Download - 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
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
� 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
� 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
Acute Alcohol Effects
� Hangover• Mild withdrawal with volume depletion• Treatment
– Fluids
– Tylenol for headache
– Not aspirin or ibuprofen
Acute Alcohol Effects
� 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
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
� Stupor-Coma• Trauma
– “Drunks fall down and hit their heads.”– Concussion
– Subdural hematoma
Acute Alcohol Effects
� Stupor-Coma• Mixed drug overdose
– Tranquilizers– Barbiturates
– Anti-depressants
Acute Alcohol Effects
� Acute alcoholic paranoia• Mean drunk
� Violence• Motor vehicle crashes (50-60% of
fatalities)• Fights
Acute Alcohol Effects
� Drug Interactions• Potentiation of CNS depressant drugs• Decreased anticonvulsant effectiveness• Potentiation of antihypertensive effects
– Orthostatic hypotension
Acute Alcohol Effects
� Worsening of other problems• Peptic ulcer disease• Liver disease• Pancreatic disease• Heart disease (decreased pump
strength)
Associated Medical Problems
Associated Medical Problems
� Head injury/subdural hematoma• Impaired clotting mechanisms• Frequent falls
Associated Medical Problems
� Hepatic cirrhosis• Causes
–Alcohol toxicity–Poor nutrition
Associated Medical Problems
� 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
� Pancreatitis• Nausea, vomiting• Severe upper abdominal pain radiating to
back• Hypovolemic shock• Secondary diabetes• Pancreatic necrosis and hemorrhage
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
� Nutritional deficiencies• Wernicke’s syndrome
–Dizziness–Confusion–Apathy–Ophthalmoplegia–Ataxia
Associated Medical Problems
� Nutritional deficiencies• Korsakoff’s psychosis
–Memory loss–Confusion, confabulation
Associated Medical Problems
� Nutritional deficiencies• Beriberi
–Paresthesias, burning of feet–Cardiovascular failure
• Peripheral vasodilation• Biventricular myocardial failure• Na+ and water retention
Associated Medical Problems
� Nutritional deficiencies• Respond to administration of thiamine
(Vitamin B1)
Associated Medical Problems
� 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