This document discusses alcohol poisoning and the effects of ethanol. It covers the categories of alcohols, ethanol uses including as a beverage and in medicine, toxicokinetics of ethanol absorption and metabolism, mechanisms of action on the body, acute and chronic poisoning symptoms, and treatment approaches for alcohol poisoning and chronic alcoholism.
This is a case study on ethanol poisoning. Ethanol poisoning involves the consumption of over 25 mg/dL of ethanol. It affects age groups from young to elderly likewise. Treatment involves preliminary ABCD and administration of Disulfiram.
Presentation explains about toxicity of alcohol and various methods used by the police to detect the presence of alcohol in the blood and various alcohol composition.
This is a case study on ethanol poisoning. Ethanol poisoning involves the consumption of over 25 mg/dL of ethanol. It affects age groups from young to elderly likewise. Treatment involves preliminary ABCD and administration of Disulfiram.
Presentation explains about toxicity of alcohol and various methods used by the police to detect the presence of alcohol in the blood and various alcohol composition.
Gut decontamination or methods of poison removal in clinical toxicology Soujanya Pharm.D
This presentation includes various methods of poison removal like emesis, gastric lavage (stomach wash), catharsis, activated charcoal, whole bowel irrigation.
Gut decontamination or methods of poison removal in clinical toxicology Soujanya Pharm.D
This presentation includes various methods of poison removal like emesis, gastric lavage (stomach wash), catharsis, activated charcoal, whole bowel irrigation.
alcohol perturbs the balance between excitatory and inhibitory influences in the brain, resulting in Anxiolysis. An increased reaction time, diminished fine motor control, impulsivity, and impaired judgement be come evident when the concentionof alcohol in the blood is 20-30mg/dl.
More than 50% of persons are grossly intoxicated by a conc. Of 150mg/dl.
The defintion of intoxication varies by country.
Alcohol can be measured in saliva, urine,sweat,and blood, level in exheled air remains the primary method of assessing the level of intoxication.
Ethanol (CH 3 CH 2 OH) is a water-soluble alcohol that rapidly crosses cell membranes.
Absorption of ethanol occurs via the gastrointestinal system, primarily in the stomach (70 percent) and duodenum (25 percent), with a small amount absorbed by the remaining intestine .
When the stomach is empty, peak blood ethanol levels are reached between 30 and 90 minutes after ingestion.
Toxic alcohol includes Methanol, Ethylene Glycol, Isopropyl alcohol. The toxicokinetics, clinical features are explained separately. Pathophysiology of toxic alcohols explained using diagrams. diagnosis can be done using HAGMA, High osmolar gap, UFR and ECG. Management is determined by block metabolism, correct pH and eliminate toxic metabolites.
micro teaching on communication m.sc nursing.pdfAnurag Sharma
Microteaching is a unique model of practice teaching. It is a viable instrument for the. desired change in the teaching behavior or the behavior potential which, in specified types of real. classroom situations, tends to facilitate the achievement of specified types of objectives.
These lecture slides, by Dr Sidra Arshad, offer a quick overview of physiological basis of a normal electrocardiogram.
Learning objectives:
1. Define an electrocardiogram (ECG) and electrocardiography
2. Describe how dipoles generated by the heart produce the waveforms of the ECG
3. Describe the components of a normal electrocardiogram of a typical bipolar leads (limb II)
4. Differentiate between intervals and segments
5. Enlist some common indications for obtaining an ECG
Study Resources:
1. Chapter 11, Guyton and Hall Textbook of Medical Physiology, 14th edition
2. Chapter 9, Human Physiology - From Cells to Systems, Lauralee Sherwood, 9th edition
3. Chapter 29, Ganong’s Review of Medical Physiology, 26th edition
4. Electrocardiogram, StatPearls - https://www.ncbi.nlm.nih.gov/books/NBK549803/
5. ECG in Medical Practice by ABM Abdullah, 4th edition
6. ECG Basics, http://www.nataliescasebook.com/tag/e-c-g-basics
The prostate is an exocrine gland of the male mammalian reproductive system
It is a walnut-sized gland that forms part of the male reproductive system and is located in front of the rectum and just below the urinary bladder
Function is to store and secrete a clear, slightly alkaline fluid that constitutes 10-30% of the volume of the seminal fluid that along with the spermatozoa, constitutes semen
A healthy human prostate measures (4cm-vertical, by 3cm-horizontal, 2cm ant-post ).
