Alcohol and alcoholism
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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

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Ethanol

  • Mechanism of Toxicity

    • CNS depressant

    • Teratogen

    • Carcinogen


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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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Ethanol

  • Colognes/Perfumes 40 - 60%

  • Glass Cleaners 10%

  • Paint Stripper 25%

  • Cough/Cold Preparations 3 - 25%

  • Mouthwashes 14 - 27%


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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


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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


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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


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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


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Alcohol and Alcoholism

  • Phases

    • Problem drinking

      • Drinks to relieve stress

      • Abstinence does not cause physical symptoms

    • Alcohol addiction

      • Abstinence produces physical symptoms


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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


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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



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Acute Alcohol Effects

  • Hangover

    • Mild withdrawal with volume depletion

    • Treatment

      • Fluids

      • Tylenol for headache

      • Not aspirin or ibuprofen


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Acute Alcohol Effects

  • Stupor-Coma

    • Acute overdose

      • Coma

      • Depressed respirations

      • Hypotension

      • Hypothermia


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Acute Overdose Treatment

  • ABC’s

  • Oxygen, assisted ventilations

  • Intubate

  • IV, infuse fluid to support perfusion

  • Lavage if within 2 hours


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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


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Acute Alcohol Effects

  • Stupor-Coma

    • Hypoglycemia

      • Inhibition of protein to sugar conversion in liver (gluconeogenesis)

      • D-stick all patients with altered LOC


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Acute Alcohol Effects

  • Stupor-Coma

    • Trauma

      • “Drunks fall down and hit their heads.”

      • Concussion

      • Subdural hematoma


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Acute Alcohol Effects

  • Stupor-Coma

    • Mixed drug overdose

      • Tranquilizers

      • Barbiturates

      • Anti-depressants


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Acute Alcohol Effects

  • Acute alcoholic paranoia

    • Mean drunk

  • Violence

    • Motor vehicle crashes (50-60% of fatalities)

    • Fights


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Acute Alcohol Effects

  • Drug Interactions

    • Potentiation of CNS depressant drugs

    • Decreased anticonvulsant effectiveness

    • Potentiation of antihypertensive effects

      • Orthostatic hypotension


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Acute Alcohol Effects

  • Worsening of other problems

    • Peptic ulcer disease

    • Liver disease

    • Pancreatic disease

    • Heart disease (decreased pump strength)



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Associated Medical Problems

  • Head injury/subdural hematoma

    • Impaired clotting mechanisms

    • Frequent falls


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Hepatic cirrhosis

Causes

Alcohol toxicity

Poor nutrition

Associated Medical Problems


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Hepatic cirrhosis

Symptoms

Ascites

Jaundice

Palmar erythema

Spider angiomata, Caput medusa

Gynecomastia (males)

Associated Medical Problems

“Lemon on toothpicks”


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Hepatic Cirrhosis

Effects

Impaired glucose metabolism, hypoglycemia

Portal hypertension, esophageal varices

Coagulopathies

Hepatic encephalopathy

Associated Medical Problems


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Associated Medical Problems

  • Pancreatitis

    • Nausea, vomiting

    • Severe upper abdominal pain radiating to back

    • Hypovolemic shock

    • Secondary diabetes

    • Pancreatic necrosis and hemorrhage


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Associated Medical Problems

  • Methanol/ethylene glycol poisoning

    • Sterno, antifreeze ingestion

    • Serve as EtOH substitutes

    • Produce

      • profound metabolic acidosis

      • hypocalcemia in ethylene glycol poisoning


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Associated Medical Problems

  • Nutritional deficiencies

    • Wernicke’s syndrome

      • Dizziness

      • Confusion

      • Apathy

      • Ophthalmoplegia

      • Ataxia


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Associated Medical Problems

  • Nutritional deficiencies

    • Korsakoff’s psychosis

      • Memory loss

      • Confusion, confabulation


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Associated Medical Problems

  • Nutritional deficiencies

    • Beriberi

      • Paresthesias, burning of feet

      • Cardiovascular failure

        • Peripheral vasodilation

        • Biventricular myocardial failure

        • Na+ and water retention


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Associated Medical Problems

  • Nutritional deficiencies

    • Respond to administration of thiamine (Vitamin B1)


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Associated Medical Problems

  • Cancer

    • Colon

    • Breast



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Abstinence Syndrome

  • Results from EtOH intake reduction

  • NOT necessarily result of complete withdrawal


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Abstinence Syndrome

  • Stages

    • Tremulousness

      • Shakes, jitters

      • Fine tremors

      • GI upset

      • Restlessness

      • Peaks at 24 hours

      • Patient may feel “shaky” for up to 2 weeks


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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


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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


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Abstinence Syndrome

  • Management

    • Oxygen, monitor, IV (LR or NS)

    • Check blood sugar

    • Consider D50W and thiamine

    • Minimum stimulation

    • Sedation

      • Phenobarbital

      • Benzodiazepines


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Antabuse (disulfiram)

  • Used in aversion therapy

  • Blocks EtOH metabolism

  • Causes buildup of acetaldehyde


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Antabuse (disulfiram)

  • Exposure to EtOH while taking causes sudden, severe vasodilation:

    • Hot, flushed face

    • Dizziness

    • Pounding heart, hypotension

    • Nausea, vomiting

    • Headache


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Antabuse (disulfiram)

  • DANGER!

  • Contact with other alcohol sources

    • Foods

    • Shaving lotion

    • Mouthwash