5. DIAGNOSTIC CRITERIA(DSM V)
A. Recent ingestion of alcohol.
B. Clinically significant problematic behavioral or
psychological changes that developed during, or
shortly after, alcohol ingestion.
6. C. One (or more) of the following signs or symptoms developing
during, or shortly after, alcohol use:
1. Slurred speech
2. Incoordination
3. Unsteady gait
4. Nystagmus
5. Impairment in attention or memory
6. Stupor or coma
D. The signs or symptoms are not attributable to another
medical condition and are not better explained by another
mental disorder
DIAGNOSTIC CRITERIA CONT…
7. All alcohols cause clinical inebriation
strength of the inebriating effects directly
proportional to the alcohol’s molecular weight
Ethanol and isopropanol are the most
common alcohols ingested.
Methanol and ethylene glycol are toxic
alcohols with serious physiologic morbidity.
8. ETHANOL
is a colorless, volatile liquid
most frequently used and abused drug
Toxicity most commonly occurs from ingestion,
Also absorbed via inhalation or percutaneous
exposure.
9. METABOLISM
Rapidly absorbed after oral administration.
Peak blood levels about 30 to 60 minutes.
The volume of distribution of
0.6 L/kg in men
0.7 L/kg in women
13. RESPIRATORY SYSTEM
respiratory depression
decreased airway sensitivity to foreign bodies
decreased ciliary clearance and aspiration
increased risk of bacterial infection
CINICAL FEATURES CONT…
14. HYPOGLYCEMIA
usually in children and malnourished individuals
Increases NADH/NAD+ ratio, which then promotes
the conversion of pyruvate to lactate, diverting
pyruvate away from the gluconeogenesis pathway
CINICAL FEATURES CONT…
15. Alcoholic Ketoacidosis
Nausea, vomiting, and abdominal pain are
common
presenting complaints.
ketonuria, and little or no glucosuria.
Serum glucose levels are usually less than 200
mg/dL.
16. Wernicke-Korsakoff Syndrome
Although they are similar pathologically and
caused by thiamine deficiency.
Wernicke’s encephalopathy,
a medical emergency
mortality rate of 10 to 20%,
17. dietary deficiencies
oculomotor abnormalities
cerebellar dysfunction
either an altered mental state or mild memory
impairment
Wernicke-Korsakoff CONT…
18. Korsakoff ’s psychosis or amnesic state
is a disorder with recent memory impairment
inability to learn new information , recall
previously learned information
apathy
Wernicke-Korsakoff CONT…
19. RBS level.
Ethanol blood levels are not necessarily
required in cases of mild or moderate
intoxication
Can cause of an osmolar gap and may be
associated with a mild metabolic acidosis
20. ISOPROPANOL
is a colorless, volatile liquid with a bitter,
burning taste and an aromatic odor.
found in many household products, such as
rubbing alcohol (usually 70% isopropanol).
a component of a variety of skin and hair
products, jewelry cleaners, detergents, paint
thinners.
21. Poisoning usually results from ingestion
Toxic dose of 70% isopropanol is about
1mL/kg
The minimum lethal dose for an adult is
approximately 2 to 4 mL/kg
22. 80% of a dose is absorbed within 30 minutes
of ingestion.
Its peak blood levels occur 30 to 120 minutes
after ingestion
23.
24. CNS
headache, dizziness, neuromuscular
incoordination, confusion, and nystagmus.
Pupillary size varies, but miosis is most common
Severe ingestions may result in CNS depression,
deep coma.
CINICAL FEATURES
25. GASTRIC IRRITATION
nausea, vomiting, abdominal pain, acute
pancreatitis, hemorrhagic gastritis and upper
GI bleeding
CINICAL FEATURES CONT…
26. Rhabdomyolysis and renal failure
hypotension secondary to peripheral
vasodilation.
Hypoglycemia
the increased NADH/NAD+ ratio
CINICAL FEATURES CONT…
27. primarily are used to exclude other ingestions
ketosis with little or no acidosis
“pseudo–renal failure”
labaratory
28. METHANOL
the simplest alcohol
colorless, volatile liquid
found in automotive windshield cleaning
solution, solid fuel for stoves and chafing
dishes, model airplane fuel, carburetor
cleaner, gas line antifreeze, photocopying
fluid, and solvents.
29. Peak blood levels achieved within 30 to 60
minutes,
volume of distribution of 0.6 to 0.77 L/kg.
minimum lethal dose is thought to be
approximately 1 gram/kg or 1.25 mL/kg.
30.
31. Formic acid’s main mechanism of
toxicity
binding to cytochrome oxidase
This leads to anaerobic metabolism and
development of lactic acidosis.
CINICAL FEATURES CONT…
32. less inebriating than ethanol,
Early symptoms of methanol poisoning include
depressed mental status, confusion, and
ataxia.
in severe cases, coma and seizures may be
seen
33. Optic neuropathy
The primary sites of ocular injury are the
retrolaminar optic nerve and retina
may present as photophobia or blurred or “snow
field” vision,
clinical findings: papilledema, nystagmus (rare),
and nonreactive mydriasis.
