect vital signs by monitoring ABCs, or Airway, Breathing, and Circulation; that is, if the person is thought to be at risk for severe respiratory depression, consider an endotracheal tube to protect the airway and assist with breathing.
• Protect the airway from aspirating stomach contents that could cause aspiration pneumonia.
• Treat hypoglycaemia (low blood sugar) with 50ml of 50% dextrose solution and saline flush, as ethanol induced hypoglycaemia is unresponsive to glucagon.
• Administer the vitamin thiamine to prevent Wernicke-Korsakoff syndrome, which can cause a seizure (more usually a treatment for chronic alcoholism, but in the acute context usually co-administered to ensure maximal benefit).
• Check urea and electrolytes to guide fluid replacement.
• Apply haemodialysis if the blood concentration is dangerously high (>400 mg%), and especially if there is metabolic acidosis.
• Provide oxygen therapy as needed via nasal cannula or non-rebreather mask.

Additional medication may be indicated for treatment of nausea, tremor, and anxiety.

Prognosis[link]

A normal liver detoxifies the blood of alcohol over a period of time that depends on the initial level and the patient's overall physical condition. An abnormal liver will take longer but still succeed, provided the alcohol does not cause liver failure.^[13]

People who have been drinking heavily for several days or weeks may have withdrawal symptoms after the acute intoxication has subsided.^[14]

A person who consumes a dangerous amount of alcohol persistently can develop memory blackouts and idiosyncratic intoxication or pathological drunkenness symptoms.^[15]

Long-term persistent consumption of excessive amounts of alcohol can cause liver damage and have other deleterious health effects.

Society and culture[link]

Legal[link]

Laws on drunkenness vary between countries. In the United States, for example, it is a criminal offense for a person to be drunk while driving a motorized vehicle (driving under the influence), operating an aircraft, or (in some states) assembling or operating an amusement park ride.^[16] This is also the case in the United Kingdom and many other countries. In some countries it is also an offense to serve alcohol to an already intoxicated person and often alcohol can only be sold by staff qualified to serve responsibly through alcohol server training.

The blood alcohol content (BAC) for legal operation of a vehicle is typically measured as a percent of unit volume of blood. This ranges from a low of 0.00% in Romania and the United Arab Emirates, to 0.05% in Australia, South Africa and Germany, to 0.08% in the United Kingdom, the United States, and New Zealand.^[17]

Additionally, the U.S. Federal Aviation Administration prohibits crewmembers from performing their duties with a BAC greater than 0.04%, within 8 hours of consuming an alcoholic beverage or while under the influence of alcohol.^[18][19]

In the UK, US, and Australia, people can be arrested for public intoxication, being "drunk and disorderly" or being "drunk and incapable".^[20] There are also often legal penalties for the sale of alcoholic beverages to intoxicated persons.^[21]

In some jurisdictions, intoxication may be a defense against some criminal charges, or a mitigating factor in sentencing.

Religious views[link]

Some religious groups permit the consumption of alcohol, some permit consumption but prohibit intoxication, and some prohibit alcohol consumption altogether. In the Qur'an,^[22][23][24] there is a prohibition on the consumption of grape-based alcoholic beverages, and intoxication is considered as an abomination in the Hadith. Islamic schools of law (Madh'hab) have interpreted this as a strict prohibition of the consumption of all types of alcohol and declared it to be haraam ("forbidden"), although other uses may be permitted.^[25]

Some Protestant Christian denominations prohibit the drinking of alcohol^[26] based upon Biblical passages which condemn drunkenness (for instance, Proverbs 23:21,^[27] Isaiah 28:1,^[28] Habakkuk 2:15.^[29]), but others allow moderate use of alcohol.^[30] In some Christian groups, wine is part of the rite of communion (see Christianity and alcohol). However, in The Church of Jesus Christ of Latter-day Saints, alcohol consumption is forbidden,^[31] to the point where teetotalism has become a distinguishing feature of its members.

In Buddhism, the consumption of intoxicants is generally discouraged for both monastics and lay followers. Many followers of Buddhism observe a code of conduct known as the Five Precepts, of which the fifth precept prohibits consumption of intoxicating substances (except for medical reasons). In the Bodhisattva Vows of the Brahma Net Sutra, observed by some monastic communities and some lay followers, distribution of intoxicants is likewise discouraged as well as consumption.

In Vaishnavism, specifically Gaudiya Vaishnavism, one of the four regulative principles forbids the taking of intoxicants, including alcohol.

See also[link]

Wikisource has the text of the 1911 Encyclopædia Britannica article Drunkenness.

