Sedentary Work Exerting up to 10 pounds (4.5 kg) of force occasionally and/or a negligible amount of force frequently or constantly to lift, carry, push, pull, or otherwise move objects, including the human body. Sedentary work involves sitting most of the time, but may involve walking or standing for brief periods of time. Jobs are sedentary if walking and standing are required only occasionally and other sedentary criteria are met.

Light Work Exerting up to 20 pounds (9.1 kg) of force occasionally and/or up to 10 pounds (4.5 kg) of force frequently, and/or negligible amount of force constantly to move objects. Physical demand requirements are in excess of those for Sedentary Work. Light Work usually requires walking or standing to a significant degree. However, if the use of the arm and/or leg controls requires exertion of forces greater than that for Sedentary Work and the worker sits most the time, the job is rated Light Work.

Medium Work Exerting up to 50 (22.7 kg) pounds of force occasionally, and/or up to 25 pounds (11.3 kg) of force frequently, and/or up to 10 pounds (4.5 kg) of forces constantly to move objects.

Heavy Work Exerting up to 100 pounds (45.4 kg) of force occasionally, and/or up to 50 pounds (22.7 kg) of force frequently, and/or in excess of 20 pounds (9.1 kg) of force constantly to move objects.

Very Heavy Work Exerting in excess of 100 pounds (45.4 kg) of force occasionally, and/or in excess of 50 pounds (22.7 kg) of force frequently, and/or in excess of 20 pounds (9.1 kg) of force constantly to move objects.

Job Classification

In most duration tables, five job classifications are displayed. These job classifications are based on the amount of physical effort required to perform the work. The classifications correspond to the Strength Factor classifications described in the United States Department of Labor's Dictionary of Occupational Titles. The following definitions are quoted directly from that publication.

Sedentary Work Exerting up to 10 pounds (4.5 kg) of force occasionally and/or a negligible amount of force frequently or constantly to lift, carry, push, pull, or otherwise move objects, including the human body. Sedentary work involves sitting most of the time, but may involve walking or standing for brief periods of time. Jobs are sedentary if walking and standing are required only occasionally and other sedentary criteria are met.

Light Work Exerting up to 20 pounds (9.1 kg) of force occasionally and/or up to 10 pounds (4.5 kg) of force frequently, and/or negligible amount of force constantly to move objects. Physical demand requirements are in excess of those for Sedentary Work. Light Work usually requires walking or standing to a significant degree. However, if the use of the arm and/or leg controls requires exertion of forces greater than that for Sedentary Work and the worker sits most the time, the job is rated Light Work.

Medium Work Exerting up to 50 (22.7 kg) pounds of force occasionally, and/or up to 25 pounds (11.3 kg) of force frequently, and/or up to 10 pounds (4.5 kg) of forces constantly to move objects.

Heavy Work Exerting up to 100 pounds (45.4 kg) of force occasionally, and/or up to 50 pounds (22.7 kg) of force frequently, and/or in excess of 20 pounds (9.1 kg) of force constantly to move objects.

Very Heavy Work Exerting in excess of 100 pounds (45.4 kg) of force occasionally, and/or in excess of 50 pounds (22.7 kg) of force frequently, and/or in excess of 20 pounds (9.1 kg) of force constantly to move objects.

Alcohol Intoxication, Acute


Medical Codes

ICD-9-CM:
303.00 - Acute Alcoholic Intoxication; Acute Drunkenness in Alcoholism; Unspecified
303.01 - Acute Alcoholic Intoxication; Acute Drunkenness in Alcoholism; Continuous
303.02 - Acute Alcoholic Intoxication; Acute Drunkenness in Alcoholism; Episodic

