Alcohol Flashcards
Which specific alcohol is found in drinks
Ethanol
What makes an alcohol
The OH group in the compound
Different number of carbons make different alcohols - methanol, ethanol, propanol etc.
What percentage of the population are teetotal
Around 10%
They don’t drink at all
What classes someone as a sensible/social drinker
For men and women it’s 14 units per week
This equates to 2-3 units per day
Within the guidliens
What classes someone as a heavy drinker
For men it is consuming more than 7 units per day
For women its more than 5 units per day
More than 14 units
What classes someone as a problem drinker
Heavy drinkers (M>7, F>5) but it is starting to affect their day to day life
What classes someone as a dependent drinker
Someone who consumes more than 8-10 units per day
What is considered hazardous drinking
Consuming more than 14 units of alcohol per week
What is considered dangerous drinking
Consuming more than 35 units per week
What is considered safe drinking
Less than 14 units per week
Around 2-3 units per day
How does the alcoholism cost the UK economy
Absenteism Unemployment Offences RTAs Health - increased healthcare needs Premature death
Costs around 2 billion
How does the alcohol industry and drinking benefit the UK economy
Excise duty
Exports
Jobs
Brings in about £7 billion - which is most than the estimated cost of alcoholism
Which areas of life/society can be affected by alcohol
Minds Bodies Families Communities Societies Economies - both a benefit and a harm
Pretty much everything
Cultural difference are thought to impact drinking behaviour - true or false
True
Thought to be due to cultural beliefs, social norms and expectations more than chemical actions of alcohol
In the UK, US, Aus it is associated with violent and antisocial behaviour whilst in the Mediterranean it has a more peaceful/harmonious rep
In which countries is alcohol associated with violent and antisocial behaviour
UK
US
Australia
Scandinavia
Which countries have a positive cultural view alcohol
Mediterranean and southern Europe - Italy, Spain, France, Greece
South America
They all associated with peaceful, harmonious drinking behaviour
List features of societies that have a positive view of alcohol
Society embraces sensible drinking
Drinking integrated into society & culture
Normal activity, to liven up
Drinking often part of working day
Open, uninhibited, outdoor drinking places
Positive beliefs & expectations
List features of societies that have a negative view of alcohol
Society has ambiguous, ambivalent & uneasy relationship with alcohol Drinking marks end of working day Drinking behaviour is antithesis of work Closed, secluded, insular indoor places Negative beliefs & expectations
Describe a social drinker
Drinks occasionally or regularly (in moderation)
Drink at safe levels 2-3 u/d
Benefits outweigh risks (probably)
How does risk of morbidity and mortality change as alcohol consumption does
As alcohol consumption rises so does the risk
Small reduction in risk for social drinkers but trend consistent above this
Describe a heavy drinker
Most drink heavily & regularly
Some drink heavily & irregularly (binge)
Exceed sensible limits (typically >8 u/d)
Will cause problems if maintained
Describe a problem drinker
Drinking causes problems in personal or social adjustment
Continues to drink heavily despite these problems
Problems can be overcome by stopping
Starting to become addicted
Describe alcohol dependence
Aware of compulsion to drink
Prominent drink seeking behaviour
Tolerance to its effects - drinking a lot but effect is the same
Withdrawal syndromes on stopping
Avoidance of withdrawal - reinforces drink seeking behaviour
Social, psychological & physical problems
In which type of drinking behaviour would you see withdrawal
Alcohol dependence
Occurs on stopping so they avoid doing so
What are the criteria for alcohol dependence
Heavy drinking (typically >10 u/d) Tolerance Withdrawal syndromes (addiction) Inability to stop drinking Abnormal blood tests - GGT, CDT, MCV
Which blood tests can indicate alcohol dependence
GGT
CDT
MCV
What is the definition of alcohol dependence
Persistent drinking which interferes with person’s health, legal position, personal relationships, or means of livelihood
How is alcohol content usually expressed
% alcohol by volume (% ABV)
ml of alcohol/100ml
How do you calculate the amount of alcohol consumed in ml
Volume Consumed (ml) x % ABV
How do you calculate the amount of alcohol consumed in g
Volume Consumed (ml) x % ABV x 0.79 (g/ml)
