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Alcohol and Alcoholism Ethanol Mechanism of Toxicity CNS depressant Teratogen Carcinogen Ethanol Lite Beer 2.5 - 3.5% Beer 4.0 - 6.0% Wine 10 - 18 % Flavored Liquors 15 - 25% Distilled Liquors 22 - 50% Everclear 95% Proof is double %

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Presentation Transcript
ethanol
Ethanol
  • Mechanism of Toxicity
    • CNS depressant
    • Teratogen
    • Carcinogen
ethanol3
Ethanol
  • Lite Beer 2.5 - 3.5%
  • Beer 4.0 - 6.0%
  • Wine 10 - 18 %
  • Flavored Liquors 15 - 25%
  • Distilled Liquors 22 - 50%
  • Everclear 95%
  • Proof is double %
ethanol4
Ethanol
  • Colognes/Perfumes 40 - 60%
  • Glass Cleaners 10%
  • Paint Stripper 25%
  • Cough/Cold Preparations 3 - 25%
  • Mouthwashes 14 - 27%
ethanol metabolism
Ethanol Metabolism
  • One drink equals:
    • 12 ounces beer
    • 5 ounces wine
    • 1.5 ounces distilled liquor
  • 70 kg person metabolizes approximately one drink/hour
  • 7 calories per gram vs. fat @ 9 calories/gm
ethanol6
Ethanol
  • Highest serum level recorded with full recovery in an adult - 1510 mg/dL
  • Legal limit for intoxication - 80mg/dL or 0.08
  • Odor threshold - 10 ppm
alcohol and alcoholism7
Alcohol and Alcoholism
  • Ethyl alcohol
    • Most commonly abused drug in U.S.
    • 6,000,000 to 10,000,000 alcoholics
    • 50% of fatal motor vehicle crashes
    • 50% of violent deaths
    • Contributes to pathology in 25-35% of all hospital patients
alcohol and alcoholism8
Alcohol and Alcoholism
  • Alcoholism
    • Addiction to alcohol or abuse of alcohol to a degree that produces problems in one or more of these areas:
      • Health
      • Social relationships
      • Economic status
      • Interpersonal relationships
alcohol and alcoholism9
Alcohol and Alcoholism
  • Phases
    • Problem drinking
      • Drinks to relieve stress
      • Abstinence does not cause physical symptoms
    • Alcohol addiction
      • Abstinence produces physical symptoms
alcohol and alcoholism10
Alcohol and alcoholism
  • Alcohol does NOT depend on type of EtOH
  • Alcoholism occurs in ALL social classes and age groups
  • “Skid row bums” = 3 to 5% of alcoholics
alcohol and alcoholism11
Typical alcoholic

Employed male

“Social drinker”

Drinks early in day

Drinks alone or secretly

Binges accompanied by memory loss

Unexplained GI upset, bleeding

Green-tongue syndrome

Cigarette burns on clothing

Chronically flushed face, palms

Tremulousness, anxiety with reduced intake

Problems with family, work, law enforcement related to EtOH

Alcohol and alcoholism
acute alcohol effects13
Acute Alcohol Effects
  • Hangover
    • Mild withdrawal with volume depletion
    • Treatment
      • Fluids
      • Tylenol for headache
      • Not aspirin or ibuprofen
acute alcohol effects14
Acute Alcohol Effects
  • Stupor-Coma
    • Acute overdose
      • Coma
      • Depressed respirations
      • Hypotension
      • Hypothermia
acute overdose treatment
Acute Overdose Treatment
  • ABC’s
  • Oxygen, assisted ventilations
  • Intubate
  • IV, infuse fluid to support perfusion
  • Lavage if within 2 hours
acute overdose treatment16
Acute Overdose Treatment
  • DONT
    • Dextrose, Oxygen, Narcan, Thiamine
    • Glucose, thiamine (50-100mg)
    • Narcan may reduce respiratory depression but not CNS depression (? Use)
  • Dialysis - removes 280mg/minute
acute alcohol effects17
Acute Alcohol Effects
  • Stupor-Coma
    • Hypoglycemia
      • Inhibition of protein to sugar conversion in liver (gluconeogenesis)
      • D-stick all patients with altered LOC
acute alcohol effects18
Acute Alcohol Effects
  • Stupor-Coma
    • Trauma
      • “Drunks fall down and hit their heads.”
      • Concussion
      • Subdural hematoma
acute alcohol effects19
Acute Alcohol Effects
  • Stupor-Coma
    • Mixed drug overdose
      • Tranquilizers
      • Barbiturates
      • Anti-depressants
acute alcohol effects20
Acute Alcohol Effects
  • Acute alcoholic paranoia
    • Mean drunk
  • Violence
    • Motor vehicle crashes (50-60% of fatalities)
    • Fights
acute alcohol effects21
Acute Alcohol Effects
  • Drug Interactions
    • Potentiation of CNS depressant drugs
    • Decreased anticonvulsant effectiveness
    • Potentiation of antihypertensive effects
      • Orthostatic hypotension
acute alcohol effects22
Acute Alcohol Effects
  • Worsening of other problems
    • Peptic ulcer disease
    • Liver disease
    • Pancreatic disease
    • Heart disease (decreased pump strength)
associated medical problems24
Associated Medical Problems
  • Head injury/subdural hematoma
    • Impaired clotting mechanisms
    • Frequent falls
associated medical problems25
Hepatic cirrhosis

