ETOH Medical Abbreviation

ETOH is the medical abbreviation for alcohol also known as ethanol. It is the type of alcohol found in alcoholic beverages. The term comes from the  acronym of ethyl (ET) and alcohol (OH).

  • ETOH is used exclusively by virtually all medical professionals as simple shorthand for alcohol.

Alcohol is a liquid absorbed into the body by drinking an alcoholic beverage. It can also refer to:

  • grain alcohol
  • ethyl hydroxide
  • ethyl hydrate

Medical Billing Codes

From the DSM-5 – 5 catalogpage 461

The current ICD 10 for uncomplicated alcohol abuse is ICD-10-CM diagnosis code F10.10.

ICD-10-CM F10.10 is within Diagnostic Related Group(s) (MS-DRG v38.0):

  • 894 left AMA
  • 895 with rehabilitation therapy
  • 896 without rehab therapy with MCC (Major Complications Comorbidities)
  • 897  without rehabilitation therapy without MCC

For medical billing, to accurately use the ICD code for alcohol withdrawal, patients must exhibit two or more of the following symptoms:

  • Visible hand tremors
  • Nausea and vomiting
  • Insomnia
  • Psychomotor agitation
  • Transient visual, tactile, or auditory hallucinations
  • Anxiety or panic
  • Grand mal seizures
  • Impaired consciousness attention

Laboratory Measurements for Alcohol Misuse

Indirect alcohol blood levels of specific biomarkers of possible heavy alcohol use are:

  • Aspartate aminotransferase (AST)
  • Alanine aminotransferase (ALT)
  • Gamma-glutamyltransferase (GGT)
  • Mean corpuscular volume (MCV)
  • Carbohydrate-deficient transferrin (CDT)

Direct alcohol biomarkers include alcohol itself and ethyl glucuronide (EtG). Blood alcohol levels that indicate alcoholism with a high degree of reliability are as follows:

  • >300 mg/dL in a patient who appears intoxicated but denies alcohol abuse
  • >150 mg/dL without obvious evidence of intoxication
  • >100 mg/dL upon routine examination

Recent Changes to the DSM-IV

Changes Disorder Terminology

  • DSM–IV described two distinct disorders, alcohol abuse and alcohol dependence, with specific criteria for each.
  • DSM–5 integrates the two DSM–IV disorders, alcohol abuse and alcohol dependence, into a single disorder called alcohol use disorder (AUD) with mild, moderate, and severe sub-classifications.

Changes Diagnostic Thresholds

  • Under DSM–IV, the diagnostic criteria for abuse and dependence were distinct: anyone meeting one or more of the “abuse” criteria (see items 1 through 4 below) within a 12-month period would receive the “abuse” diagnosis. Anyone with three or more of the “dependence” criteria (see items 5 through 11 below) during the same 12-month period would receive a “dependence” diagnosis.
  • Under DSM–5, anyone meeting any 2 of the 11 criteria during the same 12-month period would receive a diagnosis of AUD. The severity of AUD—mild, moderate, or severe—is based on the number of criteria met.

Removes Criterion

  • DSM–5 eliminates legal problems as a criterion.

Adds Criterion

  • DSM–5 adds craving as a criterion for an AUD diagnosis. It was not included in DSM–IV.

Revises Some Descriptions

  • DSM–5 modifies some of the criteria descriptions with updated language.

Download the revisions

Diagnosing Alcohol Misuse

The CAGE questions are a tool used by physicians and health care professionals and should be face-to-face (not as a paper and pencil test).

The following four questions make up the CAGE questionnaire:

  • Have you ever felt the need to cut down on drinking?
  • Have people annoyed you by criticizing your drinking?
  • Have you ever felt bad or guilty about drinking?
  • Have you ever had a drink first thing in the morning to steady your nerves or get rid of a hangover?

Patients who answer ‘yes’ to 2 questions are seven times more likely to be alcohol dependent than the general population. Those who respond ‘no’ to all four questions are one-seventh likely to have alcoholism as the general population. The sensitivity of the CAGE questionnaire may be as high as 75%.

  • There are other tests, such as the AUDIT test, a pen, and a paper questionnaire.

DSM-5

The DSM- 5 criteria are as follows: “A maladaptive pattern of substance use leading to clinically significant impairment or distress, as manifested by two or more of the following, occurring at any time in the same 12-month period:”

  • Alcohol is often taken in more significant amounts or over a more extended period than was intended.
  • There is a persistent desire or unsuccessful efforts to cut down or control alcohol use.
  • A great deal of time in activities necessary to obtain alcohol, use alcohol, or recover from its effects.
  • A craving for alcohol and a strong desire or urge to use alcohol.
  • Recurrent alcohol use failing to fulfill significant role obligations at work, school, or home.
  • Continued alcohol use despite having persistent or recurrent social or interpersonal problems caused or exacerbated by the effects of alcohol.
  • Important social, occupational, or recreational activities are given up or reduced because of alcohol use.
  • Recurrent alcohol use in situations in which it is physically hazardous.
  • Alcohol use continues despite having a persistent or recurrent physical or psychological problem that is likely caused or exacerbated by alcohol.

Tolerance, as defined by either of the following:

  1. There is a need to markedly increase amounts of alcohol to achieve intoxication or desired effect.
  2. A markedly diminished effect with continued use of the same amount of alcohol.

Withdrawal, as manifested by either of these:

  1. The characteristic withdrawal syndrome for alcohol
  2. Alcohol (or a closely related substance, benzodiazepine) relieves or avoids withdrawal symptoms.

Specify if the Alcohol Use Disorder is:

  • Mild – Presence of 2–3 symptoms
  • Moderate – Presence of 4–5 of these symptoms
  • Severe – Presence of 6 or more of the symptoms

Features of EtG in the urine are as follows:

  • Positive shortly after intake of even a tiny amount of alcohol
  • After complete cessation of alcohol intake, EtG is in urine for up to 5 days after heavy binge drinking

When severe, the following are withdrawal signs of delirium tremens are:

  • Racing pulse/heart rate and hypertension
  • Temperature elevation
  • Delirium-not coherent

Criteria of Alcohol Misuse

  • Cravings
  • Loss of control
  • Physical withdrawal symptoms
  • Increased tolerance

The following are signs of chronic alcoholism:

  • Breast enlargement
  • Spider veins
  • Dupuytren contractures
  • Testicular atrophy
  • Enlarged or shrunken liver
  • Enlarged spleen

Complications of alcoholism manifest as follows:

Wernicke encephalopathy: Difficulty walking or balance known as ataxia, eye disturbances such as persistent lateral gaze, and confusion

Korsakoff syndrome: amnesia, often with a nonsensical speech that precedes Wernicke encephalopathy

Hepatic encephalopathy: a recurrent flapping motion of the arms like a bird’s wings and confusion

Failure to medically manage alcohol withdrawal syndrome causes permanent brain damage or death. In addition, the toxic effect of alcohol on the central nervous system during withdrawal necessitates professional intervention.

Progression into clinical withdrawal depends on the levels and if the liver is still functioning at total capacity. Other factors such as age, health, gender, and psychological status also influence how quickly it takes to detox.