CLASP Alcohol Flashcards
treatment for methanol poisoning
-ethanol
-+/- dialysis
(both methanol and ethanol are metabolised by alcohol dehydrogenase so competitive inhibition effect)
recommended alcohol daily allowance
-14 units/week
what constitutes to an alcohol binge?
-6-8 units in one go
what is a unit and how do you calculate them?
- 1 unit = 10ml or 8g of pure alcohol
- no of units = strength (%) x volume (ml) /1000
-alcohol metabolised at roughly 1 unit/hour
what can increase alcohol absorption?
-antihistamines
-metoclopramide
(increase gastric emptying)
How is alcohol metabolised?
- ethanol converted to acetaldehyde by alcohol dehydrogenase
- acetaldehyde converted to acetate by aldehyde dehydrogenase
- acetate can then enter krebs, CO2, H20 produced
- lots of NADH produced by this process (down regulation of glycolysis)
what causes a hangover
-build-up of acetaldehyde
what is alcoholic ketoacidosis?
- low/normal glucose but high ketones
- excess NADH impairs FA metabolism
Management of alcohol withdrawal
-diazepam
what is Wernicke’s encephalopathy?
- thiamine (B1) deficiency
- cytotoxic oedema in mamillary bodies (part of brain limbic system)
symptoms of Wernicke’s
- ocular dysfunction (nystagmus)
- ataxic gait
- acute confusion
note that alcohol taken with benzodiazapines also causes these symptoms
treatment of Wernicke’s
treatment of Korsakoff’s
- immediate thiamine replacement (IM prabinex)
- abstinance and nutrition (little chance of recovery)
what is Korsakoff’s syndrome?
-irreversible cerebral atrophy (due to thiamine deficiency)
symptoms of korsakoff’s syndrome
- anterograde amnesia (can’t retain new info)
- variable retrograde amnesia
- confabulation (filling in gaps of retrograde amnesia)
- lack of insight
effects of ethanol on heart
- negatively ionotropic (increase HR to compensate)
- dilated cardiomyopathy
- arrythmias e.g. holiday heart syndrome (supra-ventricular tachycardia )
how may alcohol cause cancer
- ethanol metabolised to acetaldehyde all over body
- BUT acetaldehyde can only be converted to acetate in liver
- so acetaldehyde can circulate and cause damage before arriving at liver
what does acamprosate do?
- reduces cravings/pleasurable feeling of alcohol
- stabilises chemical signalling normally disrupted by alcohol
what does naltrexone do?
- reduces cravings/pleasurable feeling of alcohol
- opioid receptor antagonist
what does disulfiram do?
- inhibits acetaldehyde dehydrogenase
- acetaldehyde quickly builds up and causes unpleasant symptoms
screening tools for alcohol
- FAST
- AUDIT
What is delirium tremens
- acute onset confusion which occurs around 3 days after alcohol withdrawal
- medical emergency with confusion, autonomic hyperactivity, pyrexia, tremors, seizures
how to tread delirium tremens?
- benzodiazepines
- prabinex (IM thiamine)
- supportive measures such as anti convulsants, antipsychotics, antiemetics , fluids etc.
where in unconjugated bilirubin normally found?
- in the blood
- attached to albumin
where is conjugated bilirubin normally found?
- bile
- conjugated with glucuronic acid
