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THE WORD ALCOHOL COMES FROM THE ARABIC ‘ALKOHL’ WHICH IS A FINE METALLIC POWDER USED IN THE EAST TO STAIN THE FACE AND EYELIDS. THE NAME WAS LATER EXTENDED TO MEAN ANY POWDER PRODUCED BY TITRATION AND SUBLIMATION, AND THEN TO A FLUID OBTAINED BY DISTILLATION .
Ethanol (ethyl alcohol) is a transparent, colorless, volatile liquid having a characteristic odor and a burning taste with a specific gravity of 0.79.
Ethanol is produced by the enzymatic action of yeasts on vegetable substrate containing sugars
At low doses, alcohol is said to have beneficial effects, such as decreased rates of myocardial infarction, diabetes, stroke, gallstones and possibly Alzheimer’s dementia, but consumption of two standard drinks per day increases the risk of health problems in many organ systems
. About 210 g of alcohol in men and 140 g of alcohol in women per week are considered as safe limits for drinking, if liver damage is to be avoided
.Different types of beverages with %age of alcohol are :-
Arrack (Arabic : araq – sweet or strong liquor usually made from raisins in those regions) is country liquor distilled from coco-palm, rice, sugar or jaggery and has strength of 40-50%. Country liquor is usually more intoxicating than either imported or Indian-made foreign liquor.country liquor +
Denatured spirit (‘hooch tragedy’).
Ethanol acts mainly on the CNS.
It acts as depressant of specialized
and sensitive cells of cerebral cortex
(centres regulating conduct,
judgement and self-criticism)
with release of inhibitory tone, leading to unrestrained behaviour.
This is followed by depression of vital centres of medulla producing coma and death.Alcohol also acts a hypnotic, diaphoretic and in small doses as an appetizer .
Following absorption, the concentration of alcohol in the blood reaches a maximum in about 45-90 minutes after ingestion.
With an empty stomach, there is a rapid rise and slow decline. With diluted drinks or a full stomach, the rise is slower and the maximum peak is lower, with a flatter BAC curve. If subsequent drinks are taken, the new alcohol is superadded to the existing curve .
Factors that interfere with absorption are:
Presence of food in stomach retards absorption.
Strength of alcoholic beverages taken – higher the strength more rapid will be the rate of absorption.
Diluted drinks, such as beer may take double the time to absorb, compared to stronger drinks.
Drugs, like insulin or prostigmine increase the absorption, while atropine delays absorption.
Carbonated drinks hasten absorption, as the bubbles greatly increase the surface area carrying alcohol.
Warm alcoholic drinks which dilate gastric mucosal capillaries are more quickly absorbed than iced drinks of same strength .
Ethanol is distributed evenly throughout the body, passing the blood-brain barrier easily to affect cerebral function. However, it is poorly soluble in body fat, which is why females of the same body size, will produce a higher BAC for the same amount of drink, as their aqueous compartment is smaller.
It attains equilibrium with a constant blood alcohol concentration and concentration of alcohol in other body fluids.
Ninety percent of ethanol is metabolized in the liver, while the kidneys and lungs help to excrete about 10% only. In the liver, alcohol is oxidized by alcohol dehydrogenase . Some of the alcohol is converted to other substances (such as fat, as in beer belly.
Non-habituated persons metabolize ethanol at 13-25 mg/dl/h.
In alcoholics, this rate increases to 30-50 mg/dl/h. because of tolerance, BACs must be interpreted in conjunction with history and clinical presentation.
Excretion of alcohol is mainly by the kidneys, lungs and skin through urine, breath and sweat respectively. It is also secreted in saliva and milk .
It is characterized by a gradual physical, mental and moral deterioration .
Physical : There is lack of personal hygiene loss of appetite, chronic gastroenteritis, wasting, peripheral neuropathies, impotence, sterility, fatty changes in liver and heart, cirrhosis, tremors. Insomnia, red eyes and intermittent infections.
Mental: There is loss of memory, impaired power of judgement and dementia .
Tremulousness or shake or jitter (most common sign) weakness, pain in muscle, cold sweat, insomnia, loss of appetite, vomiting, diarrhea, restlessness, exaggerated reflexes, raised temperature, fluctuating BP, hallucinations, loss of memory and delirium tremens
The Tremors may be accompanied by tachycardia, diaphoresis, anorexia, and insomnia. After 24-72 hours, the alcoholic may have rum fits (i.e. generalized seizures).
