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Forensic Medicine > Alcohol > Flashcards

Alcohol Flashcards

1
Q

Which specific alcohol is found in drinks

A

Ethanol

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2
Q

What makes an alcohol

A

The OH group in the compound

Different number of carbons make different alcohols - methanol, ethanol, propanol etc.

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3
Q

What percentage of the population are teetotal

A

Around 10%

They don’t drink at all

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4
Q

What classes someone as a sensible/social drinker

A

For men and women it’s 14 units per week
This equates to 2-3 units per day
Within the guidliens

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5
Q

What classes someone as a heavy drinker

A

For men it is consuming more than 7 units per day
For women its more than 5 units per day
More than 14 units

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6
Q

What classes someone as a problem drinker

A

Heavy drinkers (M>7, F>5) but it is starting to affect their day to day life

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7
Q

What classes someone as a dependent drinker

A

Someone who consumes more than 8-10 units per day

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8
Q

What is considered hazardous drinking

A

Consuming more than 14 units of alcohol per week

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9
Q

What is considered dangerous drinking

A

Consuming more than 35 units per week

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10
Q

What is considered safe drinking

A

Less than 14 units per week

Around 2-3 units per day

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11
Q

How does the alcoholism cost the UK economy

A 
Absenteism
Unemployment 
Offences
RTAs
Health - increased healthcare needs
Premature death

Costs around 2 billion

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12
Q

How does the alcohol industry and drinking benefit the UK economy

A

Excise duty
Exports
Jobs

Brings in about £7 billion - which is most than the estimated cost of alcoholism

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13
Q

Which areas of life/society can be affected by alcohol

A 
Minds
Bodies
Families
Communities
Societies
Economies - both a benefit and a harm

Pretty much everything

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14
Q

Cultural difference are thought to impact drinking behaviour - true or false

A

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

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15
Q

In which countries is alcohol associated with violent and antisocial behaviour

A

UK
US
Australia
Scandinavia

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16
Q

Which countries have a positive cultural view alcohol

A

Mediterranean and southern Europe - Italy, Spain, France, Greece
South America

They all associated with peaceful, harmonious drinking behaviour

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17
Q

List features of societies that have a positive view of alcohol

A

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

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18
Q

List features of societies that have a negative view of alcohol

A 
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
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19
Q

Describe a social drinker

A

Drinks occasionally or regularly (in moderation)
Drink at safe levels 2-3 u/d
Benefits outweigh risks (probably)

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20
Q

How does risk of morbidity and mortality change as alcohol consumption does

A

As alcohol consumption rises so does the risk

Small reduction in risk for social drinkers but trend consistent above this

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21
Q

Describe a heavy drinker

A

Most drink heavily & regularly
Some drink heavily & irregularly (binge)
Exceed sensible limits (typically >8 u/d)
Will cause problems if maintained

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22
Q

Describe a problem drinker

A

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

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23
Q

Describe alcohol dependence

A

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

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24
Q

In which type of drinking behaviour would you see withdrawal

A

Alcohol dependence

Occurs on stopping so they avoid doing so

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25
Q

What are the criteria for alcohol dependence

A 
Heavy drinking (typically >10 u/d)
Tolerance
Withdrawal syndromes (addiction)
Inability to stop drinking 
Abnormal blood tests - GGT, CDT, MCV
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26
Q

Which blood tests can indicate alcohol dependence

A

GGT
CDT
MCV

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27
Q

What is the definition of alcohol dependence

A

Persistent drinking which interferes with person’s health, legal position, personal relationships, or means of livelihood

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28
Q

How is alcohol content usually expressed

A

% alcohol by volume (% ABV)

ml of alcohol/100ml

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29
Q

How do you calculate the amount of alcohol consumed in ml

A

Volume Consumed (ml) x % ABV

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30
Q

How do you calculate the amount of alcohol consumed in g

A

Volume Consumed (ml) x % ABV x 0.79 (g/ml)