• Short-term effects of alcohol
• Long-term effects of alcohol
• Driving under the influence
• Alcohol and sex
• Alcohol flush reaction

References[link]

Bibliography[link]

• Bales, Robert F. "Attitudes toward Drinking in the Irish Culture". In: Pittman, David J. and Snyder, Charles R. (Eds.) Society, Culture and Drinking Patterns. New York: Wiley, 1962, pp. 157–187.
• Gentry, Kenneth L., Jr., God Gave Wine: What the Bible Says about Alcohol. Lincoln, Calif.: Oakdown, 2001.
• Rorabaugh, W.J. "The Alcoholic Republic," Chapter 2 & 5, Oxford University Press.
• Sigmund, Paul. St. Thomas Aquinas On Politics and Ethics. W.W. Norton & Company, Inc, 1988, p. 77.
• Walton, Stuart. Out of It. A Cultural History of Intoxication. Penguin Books, 2002. ISBN 0-14-027977-6.

External links[link]

• Alcohol Poisoning: NHS Choices

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Ed Sheeran
Ed Sheeran
Background information
Birth name	Edward Christopher Sheeran
Born	(1991-02-17) 17 February 1991 (age 21)
Origin	Halifax, England
Genres	Folk, acoustic, hip hop, grime
Occupations	Singer, songwriter, producer, rapper, beatboxer
Instruments	Vocals, guitar, BOSS Loop Pedal RC-30
Years active	2005–present
Labels	Asylum, Atlantic Records
Associated acts	Yelawolf, Devlin, Wiley, Ghetts, P Money, Wretch 32, Sway DaSafo, Jamie Woon, Yasmin, Amy Wadge[1]
Website	edsheeran.com

Edward Christopher "Ed" Sheeran (born 17 February 1991) is an English singer-songwriter who is currently signed to Asylum / Atlantic Records.^[2] Sheeran broke through commercially in June 2011, when his debut single "The A Team" debuted at number 3 on the UK chart.^[3]

Life and career[link]

1991–2011: Early life and career beginnings[link]

Sheeran was born in Halifax, West Yorkshire to Irish^[4] and English^[5] parents, before moving to Framlingham, Suffolk; he is a cousin of TV journalist and presenter Gordon Burns.^[6] He learned guitar at a very young age, and began writing songs during his time at Thomas Mills High School in Framlingham.^[7] His early childhood memories, referred to in a interview on the Zane Lowe show, included listening to Van Morrison on his countless trips to London with his parents and going to an intimate gig with Damien Rice in Ireland when he was 11.^[8] He also opened for Nizlopi in Norwich in April 2008 after being one of their guitar technicians.^[7] Sheeran began recording in 2005, which led to the release of his first EP, The Orange Room EP. Sheeran also released 2 albums, a self-titled one in 2006 and Want Some? in 2007. He moved to London in 2008 to play gigs, starting off in very small venues, playing every day, to as little as five people. In 2008, he auditioned for the ITV series Britannia High.^[9]

In 2009, Sheeran played 312 gigs. He said that he read an interview with James Morrison that said that Morrison had done 200 gigs in a year, and Sheeran wanted to beat him on this number.^[10] Also in 2009, he released another EP, You Need Me, just before going on tour with Just Jack. He also did a few collaborations with Leddra Chapman, including Cee Lo Green's Fuck You. In February 2010 Sheeran posted a video through SB.TV, which led to mainstream rapper Example asking Sheeran to tour with him. Also in February 2010 he released his critically acclaimed Loose Change EP, which featured his later debut single "The A Team".

In April 2010, after leaving his old management company, Sheeran bought a ticket to Los Angeles, with no contacts other than one poetry night. He played open mic nights all over the city, before his talent was spotted at The Foxxhole by Jamie Foxx, who was so impressed that he offered Sheeran the use of his recording studio and the run of his Hollywood home for the rest of his stay. Throughout 2010, Sheeran began to be seen by more people over the internet through YouTube and his fan-base grew, with him also getting credit from The Independent newspaper, England football captain Rio Ferdinand and Elton John.^[11] Sheeran also self-released two other EPs in 2010; Ed Sheeran: Live at the Bedford and Songs I Wrote With Amy, which is a collection of love songs he wrote in Wales with fellow singer songwriter Amy Wadge.

Sheeran at Academy 1, Manchester Dot to Dot Festival on Monday 30 May 2011

On 8 January 2011, Sheeran released his final independent EP, No. 5 Collaborations Project featuring appearances by grime artists including Wiley, JME, Devlin, Sway and Ghetts.^[2] With this EP, Sheeran gained mainstream attention for reaching number 2 in the iTunes chart without any promotion or label, selling over 7,000 copies in its first week.^[12] Three months later, Sheeran put on a free show to fans at the Barfly in Camden. Over 1,000 fans turned up to see the show, so Sheeran ended up playing four different shows to make sure everyone saw a gig, including a gig outside on the street after the venue had closed. Later that month, Sheeran was signed to Asylum / Atlantic Records.

