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Year 2 CLASP Alcohol > Acute Alcohol Intoxication > Flashcards

Acute Alcohol Intoxication Flashcards

1
Q

What substance is occasionally present in contaminated home brew?

A

Methanol

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2
Q

What is methanol metabolised into and by what enzyme?

A

Formaldehyde then formic acid.

Alcohol dehydrogenase.

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3
Q

What does the build up of formic acid cause and what are the complications of this?

A

Acidosis

Leads to blindness and/or renal failure.

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4
Q

What is the treatment for methanol poisoning?

A

Ethanol with maybe dialysis.

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5
Q

How does giving ethanol cure methanol poisoning?

A

Both metabolised by alcohol dehydrogenase leading to competitive inhibition so formic acid is not made.

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6
Q

What is a hallucinogenic response to alcohol withdrawal and after what medical procedure does it sometimes happen?

A

People see spiders.

After people come out of surgery.

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7
Q

Where is alcohol absorbed?

A

Small amount in stomach, mainly in small bowel.

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8
Q

Why does drinking on a full stomach make you less drunk?

A

Gastric emptying is slowed so more time for alcohol dehydrogenase in stomach to break down the alcohol before it is absorbed.

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9
Q

What drugs increase gastric emptying and what effect does this have on alcohol absorption?

A

Antihistamines, metoclopramide.

Increases absorption.

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10
Q

Why do spirits decrease gastric emptying?

A

They irritate gastric mucosa.

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11
Q

What types of drinks are absorbed faster?

A

Aerated drinks e.g. champagne.

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12
Q

What should you drink to get maximum alcohol absorption?

A

20-30% alcohol concentration on an empty stomach e.g. sherry.

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13
Q

What are the differences between men and women when it comes to alcohol?

A

Men have higher lean body mass (fluid component) and a higher blood volume with dilutes the water soluble alcohol.
Women have lower levels of alcohol dehydrogenase.

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14
Q

Describe the enzymatic pathway of alcohol metabolism.

A

Alcohol -> (alcohol dehydrogenase) -> acetaldehyde (gives hangover) -> (aldehyde dehyrogenase -> acetate -> CO2 and H2O.
Enzymes are in brackets.

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15
Q

Where does metabolism of alcohol occur in the body?

A

90% in liver.

Small amounts in pancreas and brain.

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16
Q

How is alcohol excreted?

A

All routes (including 5% in breath).

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17
Q

What rate is alcohol removed from the body?

A

15mg/100ml/hour (roughly 1 unit per hour).

18
Q

When does alcohol concentration roughly peak and after does it decrease linearly or parabolicly?

A

60 mins after consumption (wide variation).

Linearly

19
Q

What ethnic groups have constitutionally low levels of alcohol dehydrogenase and what ones have low levels of acetaldehyde dehydrogenase?

A

Alcohol dehydrogenase: aborigines, inuits, eskimos, Japanese people.
Acetaldehyde dehydrogenase: Japanese people, south east Asians,

20
Q

What causes flushing in south east asians and why?

A

Deficient or ineffective variant of acetaldehyde dehydrogenase.
Build up of acetaldehyde is unpleasant and toxic.

21
Q

Why do south east asians have low levels of alcoholism and what drugs mimic this?

A

Acetaldehyde build up is unpleasant, antabuse inhibits aldehyde dehydrogenase.

22
Q

How does drinking tolerance develop?

A

Upregulation of alcohol dehydrogenase activity.
In heavy drinking alternative pathways are activated e.g. MEOS (microsomal enzyme oxidase system) involving catalase and induction of CP450.

23
Q

What are the consequences for MEOS induction pathway?

A

Hydrogen ions are produced which must be disposed of.

24
Q

What are the 3 main metabolic effects of alcohol on the body?

A

Krebs cycle inhibition - switch to anaerobic metabolism leading to lactic acid buildup.
Hepatic gluconeogensis inhibition - hungry and hypoglycaemia esp diabetes.
Impaired fatty acid oxidation - ketogenesis and lipid synthesis (makes you fat).

25
Q

When does alchoholic ketoacidosis only occur?

A

In the malnourished state.

26
Q

What 3 factors cause alcoholic ketoacidosis?

A
  1. Excess NADH.
  2. Impaired fatty acid metabolism (increased substrate available).
  3. Fasting state.
27
Q

What is the difference between alcoholic and diabetic ketoacidosis?

A

Alcoholic has low or normal blood glucose.

28
Q

What is alcohols overall effect on the CNS and what molecule causes this?

A

CNS depression.

Increases levels of GABA (inhibitory neurotransmitter).

29
Q

What effect does alcohol have on the cortex?

A

Disinhibition, talkativness, anxiolytic (reduces anxiety).

30
Q

What effect does alcohol have on the limbic system?

A

Memory loss, confusion, disorientation.

31
Q

What effect does alcohol have on the cerebellum?

A

Loss of muscular coordination and slurred speech.

32
Q

What effect does alcohol have on the reticular formation (upper brain stem)?

A

Loss of consciousness.

33
Q

What effect does alcohol have on the lower brain stem?

A

Control of breathing and blood pressure.

34
Q

Why does alcohol cause us to pee a lot?

A

Drink more of it than other liquids.

Directly inhibits ADH.

35
Q

Why does alcohol cause a tachycardia in the hangover?

A

It is a negative inotrope (decreases strength).

36
Q

What is holiday heart syndrome?

A

Where binge drinking causes an SVT, maybe due to adrenaline or altered magnesium levels.

37
Q

What is the name of the headache caused by alcohol?

A

Veisalgia cephalgia.

38
Q

What causes veisalgia cephalgia?

A

Congeners - other substances in alcohol that contribute to smell.

39
Q

What substance is produced which causes headaches from what congeners?

A

Serotonin

From sulfites, tannins and phenols.

40
Q

What may make a hangover headache worse?

A

Bananas and pineapples, dehydration and acetic acid.

41
Q

What potential mechanisms may a future hangover cure have?

A

Inhibit prostaglandins and increase metabolism.

Year 2 CLASP Alcohol (8 decks)

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