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31
Q

How much does 1ml of pure alcohol weigh

A

0.79g

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32
Q

What is a UK alcohol unit

A

10 ml or 8 g pure alcohol

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33
Q

Give examples of single unit drinks

A

Half pint of weak beer (3.5%)
Small (<100 ml) glass of wine (12%)
Small (28 ml) measure of spirits (40%)

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34
Q

What is the typical %ABV for beer

A

Beer contains 3–8% alcohol v/v (average = 4.5%)

Pint is usually around 2 units - depends on strength

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35
Q

What is the typical %ABV for wine

A

Wine contains 10-13% alcohol v/v (average 12%)

Size of glass and strength vary

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36
Q

What is the typical %ABV for spirits

A

Most spirits contain 40% alcohol v/v
Singe unit measure is 25ml
Scottish whiskey measure is 35ml - 1.4 units

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37
Q

Which factors can accelerate gastric emptying

A

Tolerance

Gastrectomy

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38
Q

Which factors can slow gastric emptying

A

Food in the stomach - main contributor

Certain drugs

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39
Q

Where is alcohol absorbed in the body

A

20% from stomach

80% from small intestine

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40
Q

What determines the rate of alcohol absorption

A

The rate of gastric emptying
Higher rate = greater absorption (more is absorbed in intestine)

The type of drink - strength, effect of congeners

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41
Q

What effect does food have on alcohol absorption

A

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

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42
Q

How long does alcohol absorption to be completed

A

Complete within 1-3h
Usually peaks after 1 hour
Based on 1 unit

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43
Q

Which alcohols are absorbed quickly

A

Champagne - due to bubbles and high conc

Bubbles stimulate blood flow and intestinal linings = faster absorption

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44
Q

Which alcohols are absorbed s lowly

A

Beer - low conc and effect of congeners

Neat spirits - they irritate the stomach

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45
Q

What are congeners

A

They are other alcohols, carbs, yeast products found in alcohol
Slow down absorption

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46
Q

The Co equation assumes what

A

100% absorption and instant distribution

This does not happen in life so is a theoretical level

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47
Q

How is BAC reported

A

As mg of alcohol /100ml of blood

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48
Q

How do you work out the Co

A

Weight alcohol consumed (g) x 100

All divided by Body Wt (kg) x W.F.

Widmark equation

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49
Q

What are the 3 phases of alcohol kinetics

A

Absorption phase - rising phase
Distribution phase - peak of the curve
Elimination phase - drops again

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50
Q

What is the typical rate of alcohol elimination

A

10–20 mg alcohol /100 ml blood / h
Therefore average is 15 (roughly a unit per hour)

Can be up to 40 in alcoholics

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51
Q

Alcohol levels in arterial blood rise and fall faster & sooner
than in venous blood - true or false

A

TRUE

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52
Q

Are alcohol levels in breath closer to arterial BAC or venous BAC

A

Arterial

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53
Q

What is the normal ratio of BAC:BrAC

A

2300 : 1

Much higher in blood than in breath

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54
Q

When does alcohol become present in the breath

A

1-2 hours after drinking

Some is transferred from blood to alveoli

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55
Q

How can VHAC be used

A

It can be used to corroborates PM BAC

Not done in life as obviously cannot take sample from a living person

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56
Q

Can VHAC be used to estimate BAC

A

No
Cannot reliably predict BAC from VHAC
However, can be used for corroboration

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57
Q

Describe the relationship between VHAC and BAC in different phases

A

During absorption BAC > VHAC

At equilibrium BAC < VHAC (ratio 0.8)

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58
Q

What does the urinary alcohol concentration represent

A

The average of several hours excretion

This is because the urine pools in the bladder and collects

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59
Q

Describe the relationship between UAC and BAC in different phases

A

UAC < BAC during absorption phase - start of drinking

UAC > BAC during elimination phase -

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60
Q

Which ratios are used to compare UAC and BAC

A

BAC : UAC = 0.75 : 1

UAC : BAC = 1.3 : 1

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61
Q

Describe the blood supply and drainage of the kidneys

A

Renal Artery supplies blood to kidney

Blood filtered by kidney tubules - toxins filtered out into urine

Renal Vein drains blood from kidney

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62
Q

How is alcohol distributed around the body

A

It dissolves in water and is distributed via the bloodstream
Taken up from blood by the tissues in proportion to their water content

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63
Q

Which tissues take up the most alcohol during distribution

A

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

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64
Q

Which tissues take up the least alcohol during distribution

A

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

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65
Q

What determines the blood alcohol concentration

A

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.