[edit] 2011–present: + and commercial success

On 26 April, Sheeran appeared on the TV music show Later... with Jools Holland – where he performed his debut single "The A Team". Six weeks later, "The A Team" was released as a digital download in the UK. The release served as the lead single from Sheeran's debut studio album, entitled +. "The A Team" entered the UK Singles Chart at number three, selling over 58,000 copies in the first week. It was congratulated on being the best selling debut single and the overall eight best selling single of 2011, shifting 801,000 copies.^[13] The lead single also became a top ten hit in Australia, Germany, Ireland, Japan, Luxembourg, New Zealand, Norway and the Netherlands. During a headline set in the BBC Introducing tent at Glastonbury Festival 2011, Sheeran announced that "You Need Me, I Don't Need You" would be released on 28 August as the second single from the album. The second single peaked at number four on the UK Singles Chart.^[14]

Sheeran's debut album + was released on 12 September 2011. + received generally favorable reviews from music critics. At Metacritic, which assigns a normalized rating out of 100 to reviews from mainstream critics, the album received an average score of 65, which indicates "generally favorable reviews".^[15] + debuted number one on the UK Albums Chart, selling 102,000 copies in its first week.^[16] It became the second best selling debut album and the ninth biggest-selling album of 2011 in the UK, shifting 791,000 copies.^[17] The album climbed back up to number one on the UK Albums Chart on 1 January 2012, fifteen weeks after it last peaked at the top. The album has been certified triple platinum by the British Phonographic Industry for shipments of 900,000 units.^[18] As of March 2012, the album had sold 1,021,072 copies in the UK.^[19] The album also reached the top ten on the Australian Albums Chart, Flanders Belgian Albums Chart,^[20] Dutch Albums Chart,^[21] Irish Albums Chart,^[22] New Zealand Albums Chart^[23] and the Swiss Albums Chart.^[24]

On 11 November 2011, soul ballad "Lego House" was released as the third single lifted from the debut studio album +.^[25] It received its first radio play on BBC Radio 1 on 8 September 2011.^[26][27] It entered the UK Singles Chart at number five, on 17 November. "Lego House" also reached the top ten on Australian, Irish, Scottish, New Zealand Singles Charts, Flemish Ultratop 50 and the Wallonian Ultratip. "Drunk" was released on 19 February 2012 as the fourth single lifted from +.^[28] "Drunk" became the Sheeran's fourth consecutive top ten single in the UK, when it peaked at number nine.^[29] "Small Bump" is scheduled for a release in late May 2012 as the fifth single.^[30]

The song "Moments" on the debut album by boy band One Direction was co-written by Sheeran.^[31] On 21 February 2012, Sheeran attended the 2012 Brit Awards, he received the Brit Award for Best British Male Solo Artist, and British Breaktrough of the Year.^[32][33]

On 10 January 2012, it was announced Sheeran would support Snow Patrol on their United States tour from late March until May. On the band's Fallen Empires Tour.^[34]

His song "Give Me Love" was featured in the episode "Dangerous Liaisons" of The Vampire Diaries.^[35][36] At the 2012 Ivor Novello Awards in May 2012, Sheeran's "The A Team" beat Adele's "Rolling In The Deep" and Florence and the Machine's "Shake It Out", winning the award for Best Song Musically and Lyrically.^[37]

Philanthropy[link]

Sheeran will perform a gig in Bristol, which has raised £40,000 for a charity that reaches out to street sex workers. Sheeran agreed to the event after one of the women One25 helps contacted him. "It's good to show insight that these people are real people with real emotions and they deserve the same charity work as anyone else," Sheeran said. "There's a lot more popular charities that get a lot of attention. And with certain subjects like this they're often washed over and people don't necessarily give them the attention they deserve." Tickets were available to those taking part in the charity's Give it up for One25 campaign by giving something up for 125 hours and hitting the £125 fundraising mark. Louise Willott, who organised the event at The Fleece, said of Sheeran: "He had volunteered in Crisis in London. which is a homeless shelter, and he had met a woman who told him her story. Her name was Angel. "He then went and did some more research about the issues and obviously he must have been moved and inspired to have written The A Team." Willott added: "The Fleece is quite a small venue - it only holds about 400, which makes it extra exciting as it's really intimate and Ed's not playing those size venues anymore. In total this has raised about £40,000 for the project. Its just going to give us such a boost. This is a difficult time for any charity. There's less money available and there's more competition for it, so to have one event raise £40,000 is just incredible."^[38]

Discography[link]

Album[link]

• + (2011)

Tour[link]

Opening act

• Fallen Empires Tour (North American select dates) (2012)

Filmography[link]

Television[link]

Awards and nominations[link]

[edit] BRIT Awards

[edit] BT Digital Music Awards

[edit] Ivor Novello Awards

[edit] MOBO Awards

[edit] Q Awards

[edit] UK Music Video Awards

See also[link]

• List of Official Subscription Plays Chart number-one songs from the 2010s

References[link]

External links[link]

• Interview
• Official website
• Ed Sheeran on Myspace
• Ed Sheeran on Facebook
• Ed Sheeran on Twitter
• Ed Sheeran's channel on YouTube