alcohol by dr rizwan zafar cmh lahore medical college

8/9/2019 Alcohol by dr rizwan zafar CMH lahore medical college

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THE TERM ALCOHOL IN POPULAR USE REFERS TO ETHYLALCOHOL [ ETHANOL ]

WHICH IS PRESENT IN VARIOUS FERMENTED ANDDISTILLED BEVERAGES.

ALCOHOL IS

TRANSPARENT,

COLORLESS,VOLATILE LIQUID

HAVING A SPIRIT LIKE ODOUR

AND

BURNING TASTE.


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IT IS THE ACTIVE INGREDIENT OF MANY SOCIALBEVERAGES SUCH AS

WINEBEERWHISKEYBRANDY

ITS APPROXIMATE %AGE IN SUCH BEVERAGES IS

BEVERAGES ALCOHOL %AGE BY

VOLUME

DEGREES [ PROOF ]

RUM 42.8 75

WHISKEY / BRANDY 42.8 75

GIN 42.8/ 40.0/ 37.2 75/ 70/ 65

WINE 8-15.5 14-27

BEER 2-10.0 3.5-17.5

COUNTRY LIQUOR 11.4-45.7 20-80


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THIS INDICATES A MIXTURE THAT CONTAINS

57.10 % BY VOLUME OF ABSOLUTE ALCOHOL.

OR

49.28 % BY WEIGHT OF ABSOLUTE ALCOHOL.


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` IN UNITED STATES THE TERM PROOF REFERS TO

TWICE THE PERCENTAGE OF ALCOHOL BYVOLUME.

Thus 80 proof whiskey contains 40% alcohol by volume.


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` PROOF STRENGTH OF A LIQUID IS OBTAINED BYDIVIDING THE ALCOHOL PERCENT

[ VOLUME STRENGTH ] BY 0.571

` PROOF / DEGREE= ALCOHOL % [VOL]

0.571


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` THIS IS OBTAINED BY MULTIPLYING THEPROOF STRENGTH BY 0.571

`

ALCOHOL %AGE = PROOF/ DEGREEx

0.571

` Rectified spirit contains 95% by volume of alcohol.

`

Absolute alcohol the water is removed by specialtechnique, hence bringing it down to not more than0.2% water.


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` 12 OUNCES OF BEER.

` 4 OUNCES GLASS OF WINE

` 1 SHOT OF 80-PROOF ALCOHOLIC BEVERAGE.


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This is an eastern name for any country liquor.

It is distilled from

Coco-palmRice

Sugar

Its strength may be as high as that of whisky.

It is commonly fortified [to gain extra kick] with

Potassium bromideChloral hydrate

Dhaturabhang


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This although more intoxicating but will have the sameclinical effects as ethyl alcohol.

SERIOUS TOXIC EFFECTS ARE COMMON WHEN

1. The liquor is adulterated by denatured spirit which containsmethyl alcohol.

2. The so called country liquor is prepared from toxicpreparations like varnish and French polish containing

methyl alcohol.

INCIDENCE OF DEATH IS QUITE COMMON WITH THIS TYPEOF LIQUOR.


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` ETHYL ALCOHOL IS RAPIDLY ABSORBED FROM

GASTROINTESTINAL TRACT.

The rate of absorption depends upon

1. Concentration of the alcohol in the fluid imbibed.2. Presence / absence of food in the stomach.

3. Condition of stomach wall [gastrectomy, chronic

gastritis].

4. Rate of drinking.5. Quantity of alcohol ingested.

6. Weight of the person.

7. Development of the person.


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1. CONCENTRATION OF THE ALCOHOL

` Alcohol is absorbed more rapidly from concentrated

than from dilute solution.

2. PRESENCE OF FOOD IN STOMACH.

` Fats and proteins retard the absorption, milk

being very effective for this purpose.


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FOLLOWING ABSORPTION

` the concentration of alcohol in blood reaches a maximum inabout 45-90 minutes after ingestion.

THE CONCENTRATION OF ALCOHOL IN VARIOUSTISSUES AFTER EQUILIBRIUM IS ESTABLISHED AS

FOLLOWS.