How much does 1ml of pure alcohol weigh
0.79g
What is a UK alcohol unit
10 ml or 8 g pure alcohol
Give examples of single unit drinks
Half pint of weak beer (3.5%)
Small (<100 ml) glass of wine (12%)
Small (28 ml) measure of spirits (40%)
What is the typical %ABV for beer
Beer contains 3–8% alcohol v/v (average = 4.5%)
Pint is usually around 2 units - depends on strength
What is the typical %ABV for wine
Wine contains 10-13% alcohol v/v (average 12%)
Size of glass and strength vary
What is the typical %ABV for spirits
Most spirits contain 40% alcohol v/v
Singe unit measure is 25ml
Scottish whiskey measure is 35ml - 1.4 units
Which factors can accelerate gastric emptying
Tolerance
Gastrectomy
Which factors can slow gastric emptying
Food in the stomach - main contributor
Certain drugs
Where is alcohol absorbed in the body
20% from stomach
80% from small intestine
What determines the rate of alcohol absorption
The rate of gastric emptying
Higher rate = greater absorption (more is absorbed in intestine)
The type of drink - strength, effect of congeners
What effect does food have on alcohol absorption
It reduces the rate and extent of absorption to around 2/3 of the fasting value
Some alcohol is oxidized by the food reducing extent of absorption
Don’t get as drunk, as fast - alcohol conc will be lower
How long does alcohol absorption to be completed
Complete within 1-3h
Usually peaks after 1 hour
Based on 1 unit
Which alcohols are absorbed quickly
Champagne - due to bubbles and high conc
Bubbles stimulate blood flow and intestinal linings = faster absorption
Which alcohols are absorbed s lowly
Beer - low conc and effect of congeners
Neat spirits - they irritate the stomach
What are congeners
They are other alcohols, carbs, yeast products found in alcohol
Slow down absorption
The Co equation assumes what
100% absorption and instant distribution
This does not happen in life so is a theoretical level
How is BAC reported
As mg of alcohol /100ml of blood
How do you work out the Co
Weight alcohol consumed (g) x 100
All divided by Body Wt (kg) x W.F.
Widmark equation
What are the 3 phases of alcohol kinetics
Absorption phase - rising phase
Distribution phase - peak of the curve
Elimination phase - drops again
What is the typical rate of alcohol elimination
10–20 mg alcohol /100 ml blood / h
Therefore average is 15 (roughly a unit per hour)
Can be up to 40 in alcoholics
Alcohol levels in arterial blood rise and fall faster & sooner
than in venous blood - true or false
TRUE
Are alcohol levels in breath closer to arterial BAC or venous BAC
Arterial
What is the normal ratio of BAC:BrAC
2300 : 1
Much higher in blood than in breath
When does alcohol become present in the breath
1-2 hours after drinking
Some is transferred from blood to alveoli
How can VHAC be used
It can be used to corroborates PM BAC
Not done in life as obviously cannot take sample from a living person
Can VHAC be used to estimate BAC
No
Cannot reliably predict BAC from VHAC
However, can be used for corroboration
Describe the relationship between VHAC and BAC in different phases
During absorption BAC > VHAC
At equilibrium BAC < VHAC (ratio 0.8)
What does the urinary alcohol concentration represent
The average of several hours excretion
This is because the urine pools in the bladder and collects
Describe the relationship between UAC and BAC in different phases
UAC < BAC during absorption phase - start of drinking
UAC > BAC during elimination phase -
Which ratios are used to compare UAC and BAC
BAC : UAC = 0.75 : 1
UAC : BAC = 1.3 : 1
Describe the blood supply and drainage of the kidneys
Renal Artery supplies blood to kidney
Blood filtered by kidney tubules - toxins filtered out into urine
Renal Vein drains blood from kidney
How is alcohol distributed around the body
It dissolves in water and is distributed via the bloodstream
Taken up from blood by the tissues in proportion to their water content
Which tissues take up the most alcohol during distribution
More alcohol removed from blood into water rich bone & muscle
This is why leaner people have a greater volume of distribution = muscle is water rich
Which tissues take up the least alcohol during distribution
Less alcohol removed from blood by fatty tissue
More remains in bloodstream
This is why obese individuals have greater alcohol concentration as not as big a volume of distribution
What determines the blood alcohol concentration
How much alcohol is consumed (mass, g)
The volume of distribution - increases with body size and if lean
The greater these 2 factors the lower the alcohol conc.