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66
Q

How does body composition affect water content

A

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

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67
Q

How do you calculate lean body mass

A

Weight x the Widmark factor

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68
Q

What determines the volume of distribution

A

Lean body mass

Have a higher body water content

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69
Q

What does the Widmark Factor represent

A

It is a proportion of body water

More you have (e.g. lean person) = greater the factor

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70
Q

What is the Widmark Equation used for

A

It gives rough estimate of BAC after alcohol consumption

assuming instantaneous 100% absorption

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71
Q

What is the Widmark Equation

A

C0 = Wt alcohol consumed (g) x 100 / Body Wt (kg) x W.F.

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72
Q

What are the mean experiment Widmark Factors

A
  1. 68 for men (e.g. 68% of body is water)

0. 55 for women

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73
Q

How is Widmark Factor calculated

A

Calculate for an individual from sex, height, weight via an online chart

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74
Q

How is BAC at a specific time calculated

A

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

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75
Q

How do you convert BAC to BrAC

A

BAC divided by 2.3 = BrAC

76
Q

How do you convert BrAC to BAC

A

BrAC x 2.3 = BAC

77
Q

How do you convert BAC to UAC

A

BAC / 0.75 = UAC

78
Q

How do you convert UAC to BAC

A

UAC x 0.75 = BAC

79
Q

How do you convert BAC to VHAC

A

BAC/ 0.8

80
Q

How do you convert VHAC to BAC

A

VHAC x 0.8

81
Q

What is the legal alcohol limit for driving in England

A

35 micrograms alcohol/100ml of breath
80mg/100ml blood
107mg/100ml urine

82
Q

What is the legal alcohol limit for driving in Scotland

A

22 micrograms alcohol/100ml of breath
50mg/100ml blood
67mg/100ml urine

83
Q

Does BrAC correlate more with arterial BAC or venous BAC

A

Arterial - it rises and falls earlier

Venous lags behind

84
Q

Describe the relationship between venous BAC and BrAC + arterial BAC

A

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

85
Q

Where is most alcohol broken down

A

90% is broken down in liver

Small amounts lost in breath, sweat and urine

86
Q

What is the rate of elimination of alcohol

A

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)

87
Q

How do you calculate the amount of alcohol eliminated in T hours

A

rate of elimination x T
T = time in hours
B= rate of elim

88
Q

Describe how alcohol is metabolised in the liver

A

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

89
Q

How does exercise affect alcohol metabolism

A

Increases it so BAC drops faster

However, it is not a significant effect

90
Q

What are the 3 main stages of intoxication

A

Excitement (BAC <100 mg%)

Confusion (BAC 100-200 mg%)

Stupor (BAC >200 mg%)

91
Q

What causes the excitement phase of intoxication (BAC <100mg%)

A

Depression of higher inhibitory cortical function

92
Q

What causes the confusion phase of intoxication (BAC 100-200 mg%)

A

Depression of limbic system (memory, orientation)

Depression of cerebellum (coordination, speech)

93
Q

What causes the stupor phase of intoxication (BAC >200mg%)

A

Depression of upper brainstem (RAS - conscious level)

Depression of lower brainstem (breathing & vasomotor centers)

94
Q

Alcohol affecting the cerebral cortex has what effect

A

Excitement and disinhibition

95
Q

Alcohol affecting the limbic system has what effect

A

Memory
Confusion
Disorientation

96
Q

Alcohol affecting the cerebellum has what effect

A

Incoordination

Slurring

97
Q

Alcohol affecting the hypothalamus and pituitary has what effect

A

Hypothermia

98
Q

Alcohol affecting the upper brain stem has what effect

A

Coma

99
Q

Alcohol affecting the medulla has what effect

A

Respiratory and vasomotor depression

Death

100
Q

List the features of the excitement phase of intoxication (BAC <100mg%)