Causes

Alcohol toxicity

Poor nutrition

Associated Medical Problems
associated medical problems26
Hepatic cirrhosis

Symptoms

Ascites

Jaundice

Palmar erythema

Spider angiomata, Caput medusa

Gynecomastia (males)

Associated Medical Problems

“Lemon on toothpicks”

associated medical problems27
Hepatic Cirrhosis

Effects

Impaired glucose metabolism, hypoglycemia

Portal hypertension, esophageal varices

Coagulopathies

Hepatic encephalopathy

Associated Medical Problems
associated medical problems28
Associated Medical Problems
  • Pancreatitis
    • Nausea, vomiting
    • Severe upper abdominal pain radiating to back
    • Hypovolemic shock
    • Secondary diabetes
    • Pancreatic necrosis and hemorrhage
associated medical problems29
Associated Medical Problems
  • Methanol/ethylene glycol poisoning
    • Sterno, antifreeze ingestion
    • Serve as EtOH substitutes
    • Produce
      • profound metabolic acidosis
      • hypocalcemia in ethylene glycol poisoning
associated medical problems30
Associated Medical Problems
  • Nutritional deficiencies
    • Wernicke’s syndrome
      • Dizziness
      • Confusion
      • Apathy
      • Ophthalmoplegia
      • Ataxia
associated medical problems31
Associated Medical Problems
  • Nutritional deficiencies
    • Korsakoff’s psychosis
      • Memory loss
      • Confusion, confabulation
associated medical problems32
Associated Medical Problems
  • Nutritional deficiencies
    • Beriberi
      • Paresthesias, burning of feet
      • Cardiovascular failure
        • Peripheral vasodilation
        • Biventricular myocardial failure
        • Na+ and water retention
associated medical problems33
Associated Medical Problems
  • Nutritional deficiencies
    • Respond to administration of thiamine (Vitamin B1)
abstinence syndrome36
Abstinence Syndrome
  • Results from EtOH intake reduction
  • NOT necessarily result of complete withdrawal
abstinence syndrome37
Abstinence Syndrome
  • Stages
    • Tremulousness
      • Shakes, jitters
      • Fine tremors
      • GI upset
      • Restlessness
      • Peaks at 24 hours
      • Patient may feel “shaky” for up to 2 weeks
abstinence syndrome38
Abstinence Syndrome
  • Stages
    • Hallucinations
      • Distorted vision
      • Misinterpretation of visual stimuli (snakes, vermin)
      • Auditory hallucinations
    • Seizures (“rum fits”)
      • Usually in first 24 hours
      • Major motor seizures in bursts of 2 to 6
      • May progress to status epilepticus
abstinence syndrome39
Abstinence Syndrome
  • Stages
    • Delirium tremens
      • 24 to 72 hours after reducing intake
      • Restlessness, tremors, hallucinations, seizures
      • Dilated pupils, flushed face, tachycardia, nausea, vomiting
      • 15% mortality from dehydration, electrolyte imbalance, aspiration
abstinence syndrome40
Abstinence Syndrome
  • Management
    • Oxygen, monitor, IV (LR or NS)
    • Check blood sugar
    • Consider D50W and thiamine
    • Minimum stimulation
    • Sedation
      • Phenobarbital
      • Benzodiazepines
antabuse disulfiram
Antabuse (disulfiram)
  • Used in aversion therapy
  • Blocks EtOH metabolism
  • Causes buildup of acetaldehyde
antabuse disulfiram42
Antabuse (disulfiram)
  • Exposure to EtOH while taking causes sudden, severe vasodilation:
    • Hot, flushed face
    • Dizziness
    • Pounding heart, hypotension
    • Nausea, vomiting
    • Headache
antabuse disulfiram43
Antabuse (disulfiram)
  • DANGER!
  • Contact with other alcohol sources
    • Foods
    • Shaving lotion
    • Mouthwash
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