Alcohols

Question 1

Why ethanol causes hypoglycemia?

Answer 1

Chronic ethanol use reduces gluconeogenesis in the liver by inhibiting malate dehydrogenase

Question 2

What causes Wernicke-Korsakoff?

Answer 2

Thiamine Deficiency

Ethanol inhibits thiamine absorption in GI

Question 3

What are the symptoms of Wernicke-Korsakoff and where are the lesions in the brain?

Answer 3

Paralysis of the external eye muscles, ataxia, and a confused state. It can progress to coma and death

Question 4

What is the treatment Wernicke-Korsakoff?

Answer 4

Thiamine

Question 5

Why ethanol decreases thiamine and folate?

Answer 5

Carbohydrate metabolism uses thiamine, and ethanol inhibits thiamine absorption from GI

Ethanol inhibits folate absorption, and transport, and release from hepatocyte

Question 6

What are the symptoms of acute ethanol toxicity and how do you treat?

Answer 6

Sedation, Increased reaction time, imparied motor function, slurred speech, emesis, stupor

1. Thiamine—to prevent Wernicke-Korsakoff syndrome
2. Glucose— to treat hypoglycemia
3. Electrolyte balance

should not use glucose first, because it increases thiamine deficiency due to metabolism of glucose consuming thiamine!

Question 7

Why alcohol causes cirrhosis?

Answer 7

By products of alcohol metabolism triggers inflammation that destroys liver cells replacing with fibrous tissue leads to decreased liver function

Question 8

What are the symptoms and signs of cirrhosis?

Answer 8

Encephalopathy (confusion)
Spider angioma
Sparse Body hair
Gynecomastia
Muscle wasting
Red palms
Jaundice
Fibrotic Liver
Varacies

Question 9

Does alcohol increase pancreatitis?

Answer 9

Yes

Question 10

What are the symptoms of withdrawal of alcoholism and how do you treat?

Answer 10

Symptoms: after last drinking
6-12 h later, Insomnia, tremor, anxiety, vomit, sweat,
12-14h later, hallucination
24-48 h later, life threatening seizures,
48-72h later, delirium

Treatment:
Managed with thiamine, restoration of fluid electrolyte balance
Long acting BZD (diazepam, chlordiazepoxide) if liver function is normal, then taper off in several weeks
Non-active metabolite BZD (lorazepam, oxazepam) if liver function is impaired
Intensity of withdrawal effects reduced by clonidine or propranolol

Question 11

What are the signs of ethanol on fetus?

Answer 11

low nasal bridge
epicanthal folds
short palpebral fissures
thin upper lip
flat midlface and short nose

Question 12

Which enzymes metabolize all these three ethanols?

Answer 12

Alcohol Dehydrogenase

Acetaldehyde dehydrogenase

Question 13

What causes blindness?

Answer 13

Methanol (wood spirit, windshield cleaners, Industry alcohol)

Question 14

What cause renal stone and damage?

Answer 14

Ethylene Glycol (antifreeze)
Oxalate crystals in renal tubules

Question 15

How do you treat methanol or ethylene glycol toxicity?

Answer 15

same as Methanol
Gastric lavage
Ethanol is given I.V as it high affinity for alcohol dehydrogenase, so methanol is not metabolized to formaldehyde
Fomepizole
Bicarbonate (to manage profound metabolic acidosis)
Hemodialysis

Question 16

Why all three ethanol depress CNS and cause metabolic acidosis?

Answer 16

CNS
Ethanol facilitates action of GABA at the GABAA receptors—–similar to barbiturate, at low dose, GABA-dependent, high dose directly activate GABAA receptor—-dose-dependent CNS depression

Metabolic Acidosis due acetyladehyde formation

Question 17

Disulfiram inhibits which enzyme?

Answer 17

Acetylaldehyde degydrogenase

Question 18

What drugs have disulfiram-like effects?

Answer 18

Metronidazole
Cephalosporins: 
(cefotetan, cefamandol, cefoperazone)
Procarbazine
Griseofulvin
Chlorpropamide

Question 19

Fomepizole inhibits which enzyme?

Answer 19

Alcohol Dehydrogenase