CLASP Alcohol

Question 1

treatment for methanol poisoning

Answer 1

-ethanol
-+/- dialysis
(both methanol and ethanol are metabolised by alcohol dehydrogenase so competitive inhibition effect)

Question 2

recommended alcohol daily allowance

Answer 2

-14 units/week

Question 3

what constitutes to an alcohol binge?

Answer 3

-6-8 units in one go

Question 4

what is a unit and how do you calculate them?

Answer 4

• 1 unit = 10ml or 8g of pure alcohol
• no of units = strength (%) x volume (ml) /1000

-alcohol metabolised at roughly 1 unit/hour

Question 5

what can increase alcohol absorption?

Answer 5

-antihistamines
-metoclopramide
(increase gastric emptying)

Question 6

How is alcohol metabolised?

Answer 6

• 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)

Question 7

what causes a hangover

Answer 7

-build-up of acetaldehyde

Question 8

what is alcoholic ketoacidosis?

Answer 8

• low/normal glucose but high ketones

- excess NADH impairs FA metabolism

Question 9

Management of alcohol withdrawal

Answer 9

-diazepam

Question 10

what is Wernicke’s encephalopathy?

Answer 10

• thiamine (B1) deficiency

- cytotoxic oedema in mamillary bodies (part of brain limbic system)

Question 11

symptoms of Wernicke’s

Answer 11

• ocular dysfunction (nystagmus)
• ataxic gait
• acute confusion

note that alcohol taken with benzodiazapines also causes these symptoms

Question 12

treatment of Wernicke’s

treatment of Korsakoff’s

Answer 12

• immediate thiamine replacement (IM prabinex)

- abstinance and nutrition (little chance of recovery)

Question 13

what is Korsakoff’s syndrome?

Answer 13

-irreversible cerebral atrophy (due to thiamine deficiency)

Question 14

symptoms of korsakoff’s syndrome

Answer 14

• anterograde amnesia (can’t retain new info)
• variable retrograde amnesia
• confabulation (filling in gaps of retrograde amnesia)
• lack of insight

Question 15

effects of ethanol on heart

Answer 15

• negatively ionotropic (increase HR to compensate)
• dilated cardiomyopathy
• arrythmias e.g. holiday heart syndrome (supra-ventricular tachycardia )

Question 16

how may alcohol cause cancer

Answer 16

• 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

Question 17

what does acamprosate do?

Answer 17

• reduces cravings/pleasurable feeling of alcohol

- stabilises chemical signalling normally disrupted by alcohol

Question 18

what does naltrexone do?

Answer 18

• reduces cravings/pleasurable feeling of alcohol

- opioid receptor antagonist

Question 19

what does disulfiram do?

Answer 19

• inhibits acetaldehyde dehydrogenase

- acetaldehyde quickly builds up and causes unpleasant symptoms

Question 20

screening tools for alcohol

Answer 20

• FAST

- AUDIT

Question 21

What is delirium tremens

Answer 21

• acute onset confusion which occurs around 3 days after alcohol withdrawal
• medical emergency with confusion, autonomic hyperactivity, pyrexia, tremors, seizures

Question 22

how to tread delirium tremens?

Answer 22

• benzodiazepines
• prabinex (IM thiamine)
• supportive measures such as anti convulsants, antipsychotics, antiemetics , fluids etc.

Question 23

where in unconjugated bilirubin normally found?

Answer 23

• in the blood

- attached to albumin

Question 24

where is conjugated bilirubin normally found?

Answer 24

• bile

- conjugated with glucuronic acid

Question 25

how is bilirubin formed

Answer 25

RBC -> haem -> iron + biliverdin -> unconjugated bilirubin