Alcohol and Alcoholism

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Alcohol and Alcoholism
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Ethanol

• Mechanism of Toxicity
• CNS depressant
• Teratogen
• Carcinogen

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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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Ethanol

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

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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 _at_ 9 calories/gm

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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

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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

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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

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Alcohol and Alcoholism

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

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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

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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

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• Acute Alcohol Effects

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Acute Alcohol Effects

• Hangover
• Mild withdrawal with volume depletion
• Treatment
• Fluids
• Tylenol for headache
• Not aspirin or ibuprofen

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Acute Alcohol Effects

• Stupor-Coma
• Acute overdose
• Coma
• Depressed respirations
• Hypotension
• Hypothermia

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Acute Overdose Treatment

• ABCs
• Oxygen, assisted ventilations
• Intubate
• IV, infuse fluid to support perfusion
• Lavage if within 2 hours

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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

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Acute Alcohol Effects

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

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Acute Alcohol Effects

• Stupor-Coma
• Trauma
• Drunks fall down and hit their heads.
• Concussion
• Subdural hematoma

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Acute Alcohol Effects

• Stupor-Coma
• Mixed drug overdose
• Tranquilizers
• Barbiturates
• Anti-depressants

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Acute Alcohol Effects

• Acute alcoholic paranoia
• Mean drunk
• Violence
• Motor vehicle crashes (50-60 of fatalities)
• Fights

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Acute Alcohol Effects

• Drug Interactions
• Potentiation of CNS depressant drugs
• Decreased anticonvulsant effectiveness
• Potentiation of antihypertensive effects
• Orthostatic hypotension

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Acute Alcohol Effects

• Worsening of other problems
• Peptic ulcer disease
• Liver disease
• Pancreatic disease
• Heart disease (decreased pump strength)

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• Associated Medical Problems

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Associated Medical Problems

• Head injury/subdural hematoma
• Impaired clotting mechanisms
• Frequent falls

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Associated Medical Problems

• Hepatic cirrhosis
• Causes
• Alcohol toxicity
• Poor nutrition

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Associated Medical Problems

• Hepatic cirrhosis
• Symptoms
• Ascites
• Jaundice
• Palmar erythema
• Spider angiomata, Caput medusa
• Gynecomastia (males)

Lemon on toothpicks
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Associated Medical Problems

• Hepatic Cirrhosis
• Effects
• Impaired glucose metabolism, hypoglycemia
• Portal hypertension, esophageal varices
• Coagulopathies
• Hepatic encephalopathy

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Associated Medical Problems

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

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Associated Medical Problems

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

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Associated Medical Problems

• Nutritional deficiencies
• Wernickes syndrome
• Dizziness
• Confusion
• Apathy
• Ophthalmoplegia
• Ataxia

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Associated Medical Problems

• Nutritional deficiencies
• Korsakoffs psychosis
• Memory loss
• Confusion, confabulation

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Associated Medical Problems

• Nutritional deficiencies
• Beriberi
• Paresthesias, burning of feet
• Cardiovascular failure
• Peripheral vasodilation
• Biventricular myocardial failure
• Na and water retention

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Associated Medical Problems

• Nutritional deficiencies
• Respond to administration of thiamine (Vitamin B1)

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Associated Medical Problems

• Cancer
• Colon
• Breast

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• Abstinence Syndrome

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Abstinence Syndrome

• Results from EtOH intake reduction
• NOT necessarily result of complete withdrawal

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Abstinence Syndrome

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

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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

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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

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Abstinence Syndrome

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

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Antabuse (disulfiram)

• Used in aversion therapy
• Blocks EtOH metabolism
• Causes buildup of acetaldehyde

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Antabuse (disulfiram)

• Exposure to EtOH while taking causes sudden,
  severe vasodilation
• Hot, flushed face
• Dizziness
• Pounding heart, hypotension
• Nausea, vomiting
• Headache

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Antabuse (disulfiram)

• DANGER!
• Contact with other alcohol sources
• Foods
• Shaving lotion
• Mouthwash