Laura Szczesniak, MD, PhD; Damilola Idowu, MD; Katherine Sherman, MS; Andrew Farkas, MD
WMJ. 2026;125(4):462-466. Published November 1, 2026.
ABSTRACT
Introduction: Ethanol intoxication is the most common substance use-related emergency department (ED) presentation in the United States, and the proportion of ethanol-related ED visits is increasing. Although ethanol ingestion can lead to electrolyte abnormalities, ethanol intoxication is often diagnosed on the basis of physical examination, and clinicians frequently defer laboratory testing in clinically intoxicated patients. The purpose of this study was to describe the incidence of electrolyte abnormalities in a cohort of patients evaluated in the ED for ethanol intoxication.
Methods: A retrospective cohort study was performed on Veteran Affairs (VA) ED visit data from 2010 through 2019. Eligible encounters included ED visits with a serum ethanol concentration greater than 50 mg/dL and available electrolyte results.
Results: A total of 223456 encounters involving 83178 patients were included in the analysis. The study population was 94.2% male, and the median age was 55 years. Overall, 48.8% of encounters had at least 1 electrolyte abnormality, and 2.9% had a severe electrolyte abnormality. Hypokalemia was associated with hypomagnesemia (OR, 2.64; 95% CI, 2.56-2.73) and hypophosphatemia (OR, 2.51; 95% CI, 2.21-2.84).
Discussion: The prevalence of electrolyte derangements was substantial among patients with ethanol intoxication. Abnormalities in commonly measured electrolytes were associated with abnormalities in less frequently measured electrolytes.
Conclusions: Routine serum chemistry testing should be considered in patients presenting with ethanol-related complaints to screen for electrolyte abnormalities. In particular, hypokalemia should increase concern for hypomagnesemia and hypophosphatemia.