Alcohol Flashcards
Prevalence of Alcoholism
> 90% of pop drink, 81% of 16yos drink and 30% use drugs
50% cheaper than in 1978 –> responsible for 20-40% of RTAs,
Involved in–> 50% of fire deaths, 33% of domestic violence, 40% of suicides
Alcohol in AnE
1/3 of all attendances are due to alcohol
13,000 club/pub fights every week, 350 sexual assaults and 23,000 violent incidences every week
Costs the NHS £1.7billion/yr
Acute alcohol poisoning
Fatal dose is 300-500mls of pure ethanol
Cause of death is respiratory failure, aspiration or lactic/keto- acidosis
Must exclude all other possible causes - cosider traumatic or related injuries
Chronic alcoholism
Problems with tolerance and dependance
Also liver failure and sequeale (esophageal varices) etc
Symptoms of alcohol withdrawal (8)
Tremor, sweating, tachycardia, hypertension, ataxia, pyrexia and seizures
If severe delirium tremens
Delirium Tremens
Severe alcohol withdrawal with autonomic hyperactivity, disorientation and paranoia –> will often get visual and tactile hallucinations
15-25% mortality due to arrhythmias, infection and CV collapse
Wernicke’s encepthalopathy
Acute thiamine deficiency in chronic alcoholism –> acute confusional state, nystamgus, ophthalmoplegia, ataxia, polyneuropathy
Give IV thiamine + multivitamins- recover over 1-4wks
Give magnesium sulphate to protect from seizures
Alcoholic Ketoacidosis
Occurs when there is excessive alcohol, relative starvation and volume depletion - NAD depleted so aerobic respiration inhibited leading to lipolysis and ketone production –> presents with N&V, diffuse abdo pain, SOB and metabolic acidosis
Treat with dextrose and saline
Ethylene glycol poisoning
Colourless and odourless liquid which is metabolised in the liver and kidneys into formalderhyde with a letal dose of 2mls/kg – presents with acute intoxications, metabolic acidosis with wide anion-gap. Cardiopulmonary phase and nephrotoxic phase
Management of Ethylene glycol poisoning
Supportive care with correction of acidosis –> treat with Fomepizole (inhibits alcohol dehydrogenase) +- Ca gluconate and haemodialysis –> often require ITU
Complications of alcohol misuse
Domestic violence and trauma (including falls)
STIs, alcoholic liver disease, GI haemorrhage,
Korsakoff’s psychosis
Interactions with medications
Worsens paracetamol OD
Worsens Methanol and ethylene glycol OD
Deranges INR in warfarin therapy
Complicates sedation and analgesia
Identification of alcohol problems in AnE
Paddington alcohol test - >8units/6units in 1 session/week (M/F) or an AnE attendance related to alcohol
Brief interventions and referral from AnE reduce alcohol consumption in next 6months and reduces AnE re-attendance
Use FRAMES system
Effects of Alcohol on the GIT
Oesophagitis, mallory weiss and barretts oesophagus
Acute erosive gastritis and chronic gastritis
Fatty liver/ hepatitis/cirrhosis
Cancer of everything
Malnutrition and poor dietary intake
Effects of Alcohol on the CNS
Acute intoxication/confusion
Withdrawal - hallucinations and seizures
Wernicke’s encephalopathy and Korsakoff’s psychosis
Dementia and cerebellar degeneration and peripheral neuropathy
Effects of Alcohol on the CVS
Hypertension
Cardiomyopathies (dilative)
Strokes
Arrhythmias both from intoxication and withdrawal
Effects of Alcohol on the musculoskeletal system
Fractures due to trauma and worsened by malnutrition
Myopathy due to vitamin deficiency
Effects of Alcohol on the endocrine system
Alcoholic ketoacidosis
Folic acid and thiamine deficiencies
Testicular atrophy
Effects of Alcohol on the haematological system
Thrombocytopenia due to Marrow suppression, folate deficiency and splenic sequestration
Anaemia from GI tract
Leukopenia (and monocyte suppression)
Types of Drinker
Social - low risk Over recommended - Hazardous
Problem drinker - problems but no dependance/withdrawal
Dependent drinker
Alcohol dose effects (by units)
2 - increased accident risk 5 - increased risk taking
10 - Loss of self control 25 - coma
30 - Death possible 38 - death is inevitable
Other Effects of alcohol in women
Fetal alcohol syndrome (mainly in first trimester)
Infertility
Breast cancer
Management of alcohol intoxication
Maintain and protect airway
Ensure cardiovasular stability and rehydrate if necessary
Maintain blood sugar and protect from harm
Monitor for convulsions, hypoglycaemia and aspiration
Management of alcohol withdrawal
Admit, give IV fluids, thiamine and dextrose. Give benzodiazepines to prevent seizures.
Consider phenobarbitone
Mechanism of alcohol withdrawal
Induced enzyme effects
Depressed autonomic reactions rebound
Psychological dependence
FRAMES system
Feedback Responsibility Advice Menu of alternative strategies Empathy Self efficacy