How does body composition affect water content
A larger body weight will have higher water content
A lean person with more muscle will have a high water content than an obese person (high fat)
Really depends on the build as well
More water = greater volume of distribution
How do you calculate lean body mass
Weight x the Widmark factor
What determines the volume of distribution
Lean body mass
Have a higher body water content
What does the Widmark Factor represent
It is a proportion of body water
More you have (e.g. lean person) = greater the factor
What is the Widmark Equation used for
It gives rough estimate of BAC after alcohol consumption
assuming instantaneous 100% absorption
What is the Widmark Equation
C0 = Wt alcohol consumed (g) x 100 / Body Wt (kg) x W.F.
What are the mean experiment Widmark Factors
- 68 for men (e.g. 68% of body is water)
0. 55 for women
How is Widmark Factor calculated
Calculate for an individual from sex, height, weight via an online chart
How is BAC at a specific time calculated
C at T hours = Co – (β x T)
β is the elimination rate
T is time in hours
This takes into account the alcohol that has been eliminated
How do you convert BAC to BrAC
BAC divided by 2.3 = BrAC
How do you convert BrAC to BAC
BrAC x 2.3 = BAC
How do you convert BAC to UAC
BAC / 0.75 = UAC
How do you convert UAC to BAC
UAC x 0.75 = BAC
How do you convert BAC to VHAC
BAC/ 0.8
How do you convert VHAC to BAC
VHAC x 0.8
What is the legal alcohol limit for driving in England
35 micrograms alcohol/100ml of breath
80mg/100ml blood
107mg/100ml urine
What is the legal alcohol limit for driving in Scotland
22 micrograms alcohol/100ml of breath
50mg/100ml blood
67mg/100ml urine
Does BrAC correlate more with arterial BAC or venous BAC
Arterial - it rises and falls earlier
Venous lags behind
Describe the relationship between venous BAC and BrAC + arterial BAC
It depends on the time since drinking began
Venous BAC lags behind
If less than 60 mins BrAC and ABAC > VBAC (absorption phase)
60-120mins BrAC and ABAC = VBAC (equilibrium phase)
Post absorption (elimination) BrAC and ABAC < VBAC
Where is most alcohol broken down
90% is broken down in liver
Small amounts lost in breath, sweat and urine
What is the rate of elimination of alcohol
10-20 mg alcohol per 100ml of blood per hour
Average is 15
Can be increased by tolerance - 40mg/100ml/h in alcoholics
(liver is better at processing alcohol as it’s used to it)
How do you calculate the amount of alcohol eliminated in T hours
rate of elimination x T
T = time in hours
B= rate of elim
Describe how alcohol is metabolised in the liver
Ethanol is broken down to acetaldehyde by alcohol DH (also catalase and MEOS)
This is broken down again by DH to acetate
Acetate is converted into uric acid, ketones, triglycerides (can be measured in blood) and CO2+H20
How does exercise affect alcohol metabolism
Increases it so BAC drops faster
However, it is not a significant effect
What are the 3 main stages of intoxication
Excitement (BAC <100 mg%)
Confusion (BAC 100-200 mg%)
Stupor (BAC >200 mg%)
What causes the excitement phase of intoxication (BAC <100mg%)
Depression of higher inhibitory cortical function
What causes the confusion phase of intoxication (BAC 100-200 mg%)
Depression of limbic system (memory, orientation)
Depression of cerebellum (coordination, speech)
What causes the stupor phase of intoxication (BAC >200mg%)
Depression of upper brainstem (RAS - conscious level)
Depression of lower brainstem (breathing & vasomotor centers)
Alcohol affecting the cerebral cortex has what effect
Excitement and disinhibition
Alcohol affecting the limbic system has what effect
Memory
Confusion
Disorientation
Alcohol affecting the cerebellum has what effect
Incoordination
Slurring
Alcohol affecting the hypothalamus and pituitary has what effect
Hypothermia
Alcohol affecting the upper brain stem has what effect
Coma
Alcohol affecting the medulla has what effect
Respiratory and vasomotor depression
Death
List the features of the excitement phase of intoxication (BAC <100mg%)
Loquacious, vivacious, sense of well being
Loss of emotional restraint
Forget animosities, converse with abandon (friendly)
Less critical, loss of moral integrity
Feeble jokes
Easy affection
Able to pull yourself together if need be - override with conscious thought
List the features of the confusion phase of intoxication (BAC 100-200 mg%)
Come to grief over long words, slight slurring
