alcohol symposium Flashcards
what intake of alcohol counts as low risk?
less than 14 units a week over 3 or more days
what intake of alcohol counts as increased risk?
- men 14 - 50 units
- women 14 - 35 units
what intake of alcohol counts as higher risk?
- men over 50 units a week
- women over 35 units a week
in Brighton and Hove how many adults drink over 14 units of alcohol a week?
2 in 5 people
nationally how many adults drink over 14 units of alcohol a week?
1 in 5
what factors are associated with having a drink in the last week?
- parents don’t discourage drinking
- older pupils
- recent drug use
- drinkers at home
- smoking
- white ethnicity
- playing truant
what percentage of adults don’t drink at all?
20%
globally how many deaths a year does alcohol misuse contribute to?
2.5 million deaths
what fraction of domestic violence is due to alcohol?
1/3
how many people are killed in road traffic accidents due to alcohol?
1 in 7
how many calls to Childline are related to parent’s alcohol consumption?
1/5
what factors influence alcohol consumption?
- individual factors (age, gender, health…)
- family
- culture and community
- socioeconomics
- religion
- country and laws
- taxes
how do we estimate alcohol consumption?
- reported consumption (surveys)
- taxation data from HMRC
what fraction of the UK population drink about hazardous levels?
1/3
what policies limit consumption of alcohol to reduce harm?
- taxation: limit affordability and raise revenue
- regulation and legislation: alcohol promotion and marketing, price and drink driving
how much ethanol is lost through breath/urine?
10%
what happens to the rest of ethanol that isn’t lost via breath/urine?
it is metabolised
what enzyme breaks down alcohol?
alcohol dehydrogenase
what effect does alcohol and aldehyde dehydrogenase have on the redox state?
- they both reduce NAD to NADH
- they increase lactate:pyruvate ratio and the beta-hydroxybutyrate:acetoacetate ratio
- they inhibit: glycolysis, citric acid cycle, fatty acid oxidation, gluconeogenesis
what toxic and metabolic effects does alcohol have?
- oxidant stress
- lipid peroxidation which is associated with both acute tissue damage and fibrosis
- free radicals attack cellular and mitochondrial DNA causing deletions and mutations
what are the stages of methanol metabolism?
1) methanol
2) formaldehyde
3) formic acid
4) CO2 + H20
how much pure alcohol is in one unit?
10mL or 8g
what is the legal limit of blood ethanol for driving?
<80mg/dL
what is the legal limits of alcohol for driving?
- 2-3 units in females
- 3-4 units in men
why shouldn’t pregnant women drink alcohol?
ethanol crosses the placenta and can seriously affect foetal development (foetal alcohol syndrome)
when blood ethanol levels are 50-100mg/dL what are the symptoms of sporadic and chronic drinkers?
- sporadic drinkers: euphoria, incoordination
- chronic drinkers: minimal or no effect
when blood ethanol levels are 100-200mg/dL what are the symptoms of sporadic and chronic drinkers?
- sporadic drinkers: slurred speech, ataxia, labile mood, drowsiness, nausea
- chronic drinkers: sobriety, incoordination, euphoria
when blood ethanol levels are 200-300mg/dL what are the symptoms of sporadic and chronic drinkers?
- sporadic drinkers: lethargy, combativeness, stupor, incoherent, speech, vomiting
- chronic drinkers: mild emotional and motor changes
when blood ethanol levels are 300-400mg/dL what are the symptoms of sporadic and chronic drinkers?
- sporadic drinkers: coma
- chronic drinkers: drowsiness
when blood ethanol levels are >500mg/dL what are the symptoms of sporadic and chronic drinkers?
- sporadic drinkers: respiratory depression, death
- chronic drinkers: lethargy, stupor, coma
what is alcoholic ketoacidosis?
metabolic acidosis with and increased anion gap that typically occurs in chronic alcoholics who binge with little nutritional intake
what is the pathophysiology of alcoholic ketoacidosis?
- glycogen depletion/inhibited gluconeogenesis
- lipolysis ad ketones increases
- insulin suppressed
- extracellular volume depletion/dehydration/stress-increase counter regulatory hormones further supressing insulin
how does ethanol cause hypoglycaemia?
- decreased intake of glucose
- depletion of glycogen
- blockade of gluconeogenesis
how do you treat hypoglycaemia?
- prompt treatment with glucose
- need to give parental thiamine as well as to prevent CNS damage in case there is also thiamine deficiency
what are the endocrine effects of alcohol?