It surrounds the urethra just below the urinary bladder. It has anterior, median, posterior and two lateral lobes
It’s work is regulated by androgens which are responsible for male sex characteristics
Generalised disease of the prostate due to hormonal derangement which leads to non malignant enlargement of the gland (increase in the number of epithelial cells and stromal tissue)to cause compression of the urethra leading to symptoms (LUTS
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Lung Cancer: Artificial Intelligence, Synergetics, Complex System Analysis, S...Oleg Kshivets
RESULTS: Overall life span (LS) was 2252.1±1742.5 days and cumulative 5-year survival (5YS) reached 73.2%, 10 years – 64.8%, 20 years – 42.5%. 513 LCP lived more than 5 years (LS=3124.6±1525.6 days), 148 LCP – more than 10 years (LS=5054.4±1504.1 days).199 LCP died because of LC (LS=562.7±374.5 days). 5YS of LCP after bi/lobectomies was significantly superior in comparison with LCP after pneumonectomies (78.1% vs.63.7%, P=0.00001 by log-rank test). AT significantly improved 5YS (66.3% vs. 34.8%) (P=0.00000 by log-rank test) only for LCP with N1-2. Cox modeling displayed that 5YS of LCP significantly depended on: phase transition (PT) early-invasive LC in terms of synergetics, PT N0—N12, cell ratio factors (ratio between cancer cells- CC and blood cells subpopulations), G1-3, histology, glucose, AT, blood cell circuit, prothrombin index, heparin tolerance, recalcification time (P=0.000-0.038). Neural networks, genetic algorithm selection and bootstrap simulation revealed relationships between 5YS and PT early-invasive LC (rank=1), PT N0—N12 (rank=2), thrombocytes/CC (3), erythrocytes/CC (4), eosinophils/CC (5), healthy cells/CC (6), lymphocytes/CC (7), segmented neutrophils/CC (8), stick neutrophils/CC (9), monocytes/CC (10); leucocytes/CC (11). Correct prediction of 5YS was 100% by neural networks computing (area under ROC curve=1.0; error=0.0).
CONCLUSIONS: 5YS of LCP after radical procedures significantly depended on: 1) PT early-invasive cancer; 2) PT N0--N12; 3) cell ratio factors; 4) blood cell circuit; 5) biochemical factors; 6) hemostasis system; 7) AT; 8) LC characteristics; 9) LC cell dynamics; 10) surgery type: lobectomy/pneumonectomy; 11) anthropometric data. Optimal diagnosis and treatment strategies for LC are: 1) screening and early detection of LC; 2) availability of experienced thoracic surgeons because of complexity of radical procedures; 3) aggressive en block surgery and adequate lymph node dissection for completeness; 4) precise prediction; 5) adjuvant chemoimmunoradiotherapy for LCP with unfavorable prognosis.
Pulmonary Thromboembolism - etilogy, types, medical- Surgical and nursing man...VarunMahajani
Disruption of blood supply to lung alveoli due to blockage of one or more pulmonary blood vessels is called as Pulmonary thromboembolism. In this presentation we will discuss its causes, types and its management in depth.
MANAGEMENT OF ATRIOVENTRICULAR CONDUCTION BLOCK.pdfJim Jacob Roy
Cardiac conduction defects can occur due to various causes.
Atrioventricular conduction blocks ( AV blocks ) are classified into 3 types.
This document describes the acute management of AV block.
Tom Selleck Health: A Comprehensive Look at the Iconic Actor’s Wellness Journeygreendigital
Tom Selleck, an enduring figure in Hollywood. has captivated audiences for decades with his rugged charm, iconic moustache. and memorable roles in television and film. From his breakout role as Thomas Magnum in Magnum P.I. to his current portrayal of Frank Reagan in Blue Bloods. Selleck's career has spanned over 50 years. But beyond his professional achievements. fans have often been curious about Tom Selleck Health. especially as he has aged in the public eye.
