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Alcohol and Alcoholism

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Presentation on theme: "Alcohol and Alcoholism"— Presentation transcript:

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 % Distilled Liquors % Everclear % Proof is double %

4 Ethanol Colognes/Perfumes 40 - 60% Glass Cleaners 10%
Paint Stripper % Cough/Cold Preparations % Mouthwashes %

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. 9 calories/gm

6 Ethanol Highest serum level recorded with full recovery in an adult 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
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 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

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 Violence Mean drunk
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 Associated Medical Problems
Hepatic cirrhosis Causes Alcohol toxicity Poor nutrition

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

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

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 Seizures (“rum fits”)
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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