Alcohol

Question 1

Prevalence of Alcoholism

Answer 1

> 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

Question 2

Alcohol in AnE

Answer 2

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

Question 3

Acute alcohol poisoning

Answer 3

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

Question 4

Chronic alcoholism

Answer 4

Problems with tolerance and dependance

Also liver failure and sequeale (esophageal varices) etc

Question 5

Symptoms of alcohol withdrawal (8)

Answer 5

Tremor, sweating, tachycardia, hypertension, ataxia, pyrexia and seizures
If severe delirium tremens

Question 6

Delirium Tremens

Answer 6

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

Question 7

Wernicke’s encepthalopathy

Answer 7

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

Question 8

Alcoholic Ketoacidosis

Answer 8

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

Question 9

Ethylene glycol poisoning

Answer 9

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

Question 10

Management of Ethylene glycol poisoning

Answer 10

Supportive care with correction of acidosis –> treat with Fomepizole (inhibits alcohol dehydrogenase) +- Ca gluconate and haemodialysis –> often require ITU

Question 11

Complications of alcohol misuse

Answer 11

Domestic violence and trauma (including falls)
STIs, alcoholic liver disease, GI haemorrhage,
Korsakoff’s psychosis

Question 12

Interactions with medications

Answer 12

Worsens paracetamol OD
Worsens Methanol and ethylene glycol OD
Deranges INR in warfarin therapy
Complicates sedation and analgesia

Question 13

Identification of alcohol problems in AnE

Answer 13

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

Question 14

Effects of Alcohol on the GIT

Answer 14

Oesophagitis, mallory weiss and barretts oesophagus
Acute erosive gastritis and chronic gastritis
Fatty liver/ hepatitis/cirrhosis
Cancer of everything
Malnutrition and poor dietary intake

Question 15

Effects of Alcohol on the CNS

Answer 15

Acute intoxication/confusion
Withdrawal - hallucinations and seizures
Wernicke’s encephalopathy and Korsakoff’s psychosis
Dementia and cerebellar degeneration and peripheral neuropathy

Question 16

Effects of Alcohol on the CVS

Answer 16

Hypertension
Cardiomyopathies (dilative)
Strokes
Arrhythmias both from intoxication and withdrawal

Question 17

Effects of Alcohol on the musculoskeletal system

Answer 17

Fractures due to trauma and worsened by malnutrition

Myopathy due to vitamin deficiency

Question 18

Effects of Alcohol on the endocrine system

Answer 18

Alcoholic ketoacidosis
Folic acid and thiamine deficiencies
Testicular atrophy

Question 19

Effects of Alcohol on the haematological system

Answer 19

Thrombocytopenia due to Marrow suppression, folate deficiency and splenic sequestration
Anaemia from GI tract
Leukopenia (and monocyte suppression)

Question 20

Types of Drinker

Answer 20

Social - low risk Over recommended - Hazardous
Problem drinker - problems but no dependance/withdrawal
Dependent drinker

Question 21

Alcohol dose effects (by units)

Answer 21

2 - increased accident risk 5 - increased risk taking
10 - Loss of self control 25 - coma
30 - Death possible 38 - death is inevitable

Question 22

Other Effects of alcohol in women

Answer 22

Fetal alcohol syndrome (mainly in first trimester)
Infertility
Breast cancer

Question 23

Management of alcohol intoxication

Answer 23

Maintain and protect airway
Ensure cardiovasular stability and rehydrate if necessary
Maintain blood sugar and protect from harm
Monitor for convulsions, hypoglycaemia and aspiration

Question 24

Management of alcohol withdrawal

Answer 24

Admit, give IV fluids, thiamine and dextrose. Give benzodiazepines to prevent seizures.
Consider phenobarbitone

Question 25

Mechanism of alcohol withdrawal

Answer 25

Induced enzyme effects
Depressed autonomic reactions rebound
Psychological dependence

Question 26

FRAMES system

Answer 26

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