Loss of fine motor control, blurred vision
Poor performance of coordinated motor acts (eg driving and writing)
Confused by tasks requiring thought & concentration
Emotional upsets, boasting, loud, coarse
Anger & violence may appear - may be dependent on company
Emotions stirred by company
List the features of the stupor phase of intoxication (BAC >300mg%)
Dead drunk Aroused only by strong stimuli Anaesthetic & unfeeling Flushed, drooling, snoring Simulates head injury (may coexist)
Can lead to coma and death
List potential dangers of severe intoxication
Hypotension (low BP) Hypothermia Inhalation of vomit (loss of gag reflex) Haematemesis (vomiting blood) Trauma Death
Acute intoxication can mimic which other disease processes
Head injury Neurological disease Diabetic hypoglycaemia Epilepsy & related states Drug intoxication (often coexist)
List symptoms of a hangover
Headache, malaise, nausea, tremor
What causes a hangover
Toxic effects of alcohol metabolites & congeners on brain & GI tract
Hypoglycaemia plays a big part - particularly early on
Dehydration
Hangover’s are self-limiting - true or false
True
Temporary
How does drunk driving contribute to RTAs
D&D involved in 10% of all RTAs and 20% of fatal RTAs
Injures around 30,000 per year
Increased incidence on Friday and Saturday nights
How does alcohol impact driving performance
Decreased muscular control & coordination
Increased reaction times
Impaired peripheral vision
Inability to judge speed & distance - crucial to driving
Inability to deal with unexpected events
Falsely increased confidence - think they’re okay to drive/ are driving well
How does alcohol impact relative accident risk
It increases it
More pronounced in young, inexperienced drivers
List the legal limits for driving in different countries
80 mg% in England & Wales, Ireland, Malta, Lux
50 mg% in Scotland, most Europe, USA
20mg% in Sweden, Estonia & Poland
0 in Czech, Slovakia & Hungary
Is it an offence to drink drive
YES
Driving quality is irrelevant - all to do with BAC
Stated in the Road Traffic Act section 4 and 5
In which situations can a police officer take a roadside screening breath test
If they suspect the driver has:
Been drinking
Committed a moving traffic offence
Been intoxicated at the time of an accident
Describe the RTA arrest procedure for a drunk driver
A person will be arrested & taken to police station if they: Are unfit through drink or drugs Have provided a positive roadside test or have refused to take a roadside test
Will then have to provide more samples
If a person is arrested for suspected drink driving what samples must they provide at the police station
2 evidential breath samples on CAMIC (can be done by police)
OR
A specimen of blood for analysis (must be done by doctor - might be a delay)
Which devices are approved for taking evidential breath samples
CAMIC or Lion devices approved
Which of the 2 breath samples is used by the police as the true level
The lower of the 2
What happens if someone in England or Wales has a BrAC of 35-50 (just over limit)
The driver can replace the sample with either blood or urine to be more accurate (police decide which)
Not an option in Scotland
How is an evidential blood sample taken in drink driving case
Taken by Forensic Physician, with driver’s consent
Part of sample is offered to driver - can get it analysed privately for defence
Lab analysis by Gas Chromatography
6mg% (or 6% if > 100mg%) deducted to allow for lab error
Who takes the evidential blood sample taken in drink driving case
Forensic physician
How soon after an incident must a urine sample be taken
Must be taken within an hour
How is an evidential urine
sample taken in drink driving case
Taken within an hour of incident Must first empty the bladder Then collect next smallest volume of urine which can be naturally voided Part of sample is offered to driver Lab analysis by GC
What happens if an suspected drunk driver fails to provide a sample
Constitutes an offence similar to drinking and driving
List the potential defence for being over the limit whilst driving
Post accident drink Drinks laced Inhalation of alcohol vapour - rare Disease slowing elimination Medication Skin contamination (wipes at sample site etc.) Specimen mix up In vitro artefact Alcohol on medicines IV in hospital
Describe the defence of post-accident drinking (hip flask defence)
