alcohol addiction

Alcohol and Alcoholism

Lynne Routsong-Wiechers, LISW

Ethanol

� Mechanism of Toxicity• CNS depressant• Teratogen• Carcinogen

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

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

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

� 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


� 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


� 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


� 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

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

Acute Alcohol Effects


� Hangover• Mild withdrawal with volume depletion• Treatment

– Fluids

– Tylenol for headache

– Not aspirin or ibuprofen


� 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

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


� Stupor-Coma• Hypoglycemia

– Inhibition of protein to sugar conversion in liver (gluconeogenesis)

– D-stick all patients with altered LOC


� Stupor-Coma• Trauma

– “Drunks fall down and hit their heads.”– Concussion

– Subdural hematoma


� Stupor-Coma• Mixed drug overdose

– Tranquilizers– Barbiturates

– Anti-depressants


� Acute alcoholic paranoia• Mean drunk

� Violence• Motor vehicle crashes (50-60% of

fatalities)• Fights


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

– Orthostatic hypotension


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

strength)

Associated Medical Problems


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


� Hepatic cirrhosis• Causes

–Alcohol toxicity–Poor nutrition


� Hepatic cirrhosis• Symptoms

– Ascites

– Jaundice

– Palmar erythema– Spider angiomata, Caput medusa– Gynecomastia (males)

“Lemon on toothpicks”


� Hepatic Cirrhosis• Effects

–Impaired glucose metabolism, hypoglycemia

–Portal hypertension, esophageal varices

–Coagulopathies–Hepatic encephalopathy


� Pancreatitis• Nausea, vomiting• Severe upper abdominal pain radiating to

back• Hypovolemic shock• Secondary diabetes• Pancreatic necrosis and hemorrhage


� Methanol/ethylene glycol poisoning• Sterno, antifreeze ingestion• Serve as EtOH substitutes• Produce

–profound metabolic acidosis–hypocalcemia in ethylene glycol

poisoning


� Nutritional deficiencies• Wernicke’s syndrome

–Dizziness–Confusion–Apathy–Ophthalmoplegia–Ataxia


� Nutritional deficiencies• Korsakoff’s psychosis

–Memory loss–Confusion, confabulation


� Nutritional deficiencies• Beriberi

–Paresthesias, burning of feet–Cardiovascular failure

• Peripheral vasodilation• Biventricular myocardial failure• Na+ and water retention


� Nutritional deficiencies• Respond to administration of thiamine

(Vitamin B1)


� Cancer• Colon• Breast

Abstinence Syndrome

Abstinence Syndrome

� Results from EtOH intake reduction� NOT necessarily result of complete

withdrawal

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

� 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

� 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

� Management• 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

Antabuse (disulfiram)� 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

alcohol addiction

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