Transcript Alcohol and Drug Abuse - Hatzalah of Miami-Dade

Alcohol and Alcoholism
Ethanol
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Mechanism of Toxicity
• CNS depressant
• Teratogen
• Carcinogen
Ethanol
Lite Beer
 Beer
 Wine
 Flavored Liquors
 Distilled Liquors
 Everclear
 Proof is double %
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2.5 - 3.5%
4.0 - 6.0%
10 - 18 %
15 - 25%
22 - 50%
95%
Ethanol
Colognes/Perfumes
 Glass Cleaners
 Paint Stripper
 Cough/Cold Preparations
 Mouthwashes
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40 - 60%
10%
25%
3 - 25%
14 - 27%
Ethanol Metabolism
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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
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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
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Ethyl alcohol
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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
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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
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Phases
• Problem drinking
– Drinks to relieve stress
– Abstinence does not cause physical symptoms
• Alcohol addiction
– Abstinence produces physical symptoms
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
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Typical alcoholic
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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
Acute Alcohol Effects
Acute Alcohol Effects
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Hangover
• Mild withdrawal with volume depletion
• Treatment
– Fluids
– Tylenol for headache
– Not aspirin or ibuprofen
Acute Alcohol Effects
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Stupor-Coma
• Acute overdose
– Coma
– Depressed respirations
– Hypotension
– Hypothermia
Acute Overdose Treatment
ABC’s
 Oxygen, assisted ventilations
 Intubate
 IV, infuse fluid to support perfusion
 Lavage if within 2 hours
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Acute Overdose Treatment
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DONT
• Dextrose, Oxygen, Narcan, Thiamine
• Glucose, thiamine (50-100mg)
• Narcan may reduce respiratory
depression but not CNS depression
(? Use)
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Dialysis - removes 280mg/minute
Acute Alcohol Effects
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Stupor-Coma
• Hypoglycemia
– Inhibition of protein to sugar conversion in
liver (gluconeogenesis)
– D-stick all patients with altered LOC
Acute Alcohol Effects
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Stupor-Coma
• Trauma
– “Drunks fall down and hit their heads.”
– Concussion
– Subdural hematoma
Acute Alcohol Effects
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Stupor-Coma
• Mixed drug overdose
– Tranquilizers
– Barbiturates
– Anti-depressants
Acute Alcohol Effects
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Acute alcoholic paranoia
• Mean drunk
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Violence
• Motor vehicle crashes (50-60% of
fatalities)
• Fights
Acute Alcohol Effects
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Drug Interactions
• Potentiation of CNS depressant drugs
• Decreased anticonvulsant effectiveness
• Potentiation of antihypertensive effects
– Orthostatic hypotension
Acute Alcohol Effects
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Worsening of other problems
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Peptic ulcer disease
Liver disease
Pancreatic disease
Heart disease (decreased pump
strength)
Associated Medical
Problems
Associated Medical Problems
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Head injury/subdural hematoma
• Impaired clotting mechanisms
• Frequent falls
Associated Medical Problems
 Hepatic
cirrhosis
• Causes
–Alcohol toxicity
–Poor nutrition
Associated Medical Problems
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Hepatic cirrhosis
• Symptoms
– Ascites
– Jaundice
– Palmar erythema
– Spider angiomata, Caput medusa
– Gynecomastia (males)
“Lemon on toothpicks”
Associated Medical Problems
 Hepatic
Cirrhosis
• Effects
–Impaired glucose metabolism,
hypoglycemia
–Portal hypertension, esophageal
varices
–Coagulopathies
–Hepatic encephalopathy
Associated Medical Problems
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Pancreatitis
• Nausea, vomiting
• Severe upper abdominal pain radiating to
back
• Hypovolemic shock
• Secondary diabetes
• Pancreatic necrosis and hemorrhage
Associated Medical Problems
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Methanol/ethylene glycol poisoning
• Sterno, antifreeze ingestion
• Serve as EtOH substitutes
• Produce
–profound metabolic acidosis
–hypocalcemia in ethylene glycol
poisoning
Associated Medical Problems
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Nutritional deficiencies
• Wernicke’s syndrome
–Dizziness
–Confusion
–Apathy
–Ophthalmoplegia
–Ataxia
Associated Medical Problems
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Nutritional deficiencies
• Korsakoff’s psychosis
–Memory loss
–Confusion, confabulation
Associated Medical Problems
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Nutritional deficiencies
• Beriberi
–Paresthesias, burning of feet
–Cardiovascular failure
• Peripheral vasodilation
• Biventricular myocardial failure
• Na+ and water retention
Associated Medical Problems
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Nutritional deficiencies
• Respond to administration of thiamine
(Vitamin B1)
Associated Medical Problems
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Cancer
• Colon
• Breast
Abstinence Syndrome
Abstinence Syndrome
Results from EtOH intake reduction
 NOT necessarily result of complete
withdrawal
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Abstinence Syndrome
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Stages
• Tremulousness
–Shakes, jitters
–Fine tremors
–GI upset
–Restlessness
–Peaks at 24 hours
–Patient may feel “shaky” for up to 2
weeks
Abstinence Syndrome
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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
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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
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Management
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Oxygen, monitor, IV (LR or NS)
Check blood sugar
Consider D50W and thiamine
Minimum stimulation
Sedation
– Phenobarbital
– Benzodiazepines
Antabuse (disulfiram)
Used in aversion therapy
 Blocks EtOH metabolism
 Causes buildup of acetaldehyde
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Antabuse (disulfiram)
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Exposure to EtOH while taking causes
sudden, severe vasodilation:
• Hot, flushed face
• Dizziness
• Pounding heart, hypotension
• Nausea, vomiting
• Headache
Antabuse (disulfiram)
DANGER!
 Contact with other alcohol sources
• Foods
• Shaving lotion
• Mouthwash
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