34. putaminal necrosis
Acute signs and symptoms may take several days
to develop despite the presence of these
radiographic findings
occurring in 13.5% of patients
35.
36. Cardiovascular toxicity
tachycardia and hypotension, which may
progress to shock.
Tachypnea and shortness of breath
while attempting to compensate for the metabolic
acidosis, and progress to respiratory failure.
37. Elevated osmolar gap
A severe anion gap metabolic acidosis
onset of acidosis may be delayed 12 to 24
hours
38. ETHYLENE GLYCOL
is a colorless, odorless, sweet-tasting liquid
has many contemporary uses as a glycerin
substitute, preservative, component of
hydraulic brake fluid, foam stabilizer,
component for chemical synthesis, and most
commonly an automotive coolant (antifreeze)
39.
40. End-organ damage from ethylene glycol
poisoning
due direct cytotoxicity of glycolic acid
tissue damage from precipitation of calcium
oxalate crystals.
41. The first (neurologic) stage
typically begins 30 minutes to 12 hours after
ingestion
may range from mild depression to seizure and
coma.
Metabolites effect include
cerebral edema,
basal ganglia hemorrhagic infarction
meningoencephalitis.
42. The second (cardiopulmonary) stage
begins 12 to 24 hours after ingestion
characterized by tachycardia and possibly
hypertension.
Glycolate and oxalate crystal deposition in
tissues leads to multiorgan system failure
43. The third (renal) stage
is often delayed 24 to 72 hours after ingestion
and
is characterized by renal failure due to calcium
oxalate
crystal deposition in the proximal tubules,
45. ALCOHOL WITHDRAWAL
Diagnostic Criteria
1. Cessation or reduction in alcohol use that has been heavy and prolonged
2. Two (or more) of the following,
I. Autonomic hyperactivity
II. Increased hand tremor.
III. Insomnia.
IV. Nausea or vomiting.
V. Transient visual, tactile, or auditory hallucinations or illusions.
VI. Psychomotor agitation.
VII. Anxiety.
VIII. Generalized tonic-clonic seizures.
46. 3. The signs or symptoms in Criterion B cause clinically
significant distress or impairment in social,
occupational, or other important areas of functioning.
4. The signs or symptoms are not attributable to another
medical condition and are not better explained by
another mental disorder
ALCOHOL WITHDRAWAL
47.
48. DELIRIUM TREMENS
affects 5% to 10% of patients
result of modulation of 2 primary sites
the γ-aminobutyric acid type A (GABAA)
N-methyl-D-aspartate (NMDA) receptors
49. Tintinalli’s Emergency Medicine 8th edition
Rosen's Emergency Medicine - Concepts and
Clinical Practice 8th edition
Global status report on alcohol and health
2014
Up to date 21.6
REFERRENCE
Editor's Notes
globally, individuals above 15 years of age drinkon average 6.2 litres of pure alcohol per year whichtranslates into 13.5 grams of pure alcohol per day
molecular weight 46.07
With about 10% excreted in the urine, exhaled breath, and sweat.
enhances the inhibitory neurotransmitter γ-aminobutyric acid receptors and blockade of excitatoryN-methyl-d-aspartic acid receptors
holiday heart syndrome”,characterized by atrial or ventricular tachyarrhythmias andnew-onset atrial fibrillation after acute alcohol ingestion
chronic alcohol consumption decreases the level of glutathione,
promoting inflammation and remodeling of the lung tissue.
with consequent bronchitis and pneumonia
remains a clinical diagnosis
Whereas 80% of patients with acute Wernicke’s encephalopathy
have Korsakoff ’s syndrome,
oculomotor abnormalities (nystagmus is most common),
Deficiency of thiamine-dependent enzyme(transketolase)
also called alcohol induced persisting amnestic disorder
Molecular weight of 60.10
although as little as 0.5 mL/kg may cause symptoms.
its volume of distribution is similar to that of ethanol.
The major pathway is in the liver by alcohol dehydrogenase (50% to 80%),
Acetone is excreted primarily by the kidneys,
some excretion through the lungs
Isopropanol is a potent CNS depressant, but the mechanism ofaction is unclearPatients may have a loss of deep tendon, corneal, or protective airway reflexes and have an extensor response to plantar reflex testing.
Hypotension, although rare, signifies severe poisoning, with amortality rate of 45%
serum electrolyte values, BUN and creatinine concentrations, osmolality, serum and urineketones, and arterial blood gas analysis
The ketosis is from the metabolite acetone, which can bedetected in the blood 15 minutes after ingestion and in the urine3 hours after ingestion.
isolated false elevation of creatinine with a normal BUN concentration. This condition resultsfrom interference of acetone and acetoacetate by the colorimetricmethod of creatinine determination
(CH3OH, molecular weight 32.05),
Methanol is metabolized in the liver by alcohol dehydrogenase to formaldehyde
then by aldehyde dehydrogenase to formic acid
blockade of oxidative phosphorylation.
Visual disturbances are seen in 50%, the primary sites of ocular injury are the retrolaminar opticnerve and retina
molecular weight 62.07]
(although the exact mechanism of this is unclear
Most deaths occur during this stage.
Other findings reflecting tubular dysfunction include decreased