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Introduction
Many have been interested in Tom Selleck health. not only because of his enduring presence on screen but also because of the challenges. and lifestyle choices he has faced and made over the years. This article delves into the various aspects of Tom Selleck health. exploring his fitness regimen, diet, mental health. and the challenges he has encountered as he ages. We'll look at how he maintains his well-being. the health issues he has faced, and his approach to ageing .
Early Life and Career
Childhood and Athletic Beginnings
Tom Selleck was born on January 29, 1945, in Detroit, Michigan, and grew up in Sherman Oaks, California. From an early age, he was involved in sports, particularly basketball. which played a significant role in his physical development. His athletic pursuits continued into college. where he attended the University of Southern California (USC) on a basketball scholarship. This early involvement in sports laid a strong foundation for his physical health and disciplined lifestyle.
Transition to Acting
Selleck's transition from an athlete to an actor came with its physical demands. His first significant role in "Magnum P.I." required him to perform various stunts and maintain a fit appearance. This role, which he played from 1980 to 1988. necessitated a rigorous fitness routine to meet the show's demands. setting the stage for his long-term commitment to health and wellness.
Fitness Regimen
Workout Routine
Tom Selleck health and fitness regimen has evolved. adapting to his changing roles and age. During his "Magnum, P.I." days. Selleck's workouts were intense and focused on building and maintaining muscle mass. His routine included weightlifting, cardiovascular exercises. and specific training for the stunts he performed on the show.
Selleck adjusted his fitness routine as he aged to suit his body's needs. Today, his workouts focus on maintaining flexibility, strength, and cardiovascular health. He incorporates low-impact exercises such as swimming, walking, and light weightlifting. This balanced approach helps him stay fit without putting undue strain on his joints and muscles.
Importance of Flexibility and Mobility
In recent years, Selleck has emphasized the importance of flexibility and mobility in his fitness regimen. Understanding the natural decline in muscle mass and joint flexibility with age. he includes stretching and yoga in his routine. These practices help prevent injuries, improve posture, and maintain mobilit
Ozempic: Preoperative Management of Patients on GLP-1 Receptor Agonists Saeid Safari
Preoperative Management of Patients on GLP-1 Receptor Agonists like Ozempic and Semiglutide
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Flu Vaccine Alert in Bangalore Karnatakaaddon Scans
As flu season approaches, health officials in Bangalore, Karnataka, are urging residents to get their flu vaccinations. The seasonal flu, while common, can lead to severe health complications, particularly for vulnerable populations such as young children, the elderly, and those with underlying health conditions.
Dr. Vidisha Kumari, a leading epidemiologist in Bangalore, emphasizes the importance of getting vaccinated. "The flu vaccine is our best defense against the influenza virus. It not only protects individuals but also helps prevent the spread of the virus in our communities," he says.
This year, the flu season is expected to coincide with a potential increase in other respiratory illnesses. The Karnataka Health Department has launched an awareness campaign highlighting the significance of flu vaccinations. They have set up multiple vaccination centers across Bangalore, making it convenient for residents to receive their shots.
To encourage widespread vaccination, the government is also collaborating with local schools, workplaces, and community centers to facilitate vaccination drives. Special attention is being given to ensuring that the vaccine is accessible to all, including marginalized communities who may have limited access to healthcare.
Residents are reminded that the flu vaccine is safe and effective. Common side effects are mild and may include soreness at the injection site, mild fever, or muscle aches. These side effects are generally short-lived and far less severe than the flu itself.
Healthcare providers are also stressing the importance of continuing COVID-19 precautions. Wearing masks, practicing good hand hygiene, and maintaining social distancing are still crucial, especially in crowded places.
Protect yourself and your loved ones by getting vaccinated. Together, we can help keep Bangalore healthy and safe this flu season. For more information on vaccination centers and schedules, residents can visit the Karnataka Health Department’s official website or follow their social media pages.
Stay informed, stay safe, and get your flu shot today!