If person can prove that he/she consumed alcohol after he had ceased to drive and that if he had not done so he would not have exceeded the limit then they may be found innocent
Burden of proof is on the defence - hard to prove
Which drugs can affect driving
Illegals - Opiates, cannabis, diazepam, stimulants
Prescription drugs
Over the counter drugs
How does the court decide if a person was unfit to drive
Witness observations of driving manner
Medical assessment
Toxicological analysis
Is consent required to take a blood/urine sample from a suspected drunk driver
YES
What aspects of medical history important in drink driving cases
Diabetes, asthma, epilepsy, stroke, head injury
Psychiatric conditions
Alcohol, drugs & medication history
What aspects of physical examination important in drink driving cases
Demeanour, breath, pupils, coordination, etc
If a person does not consent to a alcohol sample, what else can be noted
Simple observations about their condition
If a person is arrested for drug driving what is included in the medical assessment
Fitness for detention Medical condition mimicking intoxication Impairment of ability to drive Likelihood of drug intoxication Dr may advise blood/urine sample if exam suggests drug impairment
Can the police demand a sample for drugs in driving case
No
Dr can advise it though if exam suggests it
List features of alcohol dependence
Aware of compulsion to drink Prominent drink seeking behaviour Tolerance to its effects Withdrawal syndromes on stopping Avoidance of withdrawal Social, psychological & physical problems
What environmental factors can lead to alcoholism
Availability Peer pressure Occupation Stress Competitive lifestyle Unemployment
What personal/constitutional factors can lead to alcoholism
Low self esteem Habit Boredom Loneliness Anxiety & depression Ethnicity
How long does alcohol withdrawal take to set in/pass
Onset 6-12 h
Peak 48 h
Lasts few days
List features of alcohol withdrawal
Tremor Nausea & vomiting Malaise Headache Insomnia Weakness Sweating Tachycardia Hypertension Anxiety, depression and irritability Withdrawal fits Transient hallucinations - DT
Will feel awful
How do you manage alcohol withdrawal
There is a chart that scores the severity - higher score is more severe
Chlordiazepoxide - dose dependent on score
(keeps them comfy)
Require monitoring
Which body systems are affected by alcohol
Gastrointesitnal tract Liver Cardiovascular system Central & peripheral nervous system Endocrine Many others (except fat!)
Which GI conditions can alcoholism cause
Oesophagitis, Mallory-Weiss tears Gastritis, duodenitis, peptic ulcer Malabsorption Diarrhoea Pancreatitis
How can alcohol affect the liver
Fatty change - early and reversible Alcoholic hepatitis Cirrhosis Liver failure - jaundice & clotting failure (progresses through these stages)
Portal hypertension & oesophageal varices (can be fatal)
Liver cancer - quite rare
How can alcohol affect the cardiovascular system
Arrhythmias (& sudden death)
Alcoholic cardiomyopathy - enlarged, globular heart, rare
Wet Beri-Beri - vit B deficiency
Hypertension
Which CNS symptoms can be caused by alcohol
Acute intoxication Blackout Withdrawal syndromes Wernicke’s encephalopathy Korsakoff’s syndrome Cerebellar degeneration Cerebral atrophy (alcoholic dementia) Alcoholic hallucinosis Peripheral neuropathy
How does Wernicke’s encephalopathy present
Disorientation & eye problems
How does Korsakoff’s syndrome present
short term memory loss & confabulation
How can alcohol use affect nutrition
Early obesity (additional calories) Later malnutrition - alcohol is their major intake Vitamin deficiencies Vitamin B group, e.g. Thiamine, folate
How can alcohol use affect reproduction
Male impotence
Female menstrual & fertility problems
Miscarriage & foetal alcohol syndrome
Baby can be born with alcohol dependence
Which metabolic disturbances can be caused by alcohol
Hypoglycaemia Hyperlipidaemia Hyperuricaemia Potassium, Magnesium, Phosphate Lactic acidosis Alcoholic ketoacidosis
List some of the psychological complications of alcohol use
Anxiety & depression Suicide risk Alcoholic dementia Alcoholic hallucinosis Pathological jealousy Sexual dysfunction
List some of the social complications of alcohol use
Marital & family problems Domestic violence Work problems Unemployment Road traffic accidents Crime
What kills alcoholics
Acute alcohol intoxication
Trauma - prone to it, RTA, accidents etc.