A

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

101
Q

List the features of the confusion phase of intoxication (BAC 100-200 mg%)

A

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

102
Q

List the features of the stupor phase of intoxication (BAC >300mg%)

A 
Dead drunk
Aroused only by strong stimuli
Anaesthetic & unfeeling
Flushed, drooling, snoring
Simulates head injury (may coexist)

Can lead to coma and death

103
Q

List potential dangers of severe intoxication

A 
Hypotension (low BP)
Hypothermia 
Inhalation of vomit (loss of gag reflex)
Haematemesis (vomiting blood)
Trauma
Death
104
Q

Acute intoxication can mimic which other disease processes

A 
Head injury
Neurological disease 
Diabetic hypoglycaemia
Epilepsy & related states
Drug intoxication (often coexist)
105
Q

List symptoms of a hangover

A

Headache, malaise, nausea, tremor

106
Q

What causes a hangover

A

Toxic effects of alcohol metabolites & congeners on brain & GI tract
Hypoglycaemia plays a big part - particularly early on
Dehydration

107
Q

Hangover’s are self-limiting - true or false

A

True

Temporary

108
Q

How does drunk driving contribute to RTAs

A

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

109
Q

How does alcohol impact driving performance

A

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

110
Q

How does alcohol impact relative accident risk

A

It increases it

More pronounced in young, inexperienced drivers

111
Q

List the legal limits for driving in different countries

A

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

112
Q

Is it an offence to drink drive

A

YES
Driving quality is irrelevant - all to do with BAC
Stated in the Road Traffic Act section 4 and 5

113
Q

In which situations can a police officer take a roadside screening breath test

A

If they suspect the driver has:
Been drinking
Committed a moving traffic offence
Been intoxicated at the time of an accident

114
Q

Describe the RTA arrest procedure for a drunk driver

A 
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

115
Q

If a person is arrested for suspected drink driving what samples must they provide at the police station

A

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)

116
Q

Which devices are approved for taking evidential breath samples

A

CAMIC or Lion devices approved

117
Q

Which of the 2 breath samples is used by the police as the true level

A

The lower of the 2

118
Q

What happens if someone in England or Wales has a BrAC of 35-50 (just over limit)

A

The driver can replace the sample with either blood or urine to be more accurate (police decide which)
Not an option in Scotland

119
Q

How is an evidential blood sample taken in drink driving case

A

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

120
Q

Who takes the evidential blood sample taken in drink driving case

A

Forensic physician

121
Q

How soon after an incident must a urine sample be taken

A

Must be taken within an hour

122
Q

How is an evidential urine

sample taken in drink driving case

A 
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
123
Q

What happens if an suspected drunk driver fails to provide a sample

A

Constitutes an offence similar to drinking and driving

124
Q

List the potential defence for being over the limit whilst driving

A 
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
125
Q

Describe the defence of post-accident drinking (hip flask defence)

A

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

126
Q

Which drugs can affect driving

A

Illegals - Opiates, cannabis, diazepam, stimulants
Prescription drugs
Over the counter drugs

127
Q

How does the court decide if a person was unfit to drive

A

Witness observations of driving manner
Medical assessment
Toxicological analysis

128
Q

Is consent required to take a blood/urine sample from a suspected drunk driver

A

YES

129
Q

What aspects of medical history important in drink driving cases

A

Diabetes, asthma, epilepsy, stroke, head injury
Psychiatric conditions
Alcohol, drugs & medication history

130
Q

What aspects of physical examination important in drink driving cases

A

Demeanour, breath, pupils, coordination, etc

131
Q

If a person does not consent to a alcohol sample, what else can be noted

A

Simple observations about their condition

132
Q

If a person is arrested for drug driving what is included in the medical assessment

