Acute Alcohol Intoxication

Question 1

is methanol toxic

Answer 1

yes

Question 2

what can methanol poisoning cause

Answer 2

blindness

Question 3

describe the metabolism of methanol

Answer 3

metabolised to formaldehyde and then formic acid

Question 4

treatment of methanol poisoning

Answer 4

ethanol +/- dialysis

Question 5

why do you treat methanol poisoning with ethanol

Answer 5

they are both metabolised by alcohol dehydrogenase - ethanol outcompetes methanol and prevents the formation of formic acid

Question 6

recommended alcohol intake

Answer 6

•14units is recommended maximum

Should have several rest days and shouldn’t consume it all in 3 continuous days.

Question 7

why does drinking on an empty stomach get you drunk quicker

Answer 7

the longer the alcohol is in your stomach the slower you get drunk as the more it is metabolised before entering the small bowel, gastric emptying is also slower on a full stomach

Question 8

what increases gastric emptying and absorption

Answer 8

antihistamines and metaclopramides - drunk quicker

Question 9

are aerated drinks absorbed faster or slower

Answer 9

faster

Question 10

why are spirits absorbed slower

Answer 10

irritate gastric mucosa and delay emptying

Question 11

why do women get drunk quicker

Answer 11

have a lower level of alcohol dehydrogenase - don’t eliminate the alcohol. men also have more lean mass fat and higher blood volume so have a bigger pool for dilution

Question 12

quickest absorption of alcohol

Answer 12

•Quickest absorption is at concentrations of 20-30% (not too high) on an empty stomach.

Question 13

where does 90% of alcohol metabolism occur

Answer 13

liver

Question 14

how much alcohol is excreted via the breath

Answer 14

5%

Question 15

when does alcohol concentration peak after consumption

Answer 15

60 min

Question 16

at what rate is alcohol removed from blood

Answer 16

one unit per hour

Question 17

do some ethnic groups have less alcohol dehydrogenase

Answer 17

yes, half japanese people lack it altogether

Question 18

what enzyme converts ethanol to acetaldehyde

Answer 18

alcohol dehydrogenase

Question 19

what converts acetaldehyde to acetate

Answer 19

aldehyde dehydrogenase

Question 20

what does alcohol dehydrogenase convert ethanol to

Answer 20

acetaldehyde

Question 21

what does aldehyde dehydrogenase convert acetaldehyde to

Answer 21

acetate

Question 22

what causes the feeling of flushing or sick

Answer 22

defective or inefficient levels of aldehyde dehydrogenase , acetaldehyde is toxic and causes sweating flushing etc

Question 23

what can regular drinking do to levels of alcohol dehydrogenase

Answer 23

upregulate them - inc tolerance

Question 24

what pathways are switched on for metabolising alcohol in heavy drinking

Answer 24

MEOS, catalase and CP450

• MEOS uses CO450 enzymes and produces ROS

Question 25

name 3 negative consequences of the use of the MEOS pathway

Answer 25

citric acid cycle inhibition, inhibition of hepatic gluconeogenesis and impairment of fatty acid oxidation

Question 26

what does citric acid cycle inhibition lead to

Answer 26

switch to anaerobic metabolism - more lactic acid produced and sore muscles

Question 27

what does hepatic gluconeogenesis inhibition lead to

Answer 27

munchies, type I diabetics have to watch they dont go into hypoglycaemia

Question 28

what does fatty acid oxidation impairement lead to

Answer 28

• increased Acetyl Co A
• increasd fatty acid synthesis and dec fatty acid catabolism
• triglyceride acumulation in liver
• fat!

Question 29

what induces alcoholic Ketoacidosis

Answer 29

starvation and excess alcohol

Question 30

alcoholic ketoacidosis

Answer 30

• Alcohol diminishes hepatic gluconeogenesis and leads to decreased insulin secretion, increased lipolysis, impaired fatty acid oxidation, and subsequent ketogenesis, causing an elevated anion gap metabolic acidosis.
• ketoacidosis without significant hyperglycaemia
• presents with nausea, vomiting and abdominal pain

Question 31

what are the physical symptoms of alcoholic ketoacidosis

Answer 31

nausea, vomiting, abdominal pain and death

Question 32

mangement of alcoholic ketoacidosis

Answer 32

• Pabrinex: high dose vitamins
• IV fluids (dextrose)
• On occasion insulin is required
• Address alcohol dependency

Question 33

what effect does alcohol have on the CNS

Answer 33

depression - increases levels of GABA whichb inhibits neurotransmission

Question 34

what effects does alcohol have on the lower brain stem

Answer 34

control of breathing and blood pressure

Question 35

why does alcohol make you pee more

Answer 35

sheer volume of consumption and inhibits ADH which reduces water reabsorption and gives more diluted urine

Question 36

what is the effect of ADH

Answer 36

promotes water reabsorption in the distal tubule and therefore concentrates urine

Question 37

why do you sometimes get a heavy fast heart beat the morning after

Answer 37

alcohol is a negative inotrope - heart beats faster to maintain CO

Question 38

how does holiday heart syndrome usually present

Answer 38

supraventricular tachycardia

Question 39

what is the clinical name for a hangover

Answer 39

veisalgia cephalalgia

Question 40

drinks with high levels of what can cause worse headaches

Answer 40

serotonin and conegeners

Question 41

antabuse action

Answer 41

inhibits aldehyde dehydrogenase - unpleasant reaction to alcohol

Question 42

effects of alcohol by concentration

Answer 42

• <100 – excitement, fun, disinhibited, still in some control
• 100-200 – slurring of speech, blurred vision, falls, wide emotions
• >200 – stupor. Difficult to rouse, loud snoring
• Dangerous if brain stem is inhibited – decreased consciousness and breathing

Question 43

how to calculate alcohol units

Answer 43

1 unit = 10ml 100% alcohol

eg 70cl 40% = 28 units

Question 44

how does alcohol cause DKA in T1DM

Answer 44

causes decreased insulin secretion etc