\Contributor: Don Stader, MD Educational Pearls: Altered mental status/confusion are major symptoms associated with both alcohol use and withdrawal. Wernicke’s encephalopathy is a triad of symptoms of confusion, internuclear ophthalmoplegia, and confabulation The treatment for Wernicke’s is IV thiamine or vitamin B1 Untreated Wernicke’s leads to Korsakoff's syndrome where a prolonged thiamine deficiency leads to worsening brain function  Subdural hematomas from torn bridging veins are common in alcoholics because of the combination of frequent falls and cerebral atrophy caused by alcohol. Alcohol is a major cause of heart failure and atrial fibrillation; “holiday heart” is a-fib induced by binge drinking where high levels of acetaldehyde from the metabolism of alcohol excite the heart. Frequent alcohol use is linked to esophageal cancer Alcoholic cirrhosis can lead to a multitude of complications including esophageal varices that can rupture often with fatal outcomes Aspiration pneumonia is more common in alcoholics because of a depressed gag reflex and alteration of oral flora  References Brousse G, Geneste-Saelens J, Cabe J, Cottencin O. Alcool et urgences [Alcohol and emergencies]. Presse Med. 2018;47(7-8 Pt 1):667-676. doi:10.1016/j.lpm.2018.06.001 Chandrakumar A, Bhardwaj A, 't Jong GW. Review of thiamine deficiency disorders: Wernicke encephalopathy and Korsakoff psychosis. J Basic Clin Physiol Pharmacol. 2018;30(2):153-162. Published 2018 Oct 2. doi:10.1515/jbcpp-2018-0075 Simou E, Britton J, Leonardi-Bee J. Alcohol and the risk of pneumonia: a systematic review and meta-analysis. BMJ Open. 2018;8(8):e022344. Published 2018 Aug 22. doi:10.1136/bmjopen-2018-022344   Summarized by Jackson Roos, MS4 | Edited by Erik Verzemnieks, MD