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Y3R2 - Toxicology ☠️ > L9: Alcohol > Flashcards

L9: Alcohol Flashcards

1
Q

Source of Ethyl Alcohol (Ethanol)

A

Sugar fermentation by living yeast.

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2
Q

Characters of Ethyl Alcohol (Ethanol)

A
  • Volatile colorless liquid, highly inflammable
  • Having characteristic odor and fiery taste.
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3
Q

Uses of Ethyl Alcohol (Ethanol)

A
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4
Q

Toxic action of Ethyl Alcohol (Ethanol)

A
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4
Q

what does CP of Acute Ethyl Alcohol (Ethanol) Toxicity depend on?

A

concentration of alcohol in the blood

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4
Q

Mode of poisoning of Ethyl Alcohol (Ethanol)

A

Consumption of alcoholic beverages.

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5
Q

when do symptoms of Acute Ethyl Alcohol (Ethanol) Toxicity manifest?

A

Symptoms of CNS depression start when blood ethanol reaches 1.50 mg/dl

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6
Q

CP of Mild intoxication: “50-150 mg” of ethanol

A
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7
Q

what does Acute Ethyl Alcohol (Ethanol) toxicity predispose for?

A

trauma

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8
Q

CP of Moderate intoxication: “150-250 mg” of ethanol

A
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9
Q

CP of Severe intoxication: “150-250 mg” of ethanol

A
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10
Q

Alcohol coma (dead drunk): “350-400 mg”

A
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11
Q

Causes of death by Acute Ethanol Toxicity

A

Death within 10 hours:
- Respiratory failure.
- Brain damage (irreversible hypoxia).

Delayed couses of death:
- Fatty degeneration of liver.
- Acute hemorrhagic pancreatitis

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12
Q

Hypoglycemia in Acute Ethanol Toxicity

A
  • Hypoglycemia is Very common.
  • it is caused by impaired gluconeogenesis in patients with depleted or low glycogen stores (particularly small children and poorly nourished persons).
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13
Q

Investigations in Acute Ethanol Toxicity

A
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14
Q

emergency TTT in Acute Ethanol Toxicity

A
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15
Q

Decontamination in Acute Ethanol Toxicity

A
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16
Q

Antidotes in Acute Ethanol Toxicity

A

No specific antidotes.

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17
Q

Enhanced elimination in Acute Ethanol Toxicity

A

Hemodialysis

18
Q

Indications of Hemodialysis in Acute Ethanol Toxicity

A
  • Blood ethanol level is above 500mg/dL with coma and respiratory failure.
  • Clinical deterioration despite maximal supportive measures.
  • Impaired hepatic function.
19
Q

Alcohol & Driving

A
  • Even at low doses, there is clear evidence that alcohol impairs driving performance.
20
Q

Characters of Acute Methanol Toxicity

A
  • Methanol acquired name wood alcohol because it was once produced chiefly as a by product of the destructive distillation of wood.
  • Today, industrial methanol is produced in a catalytic process directly from carbon monoxide, carbon dioxide, and hydrogen.
21
Q

Uses of Acute Methanol Toxicity

A
  • As a solvent “In industry”
  • As a source of heat in some burners
  • Adulteration of Ethanol “in cheap alcoholics beverage”.
  • Paint remover
  • Household cleaners
22
Q

Absorbtion in Acute Methanol Toxicity

A

Rapidly absorbed through:

  • Gastrointestinal mucosa.
  • Intact skin
  • Pulmonary alveoli
23
Distribution in **Acute Methanol Toxicity**
- Methanol is quickly distributed to the body water. - Methanol enters the vitreous humor extensively, because of its extremely aqueous nature (eye is more vulnerable to damage from even small amounts).
23
Metabolism in **Acute Methanol Toxicity**
- Methanol is slowly metabolized (at a rate about one tenth that of ethanol), by alcohol dehydrogenase to formaldehyde subsequently by aldehyde dehydrogenase to formic acid (formate) **significant levels can be found up to 7 days after ingestion.**
24
Excretion in **Acute Methanol Toxicity**
- Only about 3% is excreted unchanged by kidneys, Less than 10 % through breath.
25
Toxic action of **Acute Methanol Toxicity**
26
CP of **Acute Methanol Toxicity**
27
Ocular Toxicity in **Acute Methanol Toxicity**
- Visual disturbances up to blindness. - Patients describe the visual disturbance as blurred vision, haziness, or "like standing in a snowfield. - Impaired visual acuity followed by permanent blindness after 2-6 days
28
what dose of metahnol may cause occular manifestations?
10 ml of pure methanol can affect vision, due to retinal affection.
29
Fundoscopy in Occular affection in **Acute Methanol Toxicity**
- Optic disc hyperemia or pallor, venous engorgement - Retinal or optic disc edema.
30
Investigations in **Acute Methanol Toxicity**
31
Goals of TTT in **Acute Methanol Toxicity**
- Correction of metabolic acidosis by NaHCO3. - Blockage of alcohol dehydrodenase (ADH) which inhibits formation of toxic metabolites by specific antidotes. - Removal of parental alcohol by hemodialysis.
32
Emergency & Supportive TTT in **Acute Methanol Toxicity**
- Maintain airway and assist ventilation if needed "Intubation with Hyperventilation)" - Treat metabolic acidosis with IV sodium bicarbonate guided by arterial blood gases. - Treat coma and seizures if they occur.
33
Decontamination in **Acute Methanol Toxicity**
- Aspirate gastric contents if this can be performed within 30-60 minutes of ingestion. - Activated charcoal is not likely to be useful.
34
Antidote of **Acute Methanol Toxicity**
- Alcohol dehydrogenase inhibiters (Ethanol or fomepizole) - Leucoverin (folinic acid) and folic acid
35
Guidelines of using antidote of **Acute Methanol Toxicity**
- Only give ethanol therapy until hemodialysis. become available (Definite Treatment) - Once hemodialysis is available immediate stop ethanol. - Only Adjusted ethanol dose to maintain the Ethanol Level in **(Desired Range. 100-150mg)**
36
Indications of **Alcohol dehydrogenase inhibiters (Ethanol or fomepizole)**
- Blood methanol concentration >20 mg/dl - History of significant methanol ingestion - Significant metabolic acidosis
37
Leucoverin (folinic acid) and folic acid
For conversion of formic acid to CO2 and water
38
Enhanced Elimination in **Acute Methanol Toxicity**
Hemodialysis
39
................. is the definitive management Line of methanol intoxication.
Hemodialysis
40
Effect of hemodialysis in **Acute Methanol Toxicity**
- Rapidly removes both methanol (half-life reduced to 3-6 hours) - And formate (half-life decreases to 1.5-3.1 hours) - And (corrects acidosis).
41
Indications of Hemodialysis in **Acute Methanol Toxicity**
- Methanol poisoning with significant metabolic acidosis not correctable with bicarbonate. - Serum methanol concentration ≥ 40 mg/di. - Renal failure. - Deteriorating vital signs - Vision deficits.
42
Endpoint of Hemodialysis in **Acute Methanol Toxicity**
- Concentration of methanol is less than 20 mg/dL - Correction of acidosis - Signs of toxicity disappear

Y3R2 - Toxicology ☠️ (15 decks)

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