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TYPES OF ALCOHOL
Ethylene glycol
ROUTES OF ADMINISTRATION
Topical
Inhalation
Intravenous injection
Oral ingestion
ABSORPTION
60
40
20
Time
300
250
220
200
140
120
100
60
50
20
0
0
Empty stomach
DISTRIBUTION
Body
weight
EXAMPLES
Effect of sex:
Man weighing 150 lbs
Woman weighing 150 lbs
Each consume 2 beer
BAC of the man will be 57
mg/100 mL
BAC of the woman will be
67 mg/100 mL
Effect of weight:
ALCOHOL METABOLISM
Ethan
ol
Alcohol dehydrogenase
Acetaldehyde
Aldehyde
dehydrogenase
Acetic Acid
CO2 + H2O
ELIMINATION
zero-order kinetics
Ranges from 10-20 mg/100 mL/hour
Average rate of elimination is 15 mg/100 mL/hour
Is fixed and unaffected by:
coffee
sleep
exercise
eating showering
fresh air
FRUCTOSE
PATHOPHYSIOLOGY
GABA.
Glutamate.
NAD/NAD ratio.
ketogenesis.
gluconeogenesis
glycogenolysis
Fluid & electrolyte imbalance.
Vasodilatation
Creates
Disinhibition
Responsible
Acute
effects on heart.
Acute GI efects.
Acute alcoholic myopathy
Trauma
Associated other substance
poisoining.
ALCOHOLIC KETOACIDOSIS
Alcohol
Acetaldehyde
glycogenolysis
Acetate
NADH/NAD
ratio
gluconeogenesis
ketogenesis
dehydration
counter
regulatory
hormones
glucagon
insulin
ALCOHOLIC HYPOGLYCEMIA
Chronic
Symptoms
neuroglycopenic confusion,fatigue,seizure,
loss of consciousness death
autonomic responses palpitation, tremor,
sweating
Signs
pallor, diaphoresis
tachycardia, raised systolic B.P
transient focal neurological signs
Hypophosphatemia
Hpokalemia
Hypocalcemia
WERNICKE-KORSAKOFFS
SYNDROME
As
Slight intoxication
1050
mg/100 mL May be no observable signs of intoxication
Laboratory testing may reveal some effects
30-120 Mild euphoria, sociability, talkativeness
mg/100 mL Increased self confidence, inhibitions
Sensory perception (e.g. hearing)
Loss of fine motor skills
Slowed information processing
POSITIONAL ASPHYXIA
MANAGEMENT
Airway
Breathing
Circulation
Intubate if poor gag reflex
Fingerstick glucose, iv dextrose
Thiamin 100 mg im/ iv stat.
Magnesium
2 mg naloxone
Exclude other causes of intoxication
ABG
Osmolar gap.
Serum electrolytes
Anion gap.
Correct other electrolyte abnormalities
Dilantin
CT scan.
2. Acute use
ALCOHOL
Inhibitio
n
Excitatio
n
3. Chronic use
(tolerance)
OPPOSITE
ALCOHOL
Inhibitio
n
CHANGES
Excitatio
n
t io
i
b
i
Inh n
ati
t
i
c
Ex n
4. Withdrawal
Inh
ibit
io
n
AMSP 2012
10
OPPOSITE
CHANGES
Exc
i ta
ti o
n
TOLERANCE
FUNCTIONAL TOLERANCE
METABOLIC TOLERANCE
Induction of enzymes in chronic, heavy users of
alcohol can result in an enhanced metabolic rate
Elimination rate in alcoholics has been measured at
40 mg/100 mL/hour and up
Result is a comparatively lower BAC after equivalent
doses of alcohol are ingested
ALCOHOL IN BLOOD
CASE EXAMPLE
An individual suspected of driving while impaired is
brought to the hospital for medical treatment following a
car accident in which his 2 passengers were badly
injured
Blood is drawn at the hospital for medical purposes and
hospital laboratory results reveal a serum alcohol
concentration of 17 mmol/L
Police would like to know if they can charge this
individual with driving over the legal limit
OVER 80?
17.5 mmol/L 80 mg/100 mL
Serum:blood =1.14
Therefore, a serum alcohol concentration of 80
mg/100 mL indicates a whole blood alcohol
concentration of 70 mg/100 mL
This individual is not over 80 at the time the
blood sample is drawn
ALCOHOL IN URINE
ALCOHOL IN BREATH