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Alcohol and Alcoholism

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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Alcohol and Alcoholism

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  1. Alcohol and Alcoholism

  2. Ethanol • Mechanism of Toxicity • CNS depressant • Teratogen • Carcinogen

  3. 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 %

  4. Ethanol • Colognes/Perfumes 40 - 60% • Glass Cleaners 10% • Paint Stripper 25% • Cough/Cold Preparations 3 - 25% • Mouthwashes 14 - 27%

  5. 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

  6. 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

  7. 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

  8. 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

  9. Alcohol and Alcoholism • Phases • Problem drinking • Drinks to relieve stress • Abstinence does not cause physical symptoms • Alcohol addiction • Abstinence produces physical symptoms

  10. 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

  11. 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

  12. Acute Alcohol Effects

  13. Acute Alcohol Effects • Hangover • Mild withdrawal with volume depletion • Treatment • Fluids • Tylenol for headache • Not aspirin or ibuprofen

  14. Acute Alcohol Effects • Stupor-Coma • Acute overdose • Coma • Depressed respirations • Hypotension • Hypothermia

  15. Acute Overdose Treatment • ABC’s • Oxygen, assisted ventilations • Intubate • IV, infuse fluid to support perfusion • Lavage if within 2 hours

  16. 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

  17. Acute Alcohol Effects • Stupor-Coma • Hypoglycemia • Inhibition of protein to sugar conversion in liver (gluconeogenesis) • D-stick all patients with altered LOC

  18. Acute Alcohol Effects • Stupor-Coma • Trauma • “Drunks fall down and hit their heads.” • Concussion • Subdural hematoma

  19. Acute Alcohol Effects • Stupor-Coma • Mixed drug overdose • Tranquilizers • Barbiturates • Anti-depressants

  20. Acute Alcohol Effects • Acute alcoholic paranoia • Mean drunk • Violence • Motor vehicle crashes (50-60% of fatalities) • Fights

  21. Acute Alcohol Effects • Drug Interactions • Potentiation of CNS depressant drugs • Decreased anticonvulsant effectiveness • Potentiation of antihypertensive effects • Orthostatic hypotension

  22. Acute Alcohol Effects • Worsening of other problems • Peptic ulcer disease • Liver disease • Pancreatic disease • Heart disease (decreased pump strength)

  23. Associated Medical Problems

  24. Associated Medical Problems • Head injury/subdural hematoma • Impaired clotting mechanisms • Frequent falls

  25. Hepatic cirrhosis Causes Alcohol toxicity Poor nutrition Associated Medical Problems

  26. Hepatic cirrhosis Symptoms Ascites Jaundice Palmar erythema Spider angiomata, Caput medusa Gynecomastia (males) Associated Medical Problems “Lemon on toothpicks”

  27. Hepatic Cirrhosis Effects Impaired glucose metabolism, hypoglycemia Portal hypertension, esophageal varices Coagulopathies Hepatic encephalopathy Associated Medical Problems

  28. Associated Medical Problems • Pancreatitis • Nausea, vomiting • Severe upper abdominal pain radiating to back • Hypovolemic shock • Secondary diabetes • Pancreatic necrosis and hemorrhage

  29. Associated Medical Problems • Methanol/ethylene glycol poisoning • Sterno, antifreeze ingestion • Serve as EtOH substitutes • Produce • profound metabolic acidosis • hypocalcemia in ethylene glycol poisoning

  30. Associated Medical Problems • Nutritional deficiencies • Wernicke’s syndrome • Dizziness • Confusion • Apathy • Ophthalmoplegia • Ataxia

  31. Associated Medical Problems • Nutritional deficiencies • Korsakoff’s psychosis • Memory loss • Confusion, confabulation

  32. Associated Medical Problems • Nutritional deficiencies • Beriberi • Paresthesias, burning of feet • Cardiovascular failure • Peripheral vasodilation • Biventricular myocardial failure • Na+ and water retention

  33. Associated Medical Problems • Nutritional deficiencies • Respond to administration of thiamine (Vitamin B1)

  34. Associated Medical Problems • Cancer • Colon • Breast

  35. Abstinence Syndrome

  36. Abstinence Syndrome • Results from EtOH intake reduction • NOT necessarily result of complete withdrawal

  37. Abstinence Syndrome • Stages • Tremulousness • Shakes, jitters • Fine tremors • GI upset • Restlessness • Peaks at 24 hours • Patient may feel “shaky” for up to 2 weeks

  38. 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

  39. 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

  40. Abstinence Syndrome • Management • Oxygen, monitor, IV (LR or NS) • Check blood sugar • Consider D50W and thiamine • Minimum stimulation • Sedation • Phenobarbital • Benzodiazepines

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

  42. Antabuse (disulfiram) • Exposure to EtOH while taking causes sudden, severe vasodilation: • Hot, flushed face • Dizziness • Pounding heart, hypotension • Nausea, vomiting • Headache

  43. Antabuse (disulfiram) • DANGER! • Contact with other alcohol sources • Foods • Shaving lotion • Mouthwash

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