A 
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
133
Q

Can the police demand a sample for drugs in driving case

A

No

Dr can advise it though if exam suggests it

134
Q

List features of alcohol dependence

A 
Aware of compulsion to drink
Prominent drink seeking behaviour
Tolerance to its effects
Withdrawal syndromes on stopping
Avoidance of withdrawal
Social, psychological & physical problems
135
Q

What environmental factors can lead to alcoholism

A 
Availability
Peer pressure
Occupation
Stress
Competitive lifestyle
Unemployment
136
Q

What personal/constitutional factors can lead to alcoholism

A 
Low self esteem
Habit
Boredom
Loneliness
Anxiety & depression
Ethnicity
137
Q

How long does alcohol withdrawal take to set in/pass

A

Onset 6-12 h
Peak 48 h
Lasts few days

138
Q

List features of alcohol withdrawal

A 
Tremor
Nausea & vomiting
Malaise
Headache
Insomnia
Weakness
Sweating
Tachycardia
Hypertension
Anxiety, depression and irritability
Withdrawal fits 
Transient hallucinations - DT

Will feel awful

139
Q

How do you manage alcohol withdrawal

A

There is a chart that scores the severity - higher score is more severe
Chlordiazepoxide - dose dependent on score
(keeps them comfy)
Require monitoring

140
Q

Which body systems are affected by alcohol

A 
Gastrointesitnal tract
Liver
Cardiovascular system
Central & peripheral nervous system
Endocrine
Many others (except fat!)
141
Q

Which GI conditions can alcoholism cause

A 
Oesophagitis, Mallory-Weiss tears
Gastritis, duodenitis, peptic ulcer
Malabsorption
Diarrhoea
Pancreatitis
142
Q

How can alcohol affect the liver

A 
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

143
Q

How can alcohol affect the cardiovascular system

A

Arrhythmias (& sudden death)
Alcoholic cardiomyopathy - enlarged, globular heart, rare
Wet Beri-Beri - vit B deficiency
Hypertension

144
Q

Which CNS symptoms can be caused by alcohol

A 
Acute intoxication
Blackout
Withdrawal syndromes
Wernicke’s encephalopathy
Korsakoff’s syndrome 
Cerebellar degeneration
Cerebral atrophy (alcoholic dementia)
Alcoholic hallucinosis
Peripheral neuropathy
145
Q

How does Wernicke’s encephalopathy present

A

Disorientation & eye problems

146
Q

How does Korsakoff’s syndrome present

A

short term memory loss & confabulation

147
Q

How can alcohol use affect nutrition

A 
Early obesity (additional calories)
Later malnutrition - alcohol is their major intake 
Vitamin deficiencies
Vitamin B group, e.g. Thiamine, folate
148
Q

How can alcohol use affect reproduction

A

Male impotence
Female menstrual & fertility problems

Miscarriage & foetal alcohol syndrome
Baby can be born with alcohol dependence

149
Q

Which metabolic disturbances can be caused by alcohol

A 
Hypoglycaemia
Hyperlipidaemia
Hyperuricaemia
Potassium, Magnesium, Phosphate 
Lactic acidosis 
Alcoholic ketoacidosis
150
Q

List some of the psychological complications of alcohol use

A 
Anxiety & depression
Suicide risk
Alcoholic dementia
Alcoholic hallucinosis
Pathological jealousy
Sexual dysfunction
151
Q

List some of the social complications of alcohol use

A 
Marital & family problems
Domestic violence
Work problems
Unemployment
Road traffic accidents
Crime
152
Q

What kills alcoholics

A

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)

153
Q

Describe the mechanism behind death from alcohol intoxication

A

Brain stem depression
Positional asphyxia
Inhalation of vomit

154
Q

What is considered fatal alcohol intoxication

A

Fatal level very variable
>250 mg% in non tolerant person
Alcoholics are tolerant to high levels (average fatal level is 450 mg%)

155
Q

How can UAC exceed BAC in someone who dies from alcohol intoxication

A

Urinary alcohol conc (UAC) > BAC if death follows prolonged coma

156
Q

How are PM alcohol levels measured

A

Blood
Urine
Vitreous
Compared for corroboration and confidence

157
Q

What can cause artefactual alcohol levels PM

A

PM alcohol redistribution - unabsorbed from stomach can redistribute
PM microbial alcohol production