1. Prepared by B.Muni Sai Gagan
ALCOHOL POISONING
Presented by M.DIWAKAR
PharmD IVth YEAR
2. ALCOHOLS
• Alcohols are actually (hydroxyl) derivatives of (aliphatic)
hydrocarbons. There are 3 categories of alcohols—
1. Mono hydroxy alcohols : They have only one hydroxyl (OH) group,
e.g. ethanol, methanol, isopropanol, etc.
2. Di hydroxy alcohols : They possess two hydroxyl groups and are
referred to as glycols, e.g. ethylene glycol, propylene glycol, etc.
3. Tri hydroxy alcohols : They are not really alcohols, but only
derivatives, e.g. propane derivative glycerol or glycerine.
3. ETHANOL
Synonyms
Ethyl alcohol; Grain alcohol.
Physical Appearance
Clear, colourless liquid with a faint fruity odour, and sweetish
burning taste. It is both water soluble and lipid soluble
4. ETHANOL USES
Beverage—Popular alcoholic beverages include beer, wine, whisky, gin, brandy, rum,
and vodka
• In addition there are several
indigenous preparations
peculiar to particular regions,
e.g. arrack, toddy,
and feni in India, tequila in
Mexico, sake in Japan, eau de
vie or fruit brandy in France,
etc.
■ Solvent for after-shaves,
colognes, mouthwashes, and
perfumes. The alcohol content
Beverage
Light Beer (Lager and Pilsener)
Heavy Beer (Ale and Stout)
Natural Wine (Cider)
Fortified Wine (Sherry and
Port)
Whisky, Gin, and Brandy
Rum
Liqueurs (e.g. Cognac, Crème
de menthe, Schnapps, etc.)
Ethanol Content
(percentage by
volume)
4 to 6
6 to 8
2 to 3
10 to 20
40 to 45
40 to 50
17 to 50
Ethanol Content in Alcoholic Beverages
5. MEDICINAL USES
• Several antihistaminic, decongestant, multivitamin, and cough syrups contain
varying percentage of alcohol (2 to 25 %).
• Ethanol has been popular in the past as an antiseptic. Surgical spirit used even
today is mostly ethanol with a small quantity of methanol (90 to 95% and 5 to
10 % respectively), along with traces of castor oil and methyl salicylate.
• Ethanol sponging is an effective remedy for hyperthermia.
• Injection of dehydrated alcohol (absolute alcohol) in close proximity of nerves
or sympathetic ganglia is said to be effective for the relief of long lasting pain in
conditions such as trigeminal neuralgia.
• Antidote for methanol and ethylene glycol.
6.
7. OTHER USES
Preservative— Rectified spirit (90 to 95 % ethanol) is used as
a preservative for viscera, for chemical analysis.
■ Fuel.
■ Ethanol is used to extract nucleic acids from whole tissue or
tissue culture in virtually all biotechnology processes.
8. UsualFatalDose
• One pint (approximately 550 ml) or quart (two pints or
approximately 1100 ml) of a strong distilled spirit such as whisky
taken in a short span of time can be lethal.
• The usual fatal dose corresponds to approximately 6 grams of
ethanol/Kg body weight (adult); 3 gm/Kg (child).
• In terms of blood alcohol, a level in excess of 400 to 500 mg/100
ml is usually considered to be lethal. However there is a great deal
of controversy regarding this since there are case reports of
individuals succumbing to much lower blood alcohol
concentration (BAC), while there have been reports of survival
even with a BAC of over 1000 mg.
9. TOXICOKINETIC
S
OF ETHANOL
Ethanol is toxic by oral, inhalation, subcutaneous, intravenous,
intra-arterial, intraperitoneal, and dermal routes.
Following oral administration, ethanol is rapidly absorbed from
the stomach (20%) and small intestine (80%). MAC in blood is
reached in 30 to 90 minutes following the last drink.
Following an equivalent dose of ethanol, women achieve a
higher blood alcohol level than do men as a result of decreased
gastric alcohol dehydrogenase activity
MAC=Maximum or peak alcohol concentration
10. TOXICOKINET
ICS
OF ETHANOL
More than 90% of ethanol ingested is
metabolised in the body, and only 5 to 10% is
excreted unchanged by the kidneys, lungs, and
sweat.
