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Alcohol and Alcoholism Ethanol Mechanism of Toxicity • CNS depressant • Teratogen • Carcinogen Ethanol Lite Beer Beer Wine Flavored Liquors Distilled Liquors Everclear Proof is double % 2.5 - 3.5% 4.0 - 6.0% 10 - 18 % 15 - 25% 22 - 50% 95% Ethanol Colognes/Perfumes Glass Cleaners Paint Stripper Cough/Cold Preparations Mouthwashes 40 - 60% 10% 25% 3 - 25% 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