This document discusses alcohol poisoning, including how ethanol is produced through fermentation and purified, typical alcohol concentrations in different beverages, how alcohol is metabolized in the body, signs and symptoms of alcohol intoxication in different stages from excitement to coma, and fatal doses. It also covers treatment of alcohol poisoning, potential post-mortem findings, and chronic effects of long-term alcohol abuse.

1. Alcohol poison
Dr Paresh Kared

2. • In a pure form ethyl alcohol is transparent, colourless, volatile liquid, having a
spirituous odour and burning taste. It is both water-soluble and lipid soluble.
• Ethanol is obtained by fermentation of sugars, molasses, grains, fruit juices
and starch. It is a complex enzymic process. The enzymes are obtained from
yeast. It is carried out under controlled conditions. The final fermented mass
contains about 10 per cent alcohol. It is then purified by distillation. All strong
alcoholic beverages are distilled products after fermentation.
• Proof sipirit
• Rum , whisky, gin – 42.8% by volume (75proof)
• Wines (8-15%), beers (2-10%), country liquor (11.4-45.7)(arrack)

3. Factors
• Alcohol concentration
• Food in stomach
• Condition of stomach wall
• Rate of drinking
• Weight of person
• Tolerance level
• Fat, milk and proteins retard absorption
When a person consumes
alcohol, the full effects may
take some time to become
apparent. Depending on a
number of factors—including
the amount consumed, the
rate of consumption, gender,
body weight, and whether the
drinking episode took place on
an empty or full stomach1—
there are somewhat
predictable stages of alcohol
intoxication through which the
individual may progress as
their drinking continues.

4. % in tissue
• 45-50 minutes after ingestion
• Brain 1.17
• Blood 1.00
• Plasma 1.16
• Urine 1.33
• Vitreous and bile 1.12
• Liver 0.91
• Clot 0.77
🖋🖋This all values after ingestion 45-
50 minutes.

5. Metabolism
• 90% in liver and 10 % in urine and lungs
• 15-20 ml / hours/100ml blood
• Excess leads to signs and symptoms
• 50mg/100ml blood ------consumed 70ml (75% proof alcohol)

6. Sign and Symptoms
• 30-100mg (0.05 to 0.1)per cent …excitement (behavior)
• 100-300mg(0.1 to 0.25)per cent …… incoordination (cortex)
• Above 300mg(>0.25)per cent ….. Narcosis (medulla)
• From cortex to medulla
NOTE:- This value per 100 of blood.

7. TABLE OF CONTENTS
• Alcohol Intoxication
• Stage 1: Sobriety, or Subclinical Intoxication
• Stage 2: Euphoria
• Stage 3: Excitement
• Stage 4: Confusion
• Stage 5: Stupor
• Stage 6: Coma
• Stage 7: Death
• Understand the Risks

8. • Stage of excitement: This stage develops with blood alcohol concentration
(BAC) of 0.05 to 0.1 per cent, i.e. 50-150 mg/ 100 ml of blood. In a non-
addict person, there is a sense of well-being or euphoria and is due to the
depression of inhibition controlling capacity of higher evolutionary centres;
there will also be changes in behaviour of the person and he becomes:
• Free in action, speech and emotions
• He may perform dancing, thrilling shows, etc. carelessly and fearlessly
• He might disclose secrets
• The person might show increase in confidence, but lack of self-control
• There may be easy sexual excitation and desire but cannot perform the act
due to impotency (thus, alcohol is not an aphrodisiac)
• There will be lowering of visual acuity
• There will be reduction of mental concentration power, leading to
impairment of judgement.

9. Stage of incoordination: This stage develops with a blood alcohol concentration (BAC)
of 0.15 to 0.25 per cent, i.e.150-250 mg/ 100 ml of blood. This is due to further
depression of higher centre. The individual may present with:
• Morose/gay/irritable/excitable/quarrelsome/sleepy, etc behavior depending on the
dominant impulses released. Memories of recent events are impaired.
• Soon when the centres of perception and skilled movements are involved, the victim
presents with incoordination, inabilities to perform skilled movements, alteration in
speech, etc. In addition to this he will have:
• – Face flushed ,Breath with alcoholic smell
• Eye changes such as: Increase in reaction time.
• The pupils are dilated and sluggishly react to light (this is a dangerous sign), and
accommodation.
• Positional nystagmus may be observed (i.e. jerky movements of the eyeball in
direction of gaze independent of the movement of head and is called as alcohol gaze
nystagmus, with blood level at 0.03- 0.05%).
– There will be excessive sweating, loss of body heat, resulting in fall of body
temperature (subnormal temperature). This may be also due to the depression of
temperature regulation centre.

10. Stage of Coma
• Blood alcohol concentration (BAC) required to develop stage of coma is > 0.25
per cent, i.e. >250 mg/100 ml of blood. This occurs when both motor and
sensory cells are deeply affected, resulting in:
• Speech—thick, slurred
• The victim may become giddy, stagger and may fall as
• coordination is markedly affected.
• Ultimately, he may go into the stage of coma with stertorous
• breathing, rapid thready pulse, subnormal temperature, etc.
• Pupils are constricted, but it reacts to external painful stimuli (like pinching or
slapping on the face, etc.) by dilatation followed by constriction again. This is
called as McEvan’s sign and if this is positive, it is suggestive of alcoholic coma.

11. • Fatal dose (in a non-addict)
Adult: 150-250 ml of absolute alcohol (Approximately 6 gm of
ethanol/kg body weight).
Children: 60 ml of absolute alcohol (Approximately 3 gm of ethanol/kg
body weight).
• Fatal period—12 to 24 hours though death maybe delayed for 5 to 6
days.

12. Treatment
• Gastric lavage - 5% solution of sodium bicarbonate
• Intravenous glucose
• Ventilation
• Haemodialysis
• Chlorpromazine
• Coramine 3-5 ml by slow intravenously

13. PM changes
• Odour of alcohol around mouth and nose and upon opening the body.
• Clothes are in disorderly/torn conditions. Stains due to vomit or blood may be seen.
• Bruises are generally found on various parts of the body. Other injuries may also be
present.
• Congestion of conjunctiva
• Rigor mortis is prolonged
• Decomposition is retarded
• Brain is oedematous and congested. In individuals who sustain head injury with subdural
or epidural haemorrhage and survive for house to days, the peripheral blood may be
negative for alcohol. However, chemical analysis of blood clot in case of epidural
haemorrhages can give exact concentration of alcohol at the time of injury. Vitreous
chemical analysis is also helpful in knowing accurate alcoholic status of the deceased.
• All the viscera are congested and smell of alcohol. In addicts liver may be cirrhotic and
brain may show degenerative changes
• Blood—fluid and dark.

14. Chronic
• Delirium tremenus
• Korsakoff pyschosis
• Hallucinosis
• Use of antabuse therapy (disulfiram, metronidazole) – when these
drugs are used in the treatment of alcoholism; causes nausea and
vomiting if alcohol is ingested, which makes the alcoholic give up
alcohol.