Excretion of ethanol by the lungs obeys
Henry’s Law
11. HENRY’S LAW
It is the ratio between the concentration of ethanol in the
alveolar air and the blood is constant. This alveolar
air/blood constant (1 : 2100) forms the basis for reliably
estimating blood alcohol concentration by breath analysis
12. ALCOHOL METABOLISM
Metabolism of alcohol is accomplished through 3
pathways in the liver:
1.Alcohol dehydrogenase pathway
2.Microsomal ethanol oxidising system (MEOS, located on the
endoplasmic reticulum)
3.Peroxidase-catalase system (in the hepatic
peroxisomes).
17. In adults, the average rate of ethanol metabolism is 100 to 125 mg/kg/hr
in occasional drinkers, and upto 175 mg/kg/hr in habitual drinkers. The
blood alcohol level generally falls at a rate of 15 to 20 mg/100 ml/hr. This
may be higher ( upto 30 mg/100 ml/hr) in chronic alcoholics.
ETHANOL METABOLISM RATE
One standard drink contains
14g of pure alcohol
18. MECHANISM OF ACTION
Ethanol acts by enhancing gamma aminobutyric acid (GABA)-
nergic function through interaction with GABA A receptors and
associated chloride ion channels. However some investigators
are not convinced by this theory.
The second theory which appears to be more convincing has to
do with N-methyl-d-aspartate (NMDA) ligand gated, glutamate
receptors. NMDA receptors mediate neurotoxicity by increasing
permeability to calcium and regulate neuronal long-term
potentiation. Studies demonstrate that in the acute form of
ethanol use, NMDA receptor function is inhibited, while chronic
ethanol use results in up-regulation of NMDA receptors.
19. PHARMACOLOGICAL EFFECTS
Inhibitory control mechanisms in the brain, person becomes expansive, garrulous
and may demonstrate emotional lability with mood swings, sensory and motor
disturbances general impairment of CNS function, and finally coma supervenes.
Tachycardia and vasodilation of cutaneous vessels with resultant warm and
flushed skin. No beneficial increase in coronary blood flow occurs; in fact there
may be appreciable vasoconstriction which can aggravate existing angina. recent
studies have indicated that regular use of moderate amounts of ethanol is
associated with reduced risk for coronary heart disease
Ethanol normally stimulates salivary and gastric secretion but if the concentration
is too high (> 40%) they are inhibited, and the GI mucosa becomes congested and
inflamed leading to erosive gastritis. Regular intake of excessive amounts of
ethanol leads to chronic gastritis, pancreatitis, and cirrhosis of liver.
Ethanol is an aphrodisiac induces diuresis by inhibition of antidiuretic hormone.
Chronic ethanol consumption can lead to impotence, sterility, testicular atrophy,
and gynaecomastia (because of hyper-estrogenisation, and reduced production
as well as enhanced metabolic inactivation of testosterone)
CNS
CVS
GIT
GENITO-
URINARY
SYSTEM
20. ACUTE ETHANOL POISONING
Blood Alcohol
Concentration
(mg/100 ml)
0 – 50
50 – 100
100 – 150
150 – 200
200 – 300
300 – 500
> 500
Stage of
Intoxication
Sobriety
Euphoria
Excitement
Confusion
Stupor
Coma
Death
Clinical Features
Near normal behaviour
Feeling of well being, sociability, talkativeness, increased self confidence, decreased
inhibitions, fine movements affected.
Emotional instability, impairment of memory and comprehension, increased reaction
time, mild ataxia
Disorientation, confusion, vertigo, diplopia, ataxia, slurred speech, staggering gait
General inertia, diminished response to stimuli, inability to stand or walk, vomiting
Unconsciousness, abolished reflexes, subnormal temperature, incontinence of urine and
faeces, respiratory compromise
Death due to respiratory failure
21. CHRONIC POISONING
GIT— Gastritis, periodic diarrhoea, increased incidence of oropharyngeal and oesophageal
cancer.
Liver— Fatty liver with portal hypertension, hepatitis, cirrhosis, increased incidence of hepatic
carcinoma.
Pancreas— Acute or chronic pancreatitis, pancreatic cancer.
