1 / 26

Alcohol Use & Abuse

Alcohol Use & Abuse. Alan J. Hunter, MD Assistant Professor of Medicine Director; Hospitalist Program Modifiziert T. Cremer 2004. Effects of Alcohol . Alcohol Dose-Response . * Toxicities significantl y increased with concurrent benzodiazepines. Pharmacology.

kieu
Download Presentation

Alcohol Use & Abuse

An Image/Link below is provided (as is) to download presentation Download Policy: Content on the Website is provided to you AS IS for your information and personal use and may not be sold / licensed / shared on other websites without getting consent from its author. Content is provided to you AS IS for your information and personal use only. Download presentation by click this link. While downloading, if for some reason you are not able to download a presentation, the publisher may have deleted the file from their server. During download, if you can't get a presentation, the file might be deleted by the publisher.

E N D

Presentation Transcript


  1. Alcohol Use & Abuse Alan J. Hunter, MD Assistant Professor of Medicine Director; Hospitalist Program Modifiziert T. Cremer 2004

  2. Effects of Alcohol

  3. Alcohol Dose-Response * Toxicities significantly increased with concurrent benzodiazepines

  4. Pharmacology • Absorbed rapidly form GI tract Mouth Esophagus Proximal Small Bowel Stomach Large Bowel >>> >>> • Rapidly equilibrates in blood and all tissues.

  5. Metabolism • 2-10% of blood EtOH excreted in lungs, urine, sweat • Increased clearance with high blood levels • 90% metabolism in liver • Alcohol Dehydrogenase Pathway (ADH) - 2-20% NAD NADH NAD NADH EtOH Acetaldehyde Acetate ADH ALDH • Microsomal ethanol oxidizing system (MEOS) • Highly inducible, (Especially during chronic EtOH)

  6. Metabolism • These metabolites result in many of the metabolic derangements seen with chronic alcohol abuse • “Lactic acidosis,  uric acid, •  lipids,  glucose, •  protein • Acetaldehyde  blocks protein secretion from liver cells • Increased protein/fat/water deposition  liver edema/damage • Crosses placenta  inhibits DNA methylation fetal alcohol syndrome

  7. Alcoholism • “Alcohol related difficulty” in  3/7 areas • Tolerance (Less effect/drink) • Withdrawal • Chronically increased consumption • Loss of control of use •  Time spent/day drinking • Sacrificing other activities to drink • Continued use, despite problems w/EtOH DSM IV Manual

  8. Epidemiology • > 10 million in the United States (1988) • Ethnic Groups ( Irish & Native Americans) • Social ( Separated > divorced > single) • “Hereditary” (4X  in children of alcoholics)

  9. Alcohol Abuse † USA figures. This is a conservative estimate

  10. chronic alcohol consumption, leading to physical dependence. Alcohol Withdrawal

  11. Alcohol Related Medical Disorders

  12. Nutritional Impact • 1 drink of EtOH ~ 70-100 kcal • risk for nutrient deficiencies in chronic EtOH abuse. • Folate, B-12, thiamine, vitamin A… • Electrolyte deficiencies (potassium, magnesium, phosphate…) • inhibits gluconeogenesis,  • risk for developing hypoglycemia

  13. Alcohol & The Nervous System(Chronic Use) • Thiamine Deficiency • Peripheral neuropathy • Cerebellar degeneration • Wernicke’s encephalopathy • Korsakov’s syndrome (psychosis)

  14. Alcohol & The Nervous System(Chronic Use) Korsakov’s Psychosis • Medical emergency! • Potentially irreversible syndrome • Short-term memory loss • Confabulation • Disordered temporal sequencing • Thiamine deficiency • Rx: Thiamine BEFORE glucose.

  15. Alcohol & The Nervous System(Chronic Use) Wernicke’s Encephalopathy (cerebral beriberi) • Thiamine deficiency (Malnutrion: EtOH #1) • Preventable syndrome (Clinical triad-“plus”) • Ophthamoplegia • Confusion • Ataxia (gait)– (neuropathy/cerebellar/vestibular) • Korsakov’s Psychosis may develop as sensorium clears

  16. Alcohol & The Nervous System Alcoholic Cerebellar Vermis Degeneration. • Common in alcoholics • Symptoms develop over weeks to months onset • Gait & Stance instability • Legs >>> arms • Nystagmus & dysarthria

  17. Alcohol & The Nervous System Alcoholic Peripheral Neuropathy • Associated Myopathy • Myelin degeneration of nerve sheaths.

  18. Alcohol & The Heart(Chronic Use) • Thiamine deficiency • Edema ( Sodium retention) • Biventricular cardiac failure

  19. Normal liver

  20. Alcohol & the Liver • Portal Hypertension “Caput Medusa”

  21. Alcohol & the Liver Cirrhosis Micronodular cirrhosis, solid, scarred, yellow

  22. physical signs of liver cirrhosis • Jaundice • Portal Hypertension • Hepatomegaly • Ascites • Gynecomastia • Skin changes (spider angiomata, palmar erythema)

  23. Alcohol & the Skin • “Spider Angiomas”

  24. Alcohol & the Skin • Rhynophyma (Acne rosacea variant) Seen with EtOH & other vasodilatory substances

  25. Treatment for Alcoholism •  Successful treatment/cessation • Family, friends, & peers MUST be supportive & involved • Support groups • Alcoholics Anon • Pharmacologic intervention – “antabuse” • Best if linked to the above

More Related