Alcohol poisoningBy: Imtiaz ur Rehman

4th Year MBBSKhyber Medical College Peshawar

Learning objectives• Types of alcohol• MOA and treatment of ethanol• ROA, Absorption, Distribution of alcohol• Effects of Acute and chronic alcohol poisoning on body• Treatment of acute and chronic alcohol poisoning• Postmortem findings of acute and chronic alcoholics deaths• Medicolegal significance

introduction• Alcohol belongs to inebriant group of neurotics class of poisons.• Inebriant poisons are those poisons which intoxicate and produce

symptoms of excitement and narcosis.

Beverages Alcohol%

rum 43%

Whiskey, brandy 43%

wines 8-15%

Beers 2-10%

Types of Alcohol1. Ethanol (ethyl alcohol, grain alcohol)

2. Methanol (methyl alcohol, wood alcohol)

3. Isopropanol (isopropyl alcohol, rubbing alcohol)

4. Ethylene glycol

MECHANISM OF ACTION

FORMICACID

ACIDOSIS

TISSUEHYPOXIA

LACTIC ACIDPRODUCTION

CIRCULATORYFAILURE

INHIBITION OF MITOCHONDRIAL RESPIRATION

CIRCULUSHYPOXICUS

METHANOL

FORMALDEHYDE

Symptoms of

general

toxicity

Ocular Toxicity

Alcohol Dehydrogenase

Aldehyde Dehydrogenase

Routes of administration• Topical

• Inhalation

• Intravenous injection

• Oral ingestion

Absorption and Distribution• Absorption of ethanol is by simple diffusion

• 25% of an ingested dose of ethanol is absorbed from the stomach

• 75% of an ingested dose of ethanol is absorbed from the small intestine

Factors effecting absorption• Concentration• Presence or absence of food in stomach• Condition of stomach • Rate of emptying of stomach• Rate and quantity of alcohol ingested• Tolerance

Distribution of Alcohol• Alcohol is hydrophilic and will distribute into fluids and tissues

according to their water content• Total body water (TBW) is dependent upon• Sex• Age • Body weight

Alcohol can cross placental and blood brain barrier

Fatal Dose• Logically there is no specific fatal dose.• It is the blood alcohol concentration (BAC) that Specifies the lethal

dose. (>350mg%)• Fatal dose vary from person to person.• Less in case of:

• Thin and lean person• Females• Mentally unstable subjects• Patients suffering from liver disease, epilepsy, cerebral trauma• Patients using barbiturates, anti histamines, tranquilizers, hypnotic

• More in case of tolerance

Fatal Period• Relatively more…• 12-24 hrs• May extend to 5-6 days.

Effects of Acute Alcohol poisoning on BodyCNS effects

GIT effects

Respiratory effects

Urinary effects Reproductive

Heart

Effects on CNSFrontal cortexCerebellumHippocampusHypothalamusMedulla

Stages of alcohol Intoxication

Stage of excitementInc talkativeness, inc self confidence, dec sensory perception, loss of fine motor skills, slowed information processing, inc sexual desires

Stage of incoordination• Incordination of thought, speech, impaired judgement, confusion, slurred speech,

staggering gait,• Nausea, vomiting• Dialted pupils.• Criminal offences aare commited,

Stage of narcosis• Deep sleep, rapid pulse, hypothermia, • labored breathing• Contracted pupils• MACEWAN,s sign present• Coma• Death

30-100mg%

100-300mg%

>300mg%

Laboratory tests for Diagnosisof Alcohol poisoning

• Blood test• Vitreous fluid• Urine

Effects of alcohol on Driving• Driving ability is effected by 50-60 mg%.• Faulty depth perception• Poor peripheral vision• Distorted color vision• Reduced night vision• Increased reaction time

diagnostic tests Finger nose

testStraight line Test Breathalyzer

Treatment of Acute alcohol poisoning

2 types of treatment1) First Aid2) Treatment in hospital

First Aid treatmentWhat to Do??? What NOT to DO???

Keep him awake Don’t let him sleep

Keep him in recovery position Don't let him lie straight

Give him water Don’t give him coffee

Keep him sitting up Don’t walk him around

Keep him warm Don’t put him under cold shower

Stay with him and monitor his symptoms Don’t let him drink any more alcohol

Treatment in hospital• Gastric lavage• Artificial breathing• Electrolytes• Urinary Catheter• IV hypertonic glucose solution• Fructose solution• Hemodialysis and peritoneal dialysis

Postmortem findings• Identity• Examination of clothes• External examination• Internal examination• Opening of cranial cavity• Opening of abdominal cavity• Opening of thoracic cavity

Effects of chronic alcohol poisoning on body

• Liver Cirrhosis• Physical, moral and mental deterioration• Chronic Gastroenteritis• Weight loss• Peripheral neuropathies• Impotence and sterility

Effects of Chronic Alcohol poisoning on BodyCNS effects

GIT effects

Respiratory effects

Urinary effects Reproductive

Heart

Gouty arthritis

Common clinical syndromes• Delirium tremens Korasakoff’s psychosis Attack of acute insanity Hallucinations Sleeplessness Disorientation Tremors Multiple neuritis Excitement Loss of memory for recent events Fear and hallucinations Acute hallucinosis

Auditory hallucinationsPt may become homicidal or suicidal

Treatment of chronic Alcohol poisoning

• Antabuse (Disulfram) …. OD dose of 0.5mg• Tab. Temposil (Citrated Calcium Carbamide) …. OD dose of 50mg• Psychotherapy

Postmortem findings of chronic alcohol poisoning

• Degenerative changes in liver, kidneys and brain• Atrophic gastritis• Liver cirrhosis• Cardiomyopathy

Cause of death in alcohol poisoning• RTA• Suicide• Liver diseases• Cancers• Depression of respiratory centers• Postural asphyxia

Medicolegal Significance• Road traffic accidents• Alcohol is related to crime and violence