Effects of alcohol Flashcards

1
Q

20mg/100ml of blood (1 unit)

A

-disinhibition, euphoria, emotional insatbility, release of social and sexual inhibitions

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2
Q

80mg/100ml of blood

A

-more pronounced previous effects, motor coordination becomes more affected, marked effect on judgement

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3
Q

200mg/100ml of blood

A

-motor coordination is progressively lost and speech becomes slurred

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4
Q

300mg/100ml of blood

A

unconsciousness

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5
Q

400mg/100ml of blood

A

death from respiratory failure

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6
Q

Pharmacokinetics of alcohol

A
  • rapidly absorbed from mouth, lung, stomach, small intestine (peak blood conc. in 30-60minutes)
  • cleared from the body mostly by metabolism (liver)
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7
Q

Alcohol dehydrogenase (ADH)

A

CH3CH2OH + NAD+ –> CH3CHO + NADH

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8
Q

Clearance

A
  • Zero order with respect to ethanol

- ethanol cleared at constant rate regardless of concentration therefore easy to calculate

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9
Q

Detection of alcohol in breath

A

Breath intoximeter - IR/EC detection of alcohol in expired air
Detects mouth alcohol and interfering substances

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10
Q

Detection of alcohol in blood

A
  • Gas chromatography of extracted blood sample with IR/EC detector
  • eliminates cross detection of other substances
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11
Q

Road traffic Act 1988

A
Section 4 (i) 
driving a motor vehicle whilst unfit through drink or drugs
Section 4 (ii)
being in charge of a vehicle whilst unfit through drink or drugs
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12
Q

Forward and Back calculation of alcohol conc

A

NEED

  • height and weight of subject
  • amount of alcohol consumed
  • when alcohol consumed (start time)
  • Intoximeter and/or blood sample readings
  • what times values needed for
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13
Q

Procedure -alcohol

A
  • police stop suspect
  • detect alcohol (smell)
  • roadside breath test
  • if positive -arrest
  • intoximeter procedure
  • if <40 release without charge
  • if >50 charge
  • if 40-50 - take blood/urine sample
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14
Q

Lines of defence (Section 5 - alcohol)

A
  • statutory defence - no intention to drive - need calculation of when subject would fall below statutory limit
  • post incident drinking - need calculation to verify consistency of evidence
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15
Q

Section 5 (Alcohol) cont,

A

Spiked drinks - calculations required to verify evidence

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16
Q

MEDICAL IMPACTS OF ALCOHOL

A

Types of death involving alcohol:

  • acute intoxication
  • chronic alcoholism
  • accidents
  • suicides
  • homicides
17
Q

post mortem examination

A

-history, external, internal, samples (N.B. Femoral artery/vein)

18
Q

Acute alcohol intoxication

A
  • > 300mg/100ml blood = increasing danger of death
  • direct respiratory depressant effect on the brainstem
  • aspiration of vomit
  • cardiac arrhythmia
  • trauma
  • fire deaths
  • drowning
19
Q

Post mortem findings

A
  • usually only congestion of the lungs
  • vomit in airways
  • evidence of chronic alcoholism
  • pre-existing disease
  • traumatic injury
  • burns?
20
Q

Chronic alcoholism

A
  • extremely potent drug
  • all systems of body are affected
  • bulbous nose
  • bruises
  • jaundice/spider naevi/gynaecomastia
  • ascites/oedema
21
Q

jaundice

A
  • accumulation of bilirubin in the skin
  • breakdown product of haemoglobin (Hb)
  • damaged liver cells (hepatocytes) do not function adequately
22
Q

Ascites

A
  • accumulation of fluid in the abdominal cavity

- due to portal hypertension and decreased proteins in blood (albumin esp.)

23
Q

spider naevi

A
  • skin lesion
  • small central blood vessel with radiating smaller vessels
  • affects the face, chest and upper limbs
  • sign of chronic liver disease
24
Q

Internal - C.N.S

A
  • intracranial bleeding
  • cerebellar atrophy
  • wernicke-korsakoff psychosis (nystagmus, ataxia, amnesia, confabulation, hallucinations)
  • delerium treatments
25
Intracranial bleeds
- subdural haemorrhage - extradural haemorrhage - intracerebral haemorrhage
26
extradural haemorrhage
- space between skull and dura - skull fractures (site? vessel?) - lucid interval - neurosurgical drainage is necessary
27
subdural haemorrhage
below the dura
28
intracerebral haemorrhage
- increased risk of haemorrhagic stroke if clotting is abnormal and the vessels are inherently weakened - increased risk of hypertensive stroke
29
Internal - cardiovascular system
- increase in blood pressure | - alcoholic cardiomyopathy (dilated chambers, enlargement of the cardiac myocytes, patchy fibrosis in the interstitium)
30
Internal - gastrointestinal system
- gastric ulcer/gastritis - mallory-weiss tear - pancreatitis (acute/chronic) - malabsorption
31
Pancreas
- "dual purpose" gland - endocrine portion :Islets of Langerhans (Hormones: Insulin, glucagon, somatostatin) - exocrine gland: 99% of pancreas, many digestive enzymes, bicarbonate ions
32
Pancreatitis
- direct toxic effects - acute - pain/nausea/vomiting/metabolic/shock/death - acute - haemorrhagic / necrotic pancreas - chronic - pain/weight loss/malabsorption / diabetes - chronic -fibrotic
33
Internal examination - LIVER
- alcoholic hepatitis - fatty degeneration (enlarged smooth liver) - cirrhosis (Fibrous bands, nodules, 60-70% of Western world due to alcoholism) - portal hypertension (restriction of blood flow, increased B.P., back pressure - dilated veins, oesophageal varices) - liver failure
34
Portal hypertension (liver)
- Splenomegaly - ruptured varices - haematemesis - black stools - haemorrhage - can be fatal