Alcohol Flashcards
What is the recommended weekly intake of alcohol for adults?
14units
What is the difference between an alcoholic and an alcohol abuser?
Dependancy
What are the potential consequences of being drunk?
Trauma (fights, falls) Vomiting Radial nerve palsy Risk taking behaviour Vasodilation Hyperglycaemia
What are the problems associated with vomiting when drunk
Light: Aspiration= pneumonia
Heavy: Airway obstruction and potential death
What are the problems associated with radial nerve palsy when drunk?
E.g fall asleep with your arm in an unusual position (over the back of a chair)
radial nerve can get stuck in the radial groove and compressed.
This can lead to nerve damage.
Sign= drooping wrist
Sometimes permanent, some cases last a couple of weeks.
How does alcohol work on the brain?
GABA agonist
GABA neurones are inhibitory
So alcohol suppresses brain activity- Depressant
How does alcohol withdrawal affect the brain?
1) Ethanol interacts with two major receptors in the central NS essential for normal CNS function (GABA &NMDA).
2) Chronic alcohol use upregulates NMDA receptors and down regulates GABA receptors
3) A decrease in concentration due to cessation results in imbalance between stimulatory & inhibitory systems in the CNS
4) Excessive stimulatory effect leads NS hyperactivity, dysfunction & development of the clinical signs & symptoms- can intensify as withdrawal episodes grow in number known as ‘Kindling’
What are the side effects associated with alcohol withdrawal?
Hallucinations: Persecutory Change in mental staus: Delusions Delirium Tremens: Overactive peripheral NS Tremor Seizures: Unilateral tonic-clonic Cardiac problems (Arrhythmia, tachycardia) Hypertension Vomiting & retching Diarrhoea Loss of appetite Wernickes encephalopathy
What increases the risk of seizures in alcohol withdrawal?
Frequency of detoxing
What are the most common hallucinations in alcohol withdrawal?
Persecutory (spiders/snakes crawling all over them)
What is tremens?
CAN BE LIFE-THREATENING
Overactivity of the PNS
Acute confusional state associated with tremors & autonomic dysfunction
The patient will be very sweaty (possibly sweating up to 10L of fluid a day!) and will shake.
Develops usually 1week post- heavy OH-
Tx: Lorazepam
What is the most common seizure type in alcohol withdrawal?
Unilateral often resulting in Tonic-clonic
What drugs are used to treat alcohol withdrawal?
Nutritional support Chlordiazepoxide: 50-100mg Phenobarbital Benzodiazepines: Diazepam for seizures Lorazepam, Haloperidol for Tremens
Acute: 50-100mg Chlordiazepoxide (Librium)/Diazepam 6hourly for first 3days Oral Thiamine (severe = IM Pabrinex) Folic acid & Vitamin B Magnesium sulphate Severe: Above Dexmedetomidine (sedative) Propofol (Benzo resistant withdrawal) Carbamezapine (seizures) OH- related hep: Corticosteroids Tremens: Phenobarbital Long-term: Disulfiram, Naltrexone
What are the consequences of long-term alcohol abuse?
Liver: NAFLD, Jaundice, Cirrhosis, Abnormal clotting, Alcoholic hepatitis, Reduced albumin production, Varices, Asterixis, Hypoglycaemia
Pancreas: Acute pancreatitis
GI Tract: Varices, Poor dentition, Oesophagitis, Inc risk of ulcers, Gastritis, Diarrhoea, Malnutrition
Heart: Alcohol cardiomyopathy, AF
Nervous System: Korsakoff’s syndrome, Peripheral neuropathy, thiamine deficiency
Endocrine: Diabetes, Problems metabolising oestrogen to testosterone
What are the consequences seen in the blood for long-term alcohol abuse?
Hypertension Inc atherosclerosis Folic acid & VitD deficiency Inc RBC size & MCV Bone marrow damage (reduced platelets)
What is Korsakoff’s Syndrome?
Caused by a lack of thiamine (vitamin B1) in the brain
Antero & retrograde amnesia & confabulation
Often alcoholics present just before their deficiencies are low enough for this syndrome to occur
!!Every alcoholic coming into hospital is put on a thiamine drip within an hour of admission!!
What are the signs of thiamine deficiency?
Broad based gait
Eye movements affected
How is an alcoholic managed?
IV vitamin B12 + thiamine (Pabrinex) Drain ascites Librium 10-50mg/kg every 6hrs for 3days Consider steroids Nutrition Tramadol Laxatives Spironolactone
What is asterixis?
Shaking of the hands caused by encephalopathy secondary to build up of toxic metabolites in the brain which can no longer be metabolised by the liver
How do varices occur?
If the liver is damaged, then intra-hepatic pressure increases causing portal hypertension.
Leads to oesophageal and rectal varices, as the blood tries to find another way to bypass the liver back to the systemic circulation.
Can burst & bleed, and common cause of death.
GI bleeding is a common emergency presentation in patients with alcoholic liver damage.
What is the pathophysiology of alcohol dependence?
Pleasurable & stimulant effects of alcohol are mediated by a dopaminergic pathway projecting from the ventral tegmental area to the nucleus accumbens.
Repeated excessive alcohol ingestion sensitises this pathway & leads to the development of dependence.
What are the long-term effects of alcohol on the brain?
Long-term exposure causes adaptive changes in neurotransmitter systems including down-regulation of inhibitory neuronal gamma-aminobutyric acid receptors, up-regulation of excitatory glutamate receptors & inc central norepinephrine activity
What are the signs of alcohol dependence?
Unable to keep to drinking limit Missing meals Difficulty in avoiding getting drunk Memory lapse/blackout Morning drinking Spending a considerable time drinking Excess sweating at night Ascites & jaundice Broad based gait
What are the social problems related to drinking?
Domestic violence Marital/sexual difficulties Child abuse Financial & employment difficulties Homelessness accidents
What are the different affects of alcohol at different concentrations?
20-99: Euphoria, impaired coordination
100-199: Ataxia, poorjudgement, labile mood
200-299: Marked ataxia, N&V, labile mood, poor judgement, slurred speech
300-399: Stage 1 anaesthesia, memory lapse, labile mood
400+: Resp failure, coma, death
What are the psychological effects of drinking?
Depression Anxiety Memory problems Delirium tremens Attempted suicide Suicide Pathological jealousy
How is alcohol dependence investigated?
2/11 DSM-5 criteria over the same 12 month period
CAGE questionnaire
Alcohol level (blood & breath)
CIWA-Ar >8-10 significant alcohol withdrawal
How is OH- withdrawal investigated?
U&Es
LFTs
Tox-screen: +ve for ethanol
Electrolyte panel: Metabolic acidosis
If Wernicke’s encephalopathy is left untreated what can it become?
Korsakoff’s syndrome
Permenant irreversible brain damage
What are the signs & symptoms of Wernicke’s encephalopathy? How is it treated?
TRIAD: Confusion, ataxia, nystagmus
Parenteral Thiamine (Pabrinex)
Other signs: ophthalmoplegia, memory disturbance, coma, hypothermia, hypotension
