diagnosis and pathophysiology of alcohol abuse

Question 1

when does alcohol ketoacidosis occur?

Answer 1

tends to occur the day after a massive binge

Question 2

why does lipolysis increase in alcoholic ketoacidosis?

Answer 2

Lipolysis tends to be increased due to increased levels of cortisol and catecholamines, caused by the extra stress placed on the patient’s body from the alcohol

Question 3

biochemistry changes in alcoholic ketoacidosis?

Answer 3

• lipolysis
• abundance of FFA

-Ketone production
the ketoacidosis leads to excess beta-hydroxybutyrate

-extra alcohol drives the NADH+ production with drives seton beta-hydroxybutyrate production

Question 4

what does metabolism ethanol drive?

Answer 4

l raises NADH/NAD which in turn impairs hepatic gluconeogenesis and the metabolism of lactate.

Question 5

so in alcoholic ketoacidosis

Answer 5

patient has impaired ability to make glucose, or metabolise lactate, driving the hypoglycaemia and acidosis.

Question 6

what is fit B1?

Answer 6

thiamine

Question 7

what is the wernickes triad

Answer 7

ophthalmoplegia
gait ataxia
confused

Question 8

what can wernicke’s cause?

Answer 8

Korsakoff’s

Question 9

what does thiamine deficiency do to the body -biochem

Answer 9

thiamine can cause a build up of lactic acid

Question 10

Lack of activity of alpha ketoglutarate dehydrogenase results in?

Answer 10

mitochondrial damage causing cellular necrosis, and triggering apoptosis (cell death) – cells in the cerebellum are particularly sensitive to this

Question 11

if you ever see an unexplained lactic acidosis, you should give….

Answer 11

Thiamine (or its I.V. formulation Pabrinex

Question 12

if you don’t give thiamine in unexplained lactic acidosis what could happen?

Answer 12

If you do not, and give glucose without it in the malnourished or thiamine deficient patient, you risk driving Wernicke’s Encephalopathy.

Question 13

what is the metabolite of ethanol?

Answer 13

acetaldehyde, is thought to be particularly toxic especially to hepatic proteins.

Question 14

Fatty Liver (alcoholic steatosis- what do u see on LFT? and albumin level? Gamma GT?

Answer 14

hyperbilirubinaemia

and mild elevation of transaminases (AST/ALT).

Gamma GT is elevated in a majority of patients.

Question 15

alcoholic hepatitis?

symtoms

Answer 15

a diversity of presentations from jaundice, anaemia, and leucocytosis.

Question 16

alcoholic hepatitis?

AST ALT ratio

Answer 16

The hepatic enzyalcoholic hepatitismes tend to present in a ratio of AST: ALT >2 (should normally be <1).