Intravenous thiamine initially, followed by oral (100 mg 8 hourly).
Supplementation of electrolytes, particularly magnesium and potassium.
Alcoholic paranoia :- In this, there is a fixed delusion, but no hallucinations. Patient becomes suspicious of the motives and actions of those he meets and of his family members.
Merchiafava-Bignami syndrome :- rare disorder characterized by disorientation, epilepsy, ataxia, dysarthria, hallucinations, spastic limb paralysis, and personality and intellectual deterioration. There is widespread demyelination of corpus callosum, optic tracts and cerebellar peduncles. The cause is probably some alcohol-related nutritional deficiency.
Definition : It is a condition which results from excessive intake of alcohol. The person under its influence shows the following:
Loss of control over his mental faculties.
Inability to perform the duties in which he is engaged.
Dangerous to himself or to others.
Consent for Examination
The detained persons should not be examined and blood, urine or breath should not be collected without his written consent.
If the person becomes unconscious or incapable of giving consent, examination and treatment can be carried out, but the doctor should not disclose any information obtained during examination and wait for his consent, till he regains consciousness.
Under Sec 53 (1) CrPC , examination of an accused can be carried out by a doctor at the request of the police, even without his consent and by use of force, if necessary. Such examination may include taking of body fluids in cases of suspected intoxication.
Diagnosing a Case of Drunkenness Preliminary data such as name, age, sex etc. History: should be obtained from the accused person while observing him. Note, if he admits having taken alcoholic drinks. If so, the nature, quantity and time of consumption should be recorded. Exclusion of injuries n Pathological conditions:
The report should be written at that time and at the end the police informed about the doctor’s opinion (based on examination and laboratory findings). The opinion can be drafted with any one of the following statements:
He/she has not consumed alcohol.
He/she has consumed alcohol, but not under the influence of it.
He/she has consumed alcohol and is under its influence
. sec. 85 IPC : Nothing is an offence which is done by a person who at the time of doing it, by reason of intoxication, is incapable of knowing the nature of the act , or that he is doing what is either wrong or contrary to law; provided that thing which intoxicated him was administered to him without his knowledge or against his will.
Voluntary drunkenness is not an excuse for commission of crime.
Sec. 510 IPC: Misconduct by a drunken person in public is punishable with imprisonment upto 24 hours.
Driving under the influence of alcohol or drunk driving : Operating a motor vehicle after having consumed alcohol or other drugs, to the degree that mental and motor skills are impaired.
Authorities around the world have laid down their own standards for permissible maximum BAC.
In India, according to Motor Vehicles Act 1998, for the first offence, punishment is imprisonment of 6 months and/or fine of Rs 2000. If a second offence is committed within 3 years, the punishment is 2 years and/or fine of Rs 3000. Under this Act, there can be arrest without warrant, a breath test and a laboratory test can also be carried out.
The age for possession and consumption of alcoholic beverages in Australia and Canada is 18 years, in European countries, it is between 16-18 years, in US, it is ≥21 years and India, it is between 18-25 (varies between states).
The BAC is the most useful measure, because there is rapid equilibration across the blood-brain barrier, therefore BAC reflects the concentration of alcohol currently affecting the brain.
The urine alcohol is more concentrated than blood level, due to tubular resorption of water in the ratio of 1.3: 1. However, it is less useful, as the ureteric urine concentration varies with rising or falling BAC
Breath alcohol, unlike urine, is in equilibrium with blood, even though in a very small concentration of about 1: 2300. The exact ratio of blood/breath alcohol is temperature dependent and varies slightly with other factors, such as the depth of respiration and concentration of alcohol.
Breathalyzer (or breath analyzer is a device for estimating BAC from a breath sample. In 1954, Dr. Robert Borkenstein invented the breathalyzer, which used chemical oxidation and photometry to determine alcohol concentration. The invention of the breathalyzer provided law enforcement with a non-invasive test with immediate results to determine an individual’s BAC at the time of testing.
Gas liquid chromatography (GLC): Most reliable method. It is extremely sensitive and produces accurate quantitative results. In high performance liquid chromatography (HPLC), the sample is in liquid state at the time or analysis, rather than in volatile state as in GLC*
2. Alcohol dehydrogenase (ADH) method : It is highly specific and accurate