CVS— Cardiomyopathy, dysrhythmias, hypertension.
CNS— Polyneuropathy, cerebellar degeneration, demyelination of corpus callosum
(MarchiafavaBignami disease), amblyopia, stroke.
RS— Aspiration pneumonia, alcohol-induced asthma.
Endocrine— Hypogonadism and feminisation in males, amenorrhoea, menorrhagia, and
infertility in females, pseudo-Cushing syndrome.
Blood— Anaemia, thrombocytopenia.
Skeletal muscle— Myopathy.
Neuropsychiatric— Memory disturbances (amnesia, blackout), delusions, delirium tremens,
Wernicke’s encephalopathy, Korsakoff’s psychosis, dementia, alcoholic hallucinosis.
Teratogenecity— Foetal Alcohol Syndrome (FAS)
22.
23.
24.
25. ACUTE POISONING TREATMENT
a. Airway protection- ventilatory support.
b. Activated charcoal is NOT useful.
c. Stomach wash.
d. Thiamine 100 mg IV 30
e. Dextrose
1. Indications—If rapidly determined bedside glucose level is less
than 60 mg/100ml, or if rapid determination is not available.
2. Adult—25 grams (50 ml of 50% dextrose solution)
intravenously; may repeat as needed.
3. Paediatric—0.5 to 1 gram dextrose per kg as 25% dextrose
solution or 10% dextrose solution (2 to 4 ml/kg).
4. Precautions—Glucose administration should necessarily be
preceded by 100 mg of thiamine IV or IM if chronic alcoholism or
malnutrition is suspected, to prevent development of Wernicke’s
encephalopathy.
26. f. Intravenous fluids.
g. A variety of drugs have been tried to hasten the elimination of ethanol or
reverse its intoxicating effects, including naloxone, physostigmine, and caffeine.
None of them have been proved to be truly effective. Recently, flumazenil (3 mg
IV) has been shown to be effective (in experimental studies) in reversing the
respiratory depression associated with ethanol ingestion
h. Haemodialysis can eliminate ethanol 3 to 4 times more rapidly than liver
metabolism. May be useful in patients with excessive blood levels, impaired
hepatic function and in those whose condition deteriorates in spite of maximal
supportive measures. However, it is unusual for dialysis to be necessary to treat
even severe ethanol intoxication.
27. CHRONIC POISONING
Carbamazepine— It has been shown to be effective in treating alcohol
withdrawal, including delirium tremens.
Chlormethiazole— It is one of the most popular drugs used for alcohol
withdrawal abroad, and is administered in a rapidly reducing dosage over 6 to 7
days. However it is itself associated with a strong abuse potential.
Clonidine and gamma-hydroxybutyric acid have also shown promising results in
the treatment of withdrawal symptoms. The former is given at a dose of 60 to
180 mcg/hr IV, and the latter 50 mg/ kg, orally.
most recent entrants is tiapride, an atypical neuroleptic agent which is a
selective dopamine D2-receptor antagonist. the recommended dose is 400 to
1200 mg/day 6th hourly, while the maintenance dose subsequently to help
abstain from alcohol should not exceed 300 mg/day.
28. Aversion therapy
The main aim in the treatment of alcoholism is to
gradually wean away the patient from the clutches of
ethanol, once the acute manifestations of withdrawal
have been taken care of. This process referred to quit
loosely as de-addiction or detoxification, should be
undertaken only after admission to a hospital over a
period of several days, under close medical
supervision. The insatiable craving for alcohol that is
often present must be tackled effectively, and usually
requires strongly deterrent measures one of the more
successful ways is to administer a drug called
disulfiram. It is a disulfide molecule (tetra ethyl
thiuram)
29. PRINCIPLES OF DISULFIRAM
THERAPY
• Ensure that the patient is off alcohol
for a minimum period of 12 hours
before starting therapy.
• The usual dose of disulfiram is 250
mg/day which may have to be taken
for an indefinite period of time. Such
chronic use unfortunately often
produces side effects like halitosis,
pruritis, headache, drowsiness,
impotence, peripheral neuropathies,
depression, mania, psychosis, and
hepatotoxicity.