- decreased testosterone
- Pseudo Cushings
- metabolic syndrome and dyslipidaemia
what are the general nutritional issues of alcohol?
- low calciun
- low phosphate
- low Mg, K
what are the typical liver function tests?
- gamma glutamyl transferase (GGT) increased by liver enzyme induction
- transaminases increased by hepatocellular damage
- globulin increased cirrhosis
- bilirubin and INR increased and albumin decreased by liver failure
what are the causes of thiamine deficiency?
- ethanol interferes with GI absorption
- hepatic dysfunction which hinders storage and activation
- malnourishment
what are relevant blood tests related to alcohol?
- macrocytosis: raised MCV in full blood count
- raised serum ferritin concentration
- hyperuricaemia
- hypertriglyceridaemia
- increased carbohydrate-deficient transferring or CDT
what are the possible mechanisms linking alcohol and hypertension?
- impairment of the baroreceptors
- increase of sympathetic activity
- stimulation of the renin-angiotensin-aldosterone system
- increase in plasma cortisol
- increase of intracellular calcium with subsequent increase in vascular reactivity
- endothelial
on a liver biopsy what are the signs of increased risk of progression?
- microvesicular fatty change
- extend of fibrosis
- amount of MD bodies
- intrahepatic cholestasis
what is shown with steatohepatitis?
- ballooning of hepatocytes
- inflammation: neutrophils
- necrosis of hepatocytes
- Mallory Denk bodies
what are the fibrosis/cirrhosis mechanisms?
- inflammation and necrosis cause increase in cytokines and growth factors that activate fibroblasts/myofibroblasts to deposit collagen
- centrilobular fibrosis - reversible
- septal fibrosis - increasingly irreversible
what are the portal hypertension consequences?
- impaired intestinal function and malabsorption
- splenomegaly with anaemia and thrombocytopenia
- portal bypass circulations: haemorrhoids, caput medusae, oesophageal veins
- vasodilation and compensatory increase in cardiac output
- toxic metabolised bypass the liver and may cause portosystemic encephalopathy
what are the symptoms of withdrawal?
- tremor/shaking
- sweating
- tachycardia
- nausea
- agitation
- seizures
- visual hallu
how do you manage alcohol withdrawal?
- chlordiazepoxide
- diazepam
what are the potential hazards with managing alcohol withdrawal?
- severe liver disease: precipitation of hepatic encephalopathy
- respiratory depression
- reluctance to prescribe more
- concomitant alcohol consumption
what are the core features of delirium?
- disturbance of consciousness
- change in condition or a perceptual disturbance
- tendency to fluctuate
- behaviour overactive or under active
- other features: disorganised thinking, poor memory, delusions and moof liability
what are the other causes of delirium?
- any infection
- drug side effect
- hypoxia
- drug overdose
- alcohol intoxication
- Wenicke encephalopathy
- hypoglycaemia
- meningitis/encephalitis
- psychiatric illness
- head injury
- constipation
- hepatic encephalopathy
what are the dietary sources of thiamine?
- wheat
- yeast
- nuts
- oatmeal
- potatoes
- pork
- marmite
what does the thiamine coenzyme do?
- glucose and lipid metabolism
- production of amino acids
- production of glucose derived neurotransmitters
what are the causes of thiamine deficiency?
- alcoholism
- chronic vomiting
- famine
what is the classic triad of Wernicke’s encephalopathy?
- confusion
- eye signs (ophthalmoplegia and nystagmus)
- ataxia
what is Korsakoff’s psychosis?
- permanent brain damage
- severe short term memory loss
- confabulation
what happens with Wernicke-Korsakoff syndrome?
any available thiamine in brain is utilised in the metabolism of glucose leading to sudden complete deficiency
how do you treat Wernicke-Korsakoff syndrome?
- always check glucose levels first
- give parental thiamine before dextrose or nutrition
- give pabrinex (thiamine 250mg and others)
what are the 4 categories for the reasons people drink?
1) enhancement: to feel better, to do things otherwise impossible
2) social: to be sociable, to celebrate at parties
3) conformity: because others do, to fit in
4) coping: because it helps you forget about your problems
why do people not drink?
- short term harm
- long term harm
- hangovers
- aldehyde dehydrogenase 2 deficiency
- religion/culture
what are the 3 things people must have to adhere to guidelines?
1) information
2) motivation
3) behavioural skills
