alcohol and alcoholism. ethanol n mechanism of toxicity cns depressant teratogen carcinogen

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 %

Ethanol

Colognes/Perfumes 40 - 60% Glass Cleaners

10% Paint Stripper 25% Cough/Cold Preparations 3 - 25% Mouthwashes 14 - 27%

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

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 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 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 Alcoholism

Phases• Problem drinking

– Drinks to relieve stress– Abstinence does not cause physical symptoms

• Alcohol addiction– Abstinence produces physical symptoms

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 alcoholism

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

Acute Alcohol Effects

Acute Alcohol Effects

Hangover• Mild withdrawal with volume depletion• Treatment

– Fluids– Tylenol for headache– Not aspirin or ibuprofen

Acute Alcohol Effects

Stupor-Coma• Acute overdose

– Coma– Depressed respirations– Hypotension– Hypothermia

Acute Overdose Treatment

ABC’s Oxygen, assisted ventilations Intubate IV, infuse fluid to support perfusion Lavage if within 2 hours

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 Effects

Stupor-Coma• Hypoglycemia

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

– D-stick all patients with altered LOC

Acute Alcohol Effects

Stupor-Coma• Trauma

– “Drunks fall down and hit their heads.”– Concussion– Subdural hematoma

Acute Alcohol Effects

Stupor-Coma• Mixed drug overdose

– Tranquilizers– Barbiturates– Anti-depressants

Acute Alcohol Effects

Acute alcoholic paranoia• Mean drunk

Violence• Motor vehicle crashes (50-60% of

fatalities)• Fights

Acute Alcohol Effects

Drug Interactions• Potentiation of CNS depressant drugs• Decreased anticonvulsant effectiveness• Potentiation of antihypertensive effects

– Orthostatic hypotension

Acute Alcohol Effects

Worsening of other problems• Peptic ulcer disease• Liver disease• Pancreatic disease• Heart disease (decreased pump

strength)

Associated Medical Problems

Associated Medical Problems

Head injury/subdural hematoma• Impaired clotting mechanisms• Frequent falls

Associated Medical Problems

Hepatic cirrhosis• Causes

–Alcohol toxicity–Poor nutrition

Associated Medical Problems

Hepatic cirrhosis• Symptoms

– Ascites– Jaundice– Palmar erythema– Spider angiomata, Caput medusa– Gynecomastia (males)

“Lemon on toothpicks”

Associated Medical Problems

Hepatic Cirrhosis• Effects

–Impaired glucose metabolism, hypoglycemia

–Portal hypertension, esophageal varices

–Coagulopathies–Hepatic encephalopathy

Associated Medical Problems

Pancreatitis• Nausea, vomiting• Severe upper abdominal pain radiating to

back• Hypovolemic shock• Secondary diabetes• Pancreatic necrosis and hemorrhage

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 Problems

Nutritional deficiencies• Wernicke’s syndrome

–Dizziness–Confusion–Apathy–Ophthalmoplegia–Ataxia

Associated Medical Problems

Nutritional deficiencies• Korsakoff’s psychosis

–Memory loss–Confusion, confabulation

Associated Medical Problems

Nutritional deficiencies• Beriberi

–Paresthesias, burning of feet–Cardiovascular failure

• Peripheral vasodilation• Biventricular myocardial failure• Na+ and water retention

Associated Medical Problems

Nutritional deficiencies• Respond to administration of thiamine

(Vitamin B1)

Associated Medical Problems

Cancer• Colon• Breast

Abstinence Syndrome

Abstinence Syndrome

Results from EtOH intake reduction NOT necessarily result of complete

withdrawal

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 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 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 Syndrome

Management• Oxygen, monitor, IV (LR or NS)• Check blood sugar

• Consider D50W and thiamine

• Minimum stimulation• Sedation

– Phenobarbital– Benzodiazepines

Antabuse (disulfiram) Used in aversion therapy Blocks EtOH metabolism Causes buildup of acetaldehyde

Antabuse (disulfiram) Exposure to EtOH while taking causes

sudden, severe vasodilation:

• Hot, flushed face

• Dizziness

• Pounding heart, hypotension

• Nausea, vomiting

• Headache

Antabuse (disulfiram)

DANGER! Contact with other alcohol sources

• Foods

• Shaving lotion

• Mouthwash