` BLOOD IS TAKEN AS 1

`

BRAIN 1.17` PLASMA 1.16

` URINE 1.33

` VITREOUS AND BILE 1.12

` LIVER 0.91

` BLOOD CLOT 0.77


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` approximately90% of the absorbed alcohol is oxidized in the

liver.

` remaining 10% being excreted mainly by kidney and lungs.

` NORMAL BODY METABOLISM OF ALCOHOL IN AN

HOUR IS` fluid ounce of absolute alcohol.

` One fluid ounce of whisky. [ one drink ]

` 12 ounces of beer.

IF THE INTAKE EXCEEDS THIS QUANTITY THE SUBJECTMANIFESTS SIGNS AND SYMPTOMS OF DRUNKENNESS UNLESS

TOLERANCE HAS BEEN DEVELOPED.


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THE AVERAGE FALL OF THE ALCOHOL

CONCENTRATION IS AROUND

15-18 mg ethanol per 100 ml of blood per hour.

[ 15-18 mg / 100 ml / hour ]

HENCE IT IS POSSIBLE TO CALCULATE

` how long after a given dose body will be alcohol free.

` Blood alcohol concentration a few hours before theblood analysis.


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` ethyl alcohol depresses the central nervous system

irregularly in descending order from cortex to medulla.` It first depresses the higher centres which control

judgment and behavior. [ stage of excitement-blood

alcohol 30-100 mg% ]

` Then it depresses the motor centres [ stage ofincoordination -blood alcohol 100-300 mg% ]

` Finally the vital centres in the medulla are depressed [

stage of narcosis-blood alcohol over 300 mg% ]

` The breath smells alcohol throughout.


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` EFFECTS APPEAR EARLY IN THOSE WHO ARE

` mentally or physically fatigued

` Epileptics

` Head injury patients

` Already intoxicated with barbiturates or other CNSdepressants.

THE STATUTORY LIMIT FOR A CHARGE OF

DRUNKEN DRIVING IS

` 0.08-010% in USA.

` 0.08% in Canada and Britain.

`

0.15% in India.


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THIS IS A FEELING OF WELL BEING AND PLEASURE

RESULTING FROM INHIBITION OF THE HIGHERCENTRES.

THE PERSON

` converses well.

` Laughs and smiles readily.

` Or may become angry easily.

` May disclose secrets easily.

` May behave in an obscene manner or talk in vulgar

language.

` Sexual desire may be aroused.


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THERE IS INCOORDINATION OF

` thought

` speech

` Action

MANIFESTED BY

` impaired judgment

` confusion

` slurred speech

` staggering gait

THE DRUNK PERSON MAY

` Suffer from hiccups

` May be untidy in appearance


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THE PERSON MAY DEPICT INHERENT EMOTIONS LIKE

` Remorse

` Euphoria

` Irritability

SIGN AND SYMPTOMS

` Nausea` Vomiting

` Dilated pupils

IMPAIRED JUDGMENT MAY LEAD TO MOST OFFENCES LIKE

` Accidents

` Sexual excesses` Violence

` crime


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` The patient passes on to deep sleep and responds only to

strong stimuli.` Pulse is rapid.

` Temperature subnormal.

` Breathing is stertorous.

MACEWAN SIGN

` Pupils may be contracted.

` However on pinching the neck or face, they dilate initiallyand slowly return to their original size.

` This sign is helpful to differentiate alcoholic coma fromother comatose conditions.


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If this stage lasts for more than 12 hours

Death may ensue from paralysis of

Cardiac centre respiratory centre

Or

Later from effects of pulmonary edema.


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` Death from acute alcoholism is not common.

` Recovery occurs with acute depression andgastrointestinal irritation, which continues for 24 hours

or longer.

Hang-over

` Headache is also present as a hang-over effect, which

is caused by cerebral edema.` hang-over means a temporary state of indisposition

usually following recovery from drunkenness.


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PERCENT MG % EFFECT

LESS THAN 0.03% LESS THAN 30 NOT NOTICEABLE

0.03-0.05 30-50 SELECTIVE IMPAIRMENT

0.05-0.10 50-100 SLIGHT IMPAIRMENT

0.10-0.15 100-150 UNDER THE INFLUENCE

0.15-0.20 150-200 DRUNK

0.20-0.30 200-300 VERY DRUNK

0.30-0.35 300-350 STUPOR TO COMA

OVER 0.35 OVER 350 COMATOSE TO DEATH


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` SELECTIVE IMPAIRMENT.` Increase inreactiontime.` Impairmentofcomplexskills. [ driving ]` Detectableonly on detailed examination.

