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Alcohol and Alcoholism. Ethanol n Mechanism of Toxicity CNS depressant Teratogen Carcinogen.

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Presentation on theme: "Alcohol and Alcoholism. Ethanol n Mechanism of Toxicity CNS depressant Teratogen Carcinogen."— Presentation transcript:

1 Alcohol and Alcoholism

2 Ethanol n Mechanism of Toxicity CNS depressant Teratogen Carcinogen

3 Ethanol n Lite Beer % n Beer % n Wine % n Flavored Liquors % n Distilled Liquors % n Everclear 95% n Proof is double %

4 Ethanol n Colognes/Perfumes % n Glass Cleaners 10% n Paint Stripper 25% n Cough/Cold Preparations % n Mouthwashes %

5 Ethanol Metabolism n One drink equals: 12 ounces beer 5 ounces wine 1.5 ounces distilled liquor n 70 kg person metabolizes approximately one drink/hour n 7 calories per gram vs. 9 calories/gm

6 Ethanol n Highest serum level recorded with full recovery in an adult mg/dL n Legal limit for intoxication - 80mg/dL or 0.08 n Odor threshold - 10 ppm

7 Alcohol and Alcoholism n 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 n 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 n Phases Problem drinking –Drinks to relieve stress –Abstinence does not cause physical symptoms Alcohol addiction –Abstinence produces physical symptoms

10 Alcohol and alcoholism n Alcohol does NOT depend on type of EtOH n Alcoholism occurs in ALL social classes and age groups n Skid row bums = 3 to 5% of alcoholics

11 Alcohol and alcoholism n 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 n Hangover Mild withdrawal with volume depletion Treatment –Fluids –Tylenol for headache –Not aspirin or ibuprofen

14 Acute Alcohol Effects n Stupor-Coma Acute overdose –Coma –Depressed respirations –Hypotension –Hypothermia

15 Acute Overdose Treatment n ABCs n Oxygen, assisted ventilations n Intubate n IV, infuse fluid to support perfusion n Lavage if within 2 hours

16 Acute Overdose Treatment n DONT Dextrose, Oxygen, Narcan, Thiamine Glucose, thiamine (50-100mg) Narcan may reduce respiratory depression but not CNS depression (? Use) n Dialysis - removes 280mg/minute

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

18 Acute Alcohol Effects n Stupor-Coma Trauma –Drunks fall down and hit their heads. –Concussion –Subdural hematoma

19 Acute Alcohol Effects n Stupor-Coma Mixed drug overdose –Tranquilizers –Barbiturates –Anti-depressants

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

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

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

23 Associated Medical Problems

24 n Head injury/subdural hematoma Impaired clotting mechanisms Frequent falls

25 Associated Medical Problems n Hepatic cirrhosis Causes –Alcohol toxicity –Poor nutrition

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

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

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

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

30 Associated Medical Problems n Nutritional deficiencies Wernickes syndrome –Dizziness –Confusion –Apathy –Ophthalmoplegia –Ataxia

31 Associated Medical Problems n Nutritional deficiencies Korsakoffs psychosis –Memory loss –Confusion, confabulation

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

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

34 Associated Medical Problems n Cancer Colon Breast

35 Abstinence Syndrome

36 n Results from EtOH intake reduction n NOT necessarily result of complete withdrawal

37 Abstinence Syndrome n 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 n 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 n 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 n Management Oxygen, monitor, IV (LR or NS) Check blood sugar Consider D 50 W and thiamine Minimum stimulation Sedation –Phenobarbital –Benzodiazepines

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

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

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

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