Related Terms

  • Alcohol Overdose
  • Drunkenness
  • Inebriation

Overview

Alcohol intoxication, or being drunk, is a reversible condition caused by recent ingestion of alcohol. It may or may not be associated with alcohol abuse or dependence. Behavioral symptoms such as belligerence, mood swings, forgetfulness, difficulty concentrating, and impaired judgment are due to the physiological effects of alcohol on the central nervous system. The severity and number of symptoms vary widely, depending upon the individual's tolerance for and experience with alcohol, the amount of alcohol used and how quickly it is consumed, the individual's expectations of the effects of alcohol, and even the environment in which alcohol is used. Short-term intoxication of a few hours may be associated with talkativeness, disinhibition, or a sense of feeling elated or "high" (euphoria). When intoxication persists for days or weeks, symptoms may include depression, inattention to personal hygiene, or impaired memory. In general, an individual is able to metabolize 1 drink per hour, defined as 12 ounces of beer or wine cooler, 5 ounces of non-fortified wine, or 1.5 ounces of distilled spirits. Signs and symptoms of intoxication are generally more severe when blood alcohol levels are rising rather than falling. Acute alcohol intoxication is accompanied in varying degrees by slurred speech, incoordination, unsteady gait, fast, jerky sideways movements of the eyeball (nystagmus), impaired attention or memory, stupor, coma, or death.

Alcohol is a central nervous system depressant that works by affecting the physical and chemical properties of nerve cell membranes. It enhances the action of GABA, a chemical that inhibits spread of nerve impulses and inhibits the action of glutamate, a chemical that causes excitation of nerves by enhancing spread of nerve impulses.

Incidence and Prevalence: Almost two-thirds of Americans adolescent or older drink alcoholic beverages. On average, each of these individual drinks an amount equal to 9.7 gallons of whiskey, 89 gallons of beer, or 31 gallons of wine per year. Lifetime risk of alcohol abuse or dependence in the US is about 10% and 15%, respectively (Diamond 50).

Source: Medical Disability Advisor



Diagnosis

History: Diagnosis is based on criteria listed in the DSM-IV-TR (Diagnostic and Statistical Manual of Mental Disorders, 4th Edition, Text Revision). Diagnosis requires behavioral changes that are maladaptive, such as disinhibition of sexual or aggressive impulses, mood swings (lability), impaired judgment, or impaired social or occupational functioning. These symptoms must be associated with recent ingestion of alcohol in sufficient quantity to produce intoxication. At least one of the following signs must be present: slurred speech, incoordination, unsteady gait, nystagmus, or flushed face. An individual who shows mild behavioral effects of alcohol within a socially acceptable and physically innocuous range does not meet criteria for the diagnosis.

The individual, or family, friends, or others, typically give a history of recent ingestion of alcohol over a fairly short period of time. This may or may not be the first alcohol intoxication for this individual. The individual with a first-time or infrequent alcohol intoxication may present with a different history than the individual with chronic or repeated episodes of intoxication. Repeated episodes may be associated with the symptoms and behaviors of Alcohol Abuse or Dependence, while first-time or infrequent users are at higher risk for the life-threatening consequences of severe intoxication. A thorough history of frequency, amount, and most recent alcohol use can help determine the individual's risk.

Physical exam: Physical evidence of Alcohol Intoxication includes the smell of alcohol on the breath or body, slurred speech, lack of coordination, unsteady gait, rapid movement of the eyes to one side (nystagmus), impairment in attention or memory, stupor, or coma. If the individual is not seen soon after acute ingestion, signs of withdrawal may be present. These may include tremors, sweating, increased blood pressure and heart rate, or nausea or vomiting. Mental status exam may demonstrate that the individual is confused or disoriented.

Tests: An elevated blood alcohol concentration or level (BAC or BAL) above zero indicates some level of ingestion, although there is considerable individual variation of the effects of alcohol intoxication, so that some users may become intoxicated at much lower BAC. At BAC of 0.02 to 0.03, there is a slight feeling of being "high" (euphoria) and loss of shyness. At 0.04 to 0.06 BAC, the "high" feeling intensifies, with relaxation, lower inhibitions, a sensation of warmth, minor impairment of reasoning and memory, and lowered caution. At 0.07 to 0.09 BAC, there is slight impairment of balance, speech, vision, reaction time, and hearing. Judgment and self-control are reduced, and caution, reason, and memory are impaired. Many states identify BAC levels of 0.08 (80 mg/dL) as being legally intoxicated. At 0.10 to 0.125 BAC, there is significant impairment of motor coordination and loss of judgment. Speech may be slurred, and balance, vision, reaction time, and hearing are impaired. At 0.13 to 0.15 BAC, there is gross motor impairment, lack of physical control, blurred vision, and major loss of balance. Mood changes from "high" or euphoric to dysphoric, with the perception that things are unpleasant. At 0.16 to 0.20 BAC, there may be anxiety, restlessness, and nausea, and the drinker takes on the appearance of a "sloppy drunk." At 0.25 BAC, the drinker needs assistance in walking, and experiences total mental confusion, dysphoria, nausea, and some vomiting. He or she may also fall asleep. At BAC of 0.3, there is loss of consciousness, followed by coma and possibly even death at 0.4 BAC due to respiratory arrest. Other blood tests can detect the effects of alcohol on the liver and bone marrow, with elevated liver enzymes, high blood lipids, and an anemia showing large red blood cells (macrocytic cells).

