Alcohol Misuse Flashcards
What are the main causes of alcohol-related mortality in the age group 16-34?
- Accidents/trauma
- Self Harm and Suicide
- Alcohol intoxication (poisoning)
7-10% female deaths and 15-20% male deaths in this age group
What are the main causes of alcohol-related mortality in the age group 34-64?
- Alcohol related liver disease
6-12% female deaths and 10-12% male deaths in this age group
What types of cancers are related to alcohol consumption in individuals aged 64 and older?
- Breast
- Oesophagus
- Colon
- Mouth
- Upper aerodigestive tract
2-3% of deaths in this age group are alcohol related
What was the impact of the Minimum Unit Price for Alcohol in Scotland?
- Decrease in alcohol consumption
- Downward trend in Alcohol-Related Liver Disease, especially in lower income groups
- Alcohol mortality fell by 10% in 2019
This indicates a positive effect on public health.
What are the low dosage effects of alcohol?
- Euphoria
- Reduced anxiety
- Relaxation
- Sociability
What are the high dosage effects of alcohol?
- Intoxication
- Impaired attention and judgement
- Unsteadiness
- Flushing
- Nystagmus
- Mood instability
- Slurring
- Unconsciousness
When does Delirium Tremens typically present after stopping alcohol?
48-72 hours
What are the symptoms of Delirium Tremens?
- Profound confusion
- Tremor
- Seizures
- Severe agitation
- Hallucinations
- Delusions
- Sleeplessness
What does Thiamine (Vitamin B1) deficiency in alcoholism lead to?
- Wernicke’s Encephalopathy
- Korsakoff’s Psychosis
Wernicke’s is reversible but Korsakoff’s is irreversible
What are the characteristic symptoms of Wernicke’s Encephalopathy?
- Confusion
- Opthalmoplegia
- Gait Ataxia
What are the symptoms of Korsakoff’s Psychosis?
- Impairment of recent and remote memory
- Confabulation
- Impaired learning and disorientation
- Personality changes
- Psychosis
What is Acute Alcoholic Hepatitis?
Inflammation of the liver due to alcoholic consumption >8 units/day for a prolonged period of time
What is Alcoholic Ketoacidosis?
Build-up of ketones secondary to high numbers of free fatty acids due to increased lipolysis caused by alcohol
What leads to the pathophysiology of Alcoholic Ketoacidosis?
- Increased lipolysis
- Excess alcohol drives NADH+ production
- Impaired hepatic gluconeogenesis
- Thiamine deficiency can cause lactic acid build-up
What are the reasons for Thiamine deficiency in alcoholism?
- Used as a cofactor in Krebs Cycle
- Blocks duodenal uptake of thiamine
- Interferes with thiamine storage and conversion
What are the stages of alcohol usage in diagnosis?
- Acute Intoxication
- Harmful Use
- Dependence
- Withdrawal State
- Delirium Tremens
Each stage has specific criteria for diagnosis
What are the symptoms of Acute Intoxication?
- Intoxication
- Impaired attention and judgement
- Unsteadiness
- Flushing
- Nystagmus
- Mood instability
- Slurring
- Unconsciousness
What defines Harmful Use of alcohol?
Pattern of use causing damage to physical or mental health
What criteria define Dependence on alcohol?
- Cravings/compulsions
- Difficulty controlling use
- Primacy
- Increased tolerance
- Physiological withdrawal
- Persistence despite harmful consequences
What constitutes a Withdrawal State?
- Tremor
- Weakness
- Nausea
- Vomiting
- Anxiety
- Seizures
- Confusion
- Agitation
What is the CAGE screening tool used for?
Identifying potential alcohol problems
2 or more ‘yes’ responses indicate likely alcohol problem
What does the Glasgow Alcoholic Hepatitis Score (GAHS) indicate?
If GAHS ≥9, 30-day mortality without steroid is 48% and with is 22%
What is the acid-base status in alcoholism?
- pH is acidotic
- Low bicarbonate (metabolic acidosis)
- Breathing off CO2 to compensate
What are the LFT findings in Alcoholic Hepatitis?
- Raised MCV
- AST/ALT ratio reversed (AST:ALT >2)
- Markedly High GGT
- Elevated bilirubin
What is the first-line treatment for alcohol withdrawal?
High dose Benzodiazepines (e.g., chlordiazepoxide)
What medication is used to prevent Wernicke-Korsakoff Syndrome?
IV Vitamin B1 Thiamine (Pabrinex)
What is Disulfiram (Antabuse) used for?
Aversion medication for chronic alcoholism by causing hangover effects upon drinking
What are some anti-craving medications for chronic alcoholism?
- Acamprosate
- Naltrexone
- Nalmefene
- Baclofen