158
Q

How can alcohol redistribute after death

A

Passive diffusion of unabsorbed alcohol from
stomach or aspirated vomitus in airways
Redistributes to the central vessels

159
Q

Which vessels does alcohol redistribute to PM

A

Central vessels

Heart, IVC, pulmonary artery and aorta (closer to stomach so can be affected by redistribution PM)

160
Q

Describe the difference between PM alcohol concentration in the central and peripheral vessels

A

<400% difference between central vessels & peripheral (femoral) vein

161
Q

Describe PM microbial alcohol production

A

Bacteria & yeasts present in blood convert glucose & lactate into alcohol

Longer they’ve been dead the more is produced

162
Q

List factors that favor PM microbial alcohol production

A

warmth, Hyperglycaemia, septicaemia, abdominal trauma

163
Q

Does PM microbial alcohol production occur in the sample tubes too

A

Yes it can occur invitro

However, further in vitro elevation prevented by tube preservative & refrigeration of sample

164
Q

How long does it take for PM microbial alcohol production to occur

A

Levels <70 mg/100 ml can occur within few days (<150 in some cases)

165
Q

What types of trauma are more likely under the influence of alcohol

A 
RTA
Falls
Hypothermia
Fire
Drowning
Abuse
Suicide
Homicide
Accidental death
166
Q

List signs of hypothermia

A

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)

167
Q

Why might a crime scene look suspicious in cases of hypothermia

A

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

168
Q

List some alcohol related disease

A 
Cardiomyopathy
Arrhythmia
Cirrhosis
Liver failure 
GI haemorrhage
Varices
Pneumonia
169
Q

List some obscure causes of alcoholic death

A

Arrhythmias (prolonged QT on ECG)
Vagal neuropathy
Alcoholic ketoacidosis
Hypoglycaemia
Catecholamine surge due to acute intoxication or withdrawal
Electrolyte disturbances - magnesium deficiency

170
Q

What terms are now used in the place of alcoholism

A

Alcohol dependence

Alcohol misuse

171
Q

What is the chemical formula of ethanol

A

C2H5OH

172
Q

Is binge drinking considered hazardous

A

Yes

It is more harmful than consuming the same amount of alcohol over more days of the week

173
Q

Describe the trend in numbers of each ‘alcohol consumption level’

A

Greatest number is social and sensible drinkers

As the drinking becomes heavier the numbers decrease - still a significant group!

174
Q

Can alcohol have a beneficial effect

A

Potentially

Some studies have shown small amounts can be beneficial

175
Q

How does tolerance occur

A

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)

176
Q

What causes withdrawal

A

Sudden cessation causes a rebound effect in the alcohol tolerant nerve cells
They become over-excitable which leads to the withdrawal symptoms

177
Q

What is GGT

A

Gamma-glutamyl transferase Liver enzymes
It can indicate liver damage
Raised in alcoholics

178
Q

What is CDT

A

Carbohydrate-deficient transferrin
Protein which becomes raised in the blood of alcoholics
Causes a flurry of excitement

179
Q

How is MCV affected in alcoholism

A

It is raised in alcoholics

180
Q

What is a pint in ml

A

568ml

181
Q

How quickly are neat spirits absorbed

A

Slowly
They irritate the stomach lining
This produces more mucus which forms a barrier and slows absorption

182
Q

How does alcohol circulate through the body

A

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)

183
Q

Is there a legal driving limit for drugs

A

Not really
Some drugs are starting to gain levels in legislations
Will instead be prosecuted for impaired driving

184
Q

Why must the bladder be emptied first before providing an evidential urine sample

A

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

185
Q

Which type of pneumonia is common in alcoholics

A

Lobar

186
Q

What is paradoxical undressing

A

When someone is experiencing hypothermia they can begin to feel hot and will undress themselves

Forensic Medicine (13 decks)

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