Alcohol related disease
Incidental natural disease
Some obscure mechanisms - lack of signs (e.g. arrhythmias)
Describe the mechanism behind death from alcohol intoxication
Brain stem depression
Positional asphyxia
Inhalation of vomit
What is considered fatal alcohol intoxication
Fatal level very variable
>250 mg% in non tolerant person
Alcoholics are tolerant to high levels (average fatal level is 450 mg%)
How can UAC exceed BAC in someone who dies from alcohol intoxication
Urinary alcohol conc (UAC) > BAC if death follows prolonged coma
How are PM alcohol levels measured
Blood
Urine
Vitreous
Compared for corroboration and confidence
What can cause artefactual alcohol levels PM
PM alcohol redistribution - unabsorbed from stomach can redistribute
PM microbial alcohol production
How can alcohol redistribute after death
Passive diffusion of unabsorbed alcohol from
stomach or aspirated vomitus in airways
Redistributes to the central vessels
Which vessels does alcohol redistribute to PM
Central vessels
Heart, IVC, pulmonary artery and aorta (closer to stomach so can be affected by redistribution PM)
Describe the difference between PM alcohol concentration in the central and peripheral vessels
<400% difference between central vessels & peripheral (femoral) vein
Describe PM microbial alcohol production
Bacteria & yeasts present in blood convert glucose & lactate into alcohol
Longer they’ve been dead the more is produced
List factors that favor PM microbial alcohol production
warmth, Hyperglycaemia, septicaemia, abdominal trauma
Does PM microbial alcohol production occur in the sample tubes too
Yes it can occur invitro
However, further in vitro elevation prevented by tube preservative & refrigeration of sample
How long does it take for PM microbial alcohol production to occur
Levels <70 mg/100 ml can occur within few days (<150 in some cases)
What types of trauma are more likely under the influence of alcohol
RTA Falls Hypothermia Fire Drowning Abuse Suicide Homicide Accidental death
List signs of hypothermia
Pink discolouration of knees, hips & elbows (writhing and crawling on ground)
Abrasions from crawling
Stomach (Wischnewski) ulcers - arranged in lines where the folds were
Urinary catecholamines (Adrenaline, NA)
Why might a crime scene look suspicious in cases of hypothermia
Outdoors – disturbed scene (due to scrabbling around which is common)
Paradoxical undressing - can look like sexual assault
Indoors – “Hide & Die” Syndrome
Victim will pull furniture, bedding on top of themselves
List some alcohol related disease
Cardiomyopathy Arrhythmia Cirrhosis Liver failure GI haemorrhage Varices Pneumonia
List some obscure causes of alcoholic death
Arrhythmias (prolonged QT on ECG)
Vagal neuropathy
Alcoholic ketoacidosis
Hypoglycaemia
Catecholamine surge due to acute intoxication or withdrawal
Electrolyte disturbances - magnesium deficiency
What terms are now used in the place of alcoholism
Alcohol dependence
Alcohol misuse
What is the chemical formula of ethanol
C2H5OH
Is binge drinking considered hazardous
Yes
It is more harmful than consuming the same amount of alcohol over more days of the week
Describe the trend in numbers of each ‘alcohol consumption level’
Greatest number is social and sensible drinkers
As the drinking becomes heavier the numbers decrease - still a significant group!
Can alcohol have a beneficial effect
Potentially
Some studies have shown small amounts can be beneficial
How does tolerance occur
Seen in alcohol dependence
The cells become so used to the presence of alcohol that they are able to overcome its effects (become tolerant to it)
What causes withdrawal
Sudden cessation causes a rebound effect in the alcohol tolerant nerve cells
They become over-excitable which leads to the withdrawal symptoms
What is GGT
Gamma-glutamyl transferase Liver enzymes
It can indicate liver damage
Raised in alcoholics
What is CDT
Carbohydrate-deficient transferrin
Protein which becomes raised in the blood of alcoholics
Causes a flurry of excitement
How is MCV affected in alcoholism
It is raised in alcoholics
What is a pint in ml
568ml
How quickly are neat spirits absorbed
Slowly
They irritate the stomach lining
This produces more mucus which forms a barrier and slows absorption
How does alcohol circulate through the body
Swallowed into the stomach and then passed to the small intestine - absorption
Bloodstream takes it to the liver - first organ reached so more toxic effect
Then blood moves it to the heart
Can then be distributed to the rest of the body (brain, lungs, kidneys)
Is there a legal driving limit for drugs
Not really
Some drugs are starting to gain levels in legislations
Will instead be prosecuted for impaired driving
Why must the bladder be emptied first before providing an evidential urine sample
the urine collected there will be the average of the past several hours
Could be higher or lower than the current level
Therefore you let the bladder refill so it is more indicative of current state
Which type of pneumonia is common in alcoholics
Lobar
What is paradoxical undressing
When someone is experiencing hypothermia they can begin to feel hot and will undress themselves
