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Medical Aspects of Alcohol Intoxication in Young People

Medical Aspects of Alcohol Intoxication in Young People. Jozef De Dooy, MD, PhD Paediatric Intensive care. 1 . Definition , p harmacokinetics and p harmacology. Alcohol intoxication: definition.

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Medical Aspects of Alcohol Intoxication in Young People

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  1. MedicalAspects of Alcohol Intoxication in Young People Jozef De Dooy, MD, PhD PaediatricIntensive care

  2. 1. Definition, pharmacokinetics and pharmacology

  3. Alcohol intoxication: definition • Characterized by differences in consciousness, cognition, perception, affect, judgment, behaviour and other psychophysiological functions and responses • Caused by acute pharmacological effects and learned responses to alcohol • The differences resolve with time, with complete recovery, except from the tissue damage caused by the intake of alcohol

  4. BingeDrinking • Besides amount of alcohol intake, 3 other factors are of importance in the definition of binge drinking (Gill JS, 2002) • Gender: because of gender differences in pharmacology of alcohol • Duration of consumption • Drinking frequency => NO “GENERAL” DEFINTION!

  5. Genderdifferences in alcohol pharmacology • Pharmacology in women: • Smaller first pass metabolism in the stomach • Higher alcohol elimination: oxidation in the liver • Slower gastric emptying • Smaller body distribution => Net effect: higher blood alcohol concentrations persist longer in women

  6. Absorption and Elimination • Absorption • Fast • Highest level serum: < 60 min whenemptystomach • Ethanol : spasme of the pylorus • Elimination • Constant • Independent of peak-level • Non-drinkers: drops 10 -25 mg/dl/h (2.2 to 5.6 mmol/l/uur) • Chronic drinkers : drops 30 mg/dl/h (6.7 mmol/l / uur)

  7. Accumulation = toxic

  8. 2. Clinicalpresentation and diagnosis

  9. Clinicalpresentation is influencedby: • Quantity • Weight • Tolerance (age, gender) • % alcohol • Time of ingestion

  10. Vonghia et al, 2008

  11. Symptoms • Metabolic • Hypoglycemia • Elektrolytedisturbances • Cardiovascular • Tachycardia • Hypovolemic, VD • Hypothermia • Hypotension • Cerebralembolism and AMI • Fibrinolysis • Clotting • Coronaryspasms

  12. Symptoms • Respiratory • DEPRESSION OF RESPIRATION • Clearancemucus • Risk foraspiration • Gastro-intestinal • Nausea, vomiting, diarrhea, gastritis, pancreatitis • Alcoholic hepatitis

  13. Diagnosis • Clinicalsigns • Blood • alcohol • others? • Routine lab • Onindication • RX, ECG, CT • Arterialbloodgasses • …

  14. 3. Treatment

  15. APLS/EPLS guidelines • Airway and breathing • Airwayassesment • Observation of respiratoryfunction • Prevention of aspiration • Mechanicalventilation, ifnecessary • Circulation • IV access • IV solutionadministration • Correctionhypoglycemia • Corretionelektrolyteimbalances • Thiamine! (multivitamins)

  16. Furthertreatment • Disability • Level of consciousness • Sedationifnecessary • Acceleration of elimination • metadoxine • Watch out! • Trauma • Hypothermia • Hypoglycemia

  17. 4. Conclusion

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