` SLIGHT IMPAIRMENT.` Flushedface.

` Dilated / sluggish pupils.` Euphoria.` Lossofrestraint.

` UNDER THE INFLUENCE.

` Faceflushed.` Dilated and sluggish pupils.` Euphoria.` Lossofrestraint.` Testerrors.` Staggeronsuddenturning.


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` DRUNK` Faceflushed.

` Dilated/ sluggish/ inactive pupils.` Cloudingof intellect.` Incoordinationofthought,speech,and action.` Staggeringgaitwithreelingand lurching while makingsuddenturns.

` VERY DRUNK`

Flushed or paleface.` Pupils inactive dilated [ may becontracted.]` Mental confusion.` Marked incoordinationofthought,speech,and action.

` Staggering,reelinggaitwithtendency to lurchandfall.` Vomiting.` Amnesia.

` SPECIAL NOTE.` These manifestationsappear in persons whoarenotregularand excessive

drinkers.` Recovery hasbeenrecorded afterblood alcohol levelsof780 mg%and

above.


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` THIS DEPENDS ON THE` Age.

` Habit of the person.

` Strength of the liquor taken.

` Death usually occurs from

large dose taken in shortperiod.

` FATAL DOSE.

` 0.35 % [350 mg%] and

above, concentration ofblood alcohol is usuallysufficient to cause death.

` USUALLY IT IS` 12-24 HOURS

` ALTHOUGH DEATH MAY

BE DELAYED FOR` 5-6 DAYS


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` DEATH IS DUE TO DEPRESSION OF THE RESPIRATORYCENTRE.

` ALCOHOL MAY BE LETHAL AT RELATIVELY LOWERBLOOD LEVELS WHEN

Combined with other central nervous systemdepressants, such as

Barbiturates

Carbon monoxide

Morphine

Or in the presence of

some natural heart or lung disease.


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A MOTOR VEHICLE IS A COMPLICATED PIECE OF MACHINERY,

HANDLING OF WHICH REQUIRES` skill,

` dexterity,

` and mental acuity.

` All of these are selectively reduced, even eliminated by alcohol.

` Thus an individual may be intoxicated to the point of being unable to

operate an automobile safely while appearing sober.

RESEARCH SHOWS THAT A DRIVERS ABILITY IS ADVERSELY

AFFECTED

` with a blood alcohol count of 0.03-0.05 % [ or sometimes even less].

` which means consumption of only two beers in about an hour.


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` ALCOHOL CAUSES

` faulty depth perception.

` Poor peripheral vision.` Distorted color vision.

` Reduced night vision.

` EXAMPLE 1

`

When a drunk driver is exposed to glare of head lights of an oncomingvehicle.

` It can take 2-8 seconds to adapt to the dark conditions.

` As compared to 1 second required by a normal individual.

` EXAMPLE 2

` An alcoholic impaired drivers ability to judge the distance may also bereduced.

` Making it difficult to change lanes.

` Or to determine whether car is approaching, moving away, or standingstill.


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` DRIVING ABILITY IS GENERALLY IMPAIRED EVEN IN THE

HANGOVER PHASE DUE TO AFTER AFFECTS OF ALCOHOL ON

` Judgment.

` Perception.

` Reaction time.

` Coordination.

AN INCREASE OF ONE TENTH OF A SECOND IN REACTION TIME

means

THAT A CAR TRAVELLING AT 80 KM/ HOUR

needs

AN ADDITIONAL 2.2 METRES OF ROAD TO PULL UP.


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GASTRIC LAVAGE

The stomach should be lavaged with care with

5 % solution of sodium bicarbonate in warm water.

GENERAL MEASURES

The patient should be kept warm.

HYPOGLYCEMIA

Isotonic solution with 5 % glucose [preferably fructose] may be required.

INCREASED INTRACRANIAL PRESSURE.

This often occurs and is to be treated withSaline purges

and

Intravenous hypertonic glucose solution


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RESPIRATORY DEPRESSION

Artificial respiration may be required along with oxygen inhalation.