Source: Medical Disability Advisor



Treatment

Initially, treatment is aimed at protecting the intoxicated individual from harming him or herself or others, which may require physical restraints or the use of sedatives. Identifying and treating medical problems that require immediate attention associated with acute alcohol intoxication is a first priority. Treatment may be as simple as allowing the individual to "sleep it off," if the blood alcohol level is low and the individual has no symptoms of withdrawal. Or, in cases of severe intoxication, the treatment may be as complicated as admission to an Intensive Care Unit, if the individual is experiencing respiratory arrest or coma.  In such cases, the airway must be protected, and respiratory and circulatory function must be monitored and supported. Use of other depressant drugs, disturbances in blood chemistry, infection, and head trauma must all be ruled out, or treated appropriately if discovered. Wernicke-Korsakoff syndrome may complicate acute alcohol intoxication, and should be treated aggressively with intravenous thiamine to prevent irreversible damage to the nervous system.

Once the individual has recovered from acute intoxication, he or she may be sent home with family or friends and referred to an outpatient alcoholism treatment program and Alcoholics Anonymous. The individual should not, of course, be allowed to drive while under the influence. If social supports are inadequate, referral to an inpatient alcoholism detoxification facility should be considered, particularly if there is a history of complicated withdrawal, such as seizures or delirium tremens. Psychiatric hospitalization is recommended for suicidal or homicidal thoughts, psychotic symptoms such as hallucinations, or worsening of any underlying psychiatric condition.

Source: Medical Disability Advisor



Prognosis

Prognosis is correlated with the presence of chronic alcoholism. Prognosis is positive, in most instances, unless irreversible physiological and / or psychological damage occurs through overdose or persistent episodes of intoxication.

Source: Medical Disability Advisor



Differential Diagnosis

  • Diabetic ketoacidosis
  • Hypoglycemia
  • Liver failure
  • Other substance abuse

Source: Medical Disability Advisor



Specialists

  • Psychiatrist

Source: Medical Disability Advisor



Comorbid Conditions

  • Anxiety disorders
  • Bipolar disorders
  • Depressive disorders
  • Diabetes
  • Hypertension
  • Liver disease
  • Personality disorder
  • Post-traumatic stress disorder
  • Psychotic disorders
  • Substance abuse

Source: Medical Disability Advisor



Complications

Alcohol intoxication, especially in an intolerant individual, can lead to seizures, respiratory arrest, coma, or death. Sudden withdrawal of alcohol in someone who has had an excessive intake can lead to tremors, anxiety, agitation, hallucinations, grand mal seizures, or death. Wernicke-Korsakoff syndrome is a neurological condition caused by an acute deficiency of the vitamin thiamine, often related to acute and chronic alcohol use. Symptoms include confusion, profound short-term memory loss, incoordination, and abnormalities of eye movement (gaze palsies).

Excessive prolonged use of alcohol can damage the stomach lining (gastritis), esophagus (esophageal varices), liver (liver failure, cirrhosis), pancreas (pancreatitis), and heart (cardiomyopathy). Accidental inhalation of vomit or oropharyngeal fluids while intoxicated may lead to aspiration pneumonia through colonization of the upper respiratory tract with gram-negative bacteria (GNB), which may be found in up to 50% of alcoholics but only 10% of non-alcoholics (Johanson). Poor nutrition contributes to anemias and vitamin deficiencies. Prolonged alcohol intake is toxic to the nervous system, and can damage the nerves in the hands, lower legs, and feet (peripheral neuropathy). Brain function may be chronically impaired and can lead to short- and long-term memory impairment, disturbances of balance and coordination, or the loss of higher brain functions such as judgment, abstract thinking, and language. Psychosocial consequences, such as loss of relationships and employment; legal consequences, such as arrests for "driving under the influence," motor vehicle accidents; violence; and suicide can be consequences of alcoholism. Heavy drinking during pregnancy can result in fetal alcohol syndrome.

