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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
Q

Distribution in Acute Methanol Toxicity

A
  • 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
Q

Metabolism in Acute Methanol Toxicity

A
  • 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
Q

Excretion in Acute Methanol Toxicity

A
  • Only about 3% is excreted unchanged by kidneys, Less than 10 % through breath.
25
Q

Toxic action of Acute Methanol Toxicity

A
26
Q

CP of Acute Methanol Toxicity

A
27
Q

Ocular Toxicity in Acute Methanol Toxicity

A
  • 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
Q

what dose of metahnol may cause occular manifestations?

A

10 ml of pure methanol can affect vision, due to retinal affection.

29
Q

Fundoscopy in Occular affection in Acute Methanol Toxicity

A
  • Optic disc hyperemia or pallor, venous engorgement
  • Retinal or optic disc edema.
30
Q

Investigations in Acute Methanol Toxicity

A
31
Q

Goals of TTT in Acute Methanol Toxicity

A
  • 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
Q

Emergency & Supportive TTT in Acute Methanol Toxicity

A
  • 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
Q

Decontamination in Acute Methanol Toxicity

A
  • Aspirate gastric contents if this can be performed within 30-60 minutes of ingestion.
  • Activated charcoal is not likely to be useful.
34
Q

Antidote of Acute Methanol Toxicity

A
  • Alcohol dehydrogenase inhibiters (Ethanol or fomepizole)
  • Leucoverin (folinic acid) and folic acid
35
Q

Guidelines of using antidote of Acute Methanol Toxicity

A
  • 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
Q

Indications of Alcohol dehydrogenase inhibiters (Ethanol or fomepizole)

A
  • Blood methanol concentration >20 mg/dl
  • History of significant methanol ingestion
  • Significant metabolic acidosis
37
Q

Leucoverin (folinic acid) and folic acid

A

For conversion of formic acid to CO2 and water

38
Q

Enhanced Elimination in Acute Methanol Toxicity

A

Hemodialysis

39
Q

…………….. is the definitive management Line of methanol intoxication.

A

Hemodialysis

40
Q

Effect of hemodialysis in Acute Methanol Toxicity

A
  • 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
Q

Indications of Hemodialysis in Acute Methanol Toxicity

A
  • Methanol poisoning with significant metabolic acidosis not correctable with bicarbonate.
  • Serum methanol concentration ≥ 40 mg/di.
  • Renal failure.
  • Deteriorating vital signs
  • Vision deficits.
42
Q

Endpoint of Hemodialysis in Acute Methanol Toxicity

A
  • Concentration of methanol is less than 20 mg/dL
  • Correction of acidosis
  • Signs of toxicity disappear

Y3R2 - Toxicology ☠️ (15 decks)

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