SERIOUS LIFE THREATENING EMERGENGENCY MAY NEED

peritoneal dialysis

Haemodialysis


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` CLOTHES.

` Tornand disorderly.` Stained withblood and vomitus.

` MISCELLANEOUS.

` Tongue may befurred.

` Rigor mortis lasts longer.

` Bruisesarefound onvarious partsofthebody.

` Other injuries may be present.

`

ON OPENING UP THE BODY.` Odourofalcoholicbeverages isoftenevident.

` Blood isfluid and dark.


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BRAIN

` isslightly edematous.

` Shrinkageofthecerebral cortex [grey mater] iscommon inchronic

alcoholics.

` In individuals whosustainhead injury withsubdural / epiduralhemorrhageand surviveforhoursto days

THE ANALYSIS OF THE BLOO CLOT MAY REVEAL INITIAL BLOOD

ALCOHOL LEVEL AT THE TIME OF INJURY.

VITREOUS.

` Vitreousanalysis will reveal alcohol level inall thecases.


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` GASTROINTESTINAL TRACT FINDINGS

` Edemaofthe larynx.

` Cafcoronary. [ bolusoffood obstructingthe larynx.]

` Fatty liver.` Acutehemorrhagic pancreatitis.

` Stomachshowssignsofalcoholicgastritistoavarying degree.

` Mucus membraneofthesmall intestine isedematousbutnot

ulcerated.

[ a differentiating pointfrom infective death likesalmonella infectionwhere ulcerationsare present.]


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VISCERA SENT FOR THE CHEMICAL ANALYSIS ARE

Stomach and its contents.

Small intestine.

Piece of liver, spleen, kidney.

Vitreous fluid.

Cerebrospinal fluid.

Blood collected from a peripheral vein.


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POISONING BY ALCOHOLAlthough itiscomparatively commonbutdeath directly dueto its

ingestionoccurs inafarsmallernumberofcases.

LIABILITY TO FATAL COMPLICATIONS MAY OCCUR SUCH AS

Head injuries.Seriousbleedingfrom trivial injuries.

Cafcoronary leadingtosuffocation.

Drowning.

A STRONG RELATIONSHIP EXISTS BETWEEN ALCOHOL, CRIME,AND VIOLENCE.


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THIS IS A COMMON CAUSE OF

Sexual jealousy crimes, especially those of a homicidal nature.

CONTRIBUTORY NEGLIGENCE

A passenger who accepts a lift from the driver of a motor

vehicle whom he knows from to be drunk accepts the risk

of contributory negligence in the event of an accident.


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This results from the continued use of alcohol.

IT IS CHARACTERISED BY GRADUAL DETERIORATION

OF

Physical health.

Moral values.

Mental intellect.

Also known as ALCOHOLIC DEMENTIA.


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THIS IS MANIFESTED BY

Lack of personal hygiene.

Loss of appetite.

Chronic gastroenteritis.

Wasting.

Peripheral neuropathies.

Impotence.

Sterility.Fatty changes in liver and heart.


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ALCOHOL IS A HEPATOTOXIC POISON.

Cirrhosis of liver is common.

A useful index of liver damage is level of

enzyme

GAMMA GLUTAMYL TRANSPEPTIDASE,in the serum,

the normal level being less than 36 units.


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This manifests as crimes which the addictcommits to get the drink.

Mental degeneration results in dementia.

The person may hit the family members and

have an aggressive attitude.


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DELERIUM TREMENS

KORSAKOFFS PSYCHOSIS.

ACUTE HALLUCINOSIS.


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This is a state of excitement with hallucinosis which

lasts

34 days.

THIS RESULTS FROM.

` Unusual bout of drinking.

` Sudden withdrawal of alcohol.

` Acute infection, e.g. pneumonia or influenza.

` Shock from injury e.g. fracture of bone.

` Exposure to cold.


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THIS IS CHARACTERIZED BY

Acute attack of insanity in which the main symptoms are

` Sleeplessness.

` Marked tremors.

` Excitement.

` Fear.` Visual and Auditory hallucinations.

The person may seek escape from his terrifying new world

by suicide.

` The person isoftenviolentwithahomicidal tendency.

` The person isconsidered insaneforthetimebeingand not

h ld ibl f hi ti

alcohol by dr rizwan zafar cmh lahore medical college

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