Source: Medical Disability Advisor



Factors Influencing Duration

The amount of alcohol consumed, duration of consumption and the amount of time passed since the last ingestion can determine the course of alcohol metabolism, blood alcohol concentration, and resulting symptoms. Individuals vary considerably in their individual tolerance to the effects of alcohol. During the time the individual is intoxicated, there can be severe physiologic changes in the body. This can alter electrolytes, cardiac output, cerebral blood flow, and availability of oxygen to the brain. Cardiac arrhythmias may hasten myocardial infarction and cerebrovascular accidents. Long duration of intoxication (binge) can often lead to infections, pneumonia, and malnutrition.

Source: Medical Disability Advisor



Ability to Work (Return to Work Considerations)

The necessity of work restrictions and accommodations is rare unless a long lasting physiological impact or persistent episodes of intoxication occur. Depending on the occupational and / or business requirements, some employers have systems in place for individuals recovering from alcohol use disorders to return to work under special contracts or conditions, and may include attendance at partial day outpatient treatment programs. These conditions may provide guidelines for testing blood and urine levels of identified substances, and work performance and substance abuse treatment guidelines for the recovering individual. Individuals who are intoxicated should not be in the work place until after detoxification.

Source: Medical Disability Advisor



Failure to Recover

If an individual fails to recover within the expected maximum duration period, the reader may wish to consider the following questions to better understand the specifics of an individual's medical case.

Regarding diagnosis:

  • Was diagnosis of acute alcohol intoxication confirmed?
  • Was this an isolated event or was there a history of alcohol intoxication?
  • How frequently were the episodes occurring? For how long?
  • Does each drinking episode result in intoxication?
  • How much alcohol does individual estimate he or she consumes before becoming intoxicated?
  • Did any medical complications result from the intoxication?
  • Were any other chemical dependencies identified? Was each appropriately addressed?
  • Were all underlying conditions, physical and psychiatric, identified? How do they affect treatment or prognosis?

Regarding treatment:

  • Did individual make an uncomplicated recovery from the acute effects of alcohol?
  • What further treatment is indicated?
  • If complications occurred, what were they and how were they treated?
  • Have they now been resolved?
  • If concurrent chemical abuse was also identified, is appropriate treatment being applied to each issue?
  • Are psychiatric illnesses complicating treatment?
  • Are these illnesses being addressed with regard to overall treatment?
  • Is individual able to safely and consistently follow the treatment regimen?
  • Is individual being treated on an inpatient or outpatient basis?
  • Would individual benefit from a more supervised, structured treatment plan or an in-house treatment program?

Regarding prognosis:

  • Did individual make appreciable progress within the treatment modality?
  • Do any complications remain?
  • What additional treatment(s) may be warranted?
  • What are individual's social supports?
  • Is there a functional support system in place? Family? Friends? Church or other community affiliations? Are these being utilized?
  • Is individual involved in a local support group?
  • If alcohol intoxication is an ongoing or frequent habit, how is it being addressed?
  • How are current stresses being dealt with?
  • How were major stresses dealt with in the past?
  • If healthy and adaptive methods were used in the past, are they being used currently?
  • What is happening outside of work that may be contributing to or worsening the problems experienced at work?
  • What is being done to motivate individual towards rebuilding a functional, meaningful life?

Source: Medical Disability Advisor



References

Cited

Diamond, I., and C. A. Jay. "Alcoholism and Alcohol Abuse." Cecil Textbook of Medicine. Eds. Lee Goldman and J. Claude Bennett. 21st ed. Philadelphia: W.B. Saunders, 2000. 39-54.

Frances, Allen, ed. Diagnostic and Statistical Manual of Mental Disorders (DSM-IV-TR). 4th ed. Washington, DC: American Psychiatric Association, 2000.

Johanson, W. G. "Pneumonia Caused by Aerobic Gram-Negative Bacilli." Cecil Textbook of Medicine. Eds. Lee Goldman and J. Claude Bennett. 21st ed. Philadelphia: W.B. Saunders, 2000.

Source: Medical Disability Advisor