Alcohol and Alcoholism

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Information about Alcohol and Alcoholism
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Published on October 15, 2008

Author: aSGuest995

Source: authorstream.com

Alcohol and Alcoholism : Alcohol and Alcoholism Ethanol : Ethanol Mechanism of Toxicity CNS depressant Teratogen Carcinogen Ethanol : 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 % Ethanol : Ethanol Colognes/Perfumes 40 - 60% Glass Cleaners 10% Paint Stripper 25% Cough/Cold Preparations 3 - 25% Mouthwashes 14 - 27% Ethanol Metabolism : 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 Ethanol : 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 Alcohol and Alcoholism : 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 Alcohol and Alcoholism : 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 Alcohol and Alcoholism : Alcohol and Alcoholism Phases Problem drinking Drinks to relieve stress Abstinence does not cause physical symptoms Alcohol addiction Abstinence produces physical symptoms Alcohol and alcoholism : 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 Alcohol and alcoholism : 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 Slide 12: Acute Alcohol Effects Acute Alcohol Effects : Acute Alcohol Effects Hangover Mild withdrawal with volume depletion Treatment Fluids Tylenol for headache Not aspirin or ibuprofen Acute Alcohol Effects : Acute Alcohol Effects Stupor-Coma Acute overdose Coma Depressed respirations Hypotension Hypothermia Acute Overdose Treatment : Acute Overdose Treatment ABC’s Oxygen, assisted ventilations Intubate IV, infuse fluid to support perfusion Lavage if within 2 hours Acute Overdose Treatment : 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 Acute Alcohol Effects : Acute Alcohol Effects Stupor-Coma Hypoglycemia Inhibition of protein to sugar conversion in liver (gluconeogenesis) D-stick all patients with altered LOC Acute Alcohol Effects : Acute Alcohol Effects Stupor-Coma Trauma “Drunks fall down and hit their heads.” Concussion Subdural hematoma Acute Alcohol Effects : Acute Alcohol Effects Stupor-Coma Mixed drug overdose Tranquilizers Barbiturates Anti-depressants Acute Alcohol Effects : Acute Alcohol Effects Acute alcoholic paranoia Mean drunk Violence Motor vehicle crashes (50-60% of fatalities) Fights Acute Alcohol Effects : Acute Alcohol Effects Drug Interactions Potentiation of CNS depressant drugs Decreased anticonvulsant effectiveness Potentiation of antihypertensive effects Orthostatic hypotension Acute Alcohol Effects : Acute Alcohol Effects Worsening of other problems Peptic ulcer disease Liver disease Pancreatic disease Heart disease (decreased pump strength) Slide 23: Associated Medical Problems Associated Medical Problems : Associated Medical Problems Head injury/subdural hematoma Impaired clotting mechanisms Frequent falls Associated Medical Problems : Associated Medical Problems Hepatic cirrhosis Causes Alcohol toxicity Poor nutrition Associated Medical Problems : Associated Medical Problems Hepatic cirrhosis Symptoms Ascites Jaundice Palmar erythema Spider angiomata, Caput medusa Gynecomastia (males) “Lemon on toothpicks” Associated Medical Problems : Associated Medical Problems Hepatic Cirrhosis Effects Impaired glucose metabolism, hypoglycemia Portal hypertension, esophageal varices Coagulopathies Hepatic encephalopathy Associated Medical Problems :  Associated Medical Problems Pancreatitis Nausea, vomiting Severe upper abdominal pain radiating to back Hypovolemic shock Secondary diabetes Pancreatic necrosis and hemorrhage Associated Medical Problems :  Associated Medical Problems Methanol/ethylene glycol poisoning Sterno, antifreeze ingestion Serve as EtOH substitutes Produce profound metabolic acidosis hypocalcemia in ethylene glycol poisoning Associated Medical Problems :  Associated Medical Problems Nutritional deficiencies Wernicke’s syndrome Dizziness Confusion Apathy Ophthalmoplegia Ataxia Associated Medical Problems :  Associated Medical Problems Nutritional deficiencies Korsakoff’s psychosis Memory loss Confusion, confabulation Associated Medical Problems :  Associated Medical Problems Nutritional deficiencies Beriberi Paresthesias, burning of feet Cardiovascular failure Peripheral vasodilation Biventricular myocardial failure Na+ and water retention Associated Medical Problems :  Associated Medical Problems Nutritional deficiencies Respond to administration of thiamine (Vitamin B1) Associated Medical Problems :  Associated Medical Problems Cancer Colon Breast Slide 35: Abstinence Syndrome Abstinence Syndrome : Abstinence Syndrome Results from EtOH intake reduction NOT necessarily result of complete withdrawal Abstinence Syndrome : Abstinence Syndrome Stages Tremulousness Shakes, jitters Fine tremors GI upset Restlessness Peaks at 24 hours Patient may feel “shaky” for up to 2 weeks Abstinence Syndrome : 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 Abstinence Syndrome : 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 Abstinence Syndrome : Abstinence Syndrome Management Oxygen, monitor, IV (LR or NS) Check blood sugar Consider D50W and thiamine Minimum stimulation Sedation Phenobarbital Benzodiazepines Antabuse (disulfiram) : Antabuse (disulfiram) Used in aversion therapy Blocks EtOH metabolism Causes buildup of acetaldehyde Antabuse (disulfiram) : Antabuse (disulfiram) Exposure to EtOH while taking causes sudden, severe vasodilation: Hot, flushed face Dizziness Pounding heart, hypotension Nausea, vomiting Headache Antabuse (disulfiram) : Antabuse (disulfiram) DANGER! Contact with other alcohol sources Foods Shaving lotion Mouthwash

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