Examination of case of Drunkenness

1. Examination of case of
Drunkenness

2. Drunkenness
• It is a condition which results from excessive intake of
alcohol to a degree that mental and physical faculties are
noticeably impaired.
• The person under its influence shows the following:
1 . Loss of control over his mental faculties.
2. Inability to perform the duties in which he is engaged.
3. Dangerous to himself or to others.

3. Consent for Examination
• The detained person 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
collection of body fluids in cases of suspected intoxication.

4. Diagnosing a Case of Drunkenness
 Collect Priliminary data such as:
• Name
• Age
• Sex
• Address
• Time of examination
• Two identification marks
• Name of person who brought the patient

5. HISTORY
Enquire About
o Past illness
o Drug Treatment
o Nature , Quality and Time of Consumption of Alcohol
Before Diagnosing the case of drunkenness, rule out conditions like
Injuries (Head Injury) and other Pathological Conditions ,
psychological disorders which can stimulate alcoholic intoxication.

6. Clinical Examination
General appearance
Manner of dressing—properly dressed or not, and soiling
of clothes.
Posture—whether over-erect and over smart, can stand
steady or not, leans to a side or stoops forward, and can
stand without support or not

7. General Examination
The scalp should be inspected and palpated for evidence of any
head injury. Careful documentation of these injuries needs to be
done.
Specific Physical Examination
1. Gait : It is observed for any unsteadiness, staggering, bumping
into people or furniture.
2. Orientation and memory : Ask him about incidents which have
occurred few hours prior to examination to check his memory
(clear, vague or confused) and mental alertness.
3. Behavior : Whether noisy, jovial, boastful, rude, emotional,
talkative, excited, nervous or uncontrollable. If the subject is
cooperative, state it.

8. 4. Face : Note his face, whether normal, flushed or pale. Alcohol is
vasodilatatory, and redness of the face is indicative of this.
5. Speech: Record whether the patient can understand, and
whether his speech is normal, thick and slurred, stuttering or
confused.
6. Signs of vomiting and salivation: As soon as the alcohol reaches
a concentration of about 20% in the intestines, an ileus follows
which is responsible for vomiting. Nausea is responsible for
abnormal salivation.
7. Smell of alcohol: Strong, moderate, faint or none
8. Handwriting : The person is asked to copy a few lines from a
book or newspaper, and handwriting should be assessed.

9. 9. Eyes: Examine the eyes
• Conjunctiva : State of conjunctiva - Normal or Congested)
• Pupillary size : Normal, Equal, Unequal, Mydriasis or Miosis
• Response to light: The person is asked to look at an object in the room while a
light is shone into the eye. The reaction may be normal, delayed
(intoxication), or non-reacting (severe intoxication).
• Nystagmus : The head is held in the neutral position. The subject is asked to
follow with the eyes of an object held about 30–40 cm in front of him/her. The
object is moved from side to side to a maximum angle of about 45°. If the
object is moved to a more acute angle, the muscles of eye movement will be
stressed and nystagmus can be observed.
• In drunkenness, drooping and swollen eyelids, congestion of conjunctiva and
horizontal nystagmus may be seen, and convergence test is negative.

10. 10. Tests to determine in-coordination: These tests consist of -
• Romberg test
• Walk and Turn test
• One Leg Stand test
• Finger Nose test
11. Knee reflexes : Knee reflexes are elicited to check whether normal, exaggerated
or depressed. Reflexes are equally depressed in intoxication.
12. Examine for drug abuse: Look for needle marks, shivering, yawning, rhinorrhea
and lacrimation.
13.Examine the cardiovascular system: Note pulse, blood pressure (slight rise in
BP may occur), temperature and heart sounds.
14. Respiratory (slow, shallow, deep, sighing or gasping) and Gastrointestinal
system (soft, tender, bowel sounds, enlarged liver or spleen, ascites)

11. Laboratory Investigations
A. BLOOD
Collection: Soap and water is used to clean the site to be venepunctured. The
blood is collected from antecubital or femoral vein using a disposable syringe.
Blood container should be tightly stoppered and labelled.
Measurement: The BAC is the most useful measure, as there is rapid
equilibration across the blood-brain barrier, therefore BAC reflects the
concentration of alcohol currently affecting the brain.
a– the total amount of alcohol (in grams)
absorbed in the body
c – the concentration of alcohol in blood (in g/kg)
p – the weight of the person (in kg)
r – constant (0.68 in men and 0.5 in women)
a= cpr
Widmark’s
Formula

12. B. Urine: Full quantity of urine passed must be collected. The patient is
asked to pass urine in a toilet where there is no water source (preventing
him to dilute alcohol concentration by adding water). It is collected in a large
clean, sterilized, screw capped bottle. The urine is preserved, and labeled
with name, date, time of taking the specimen and signature of the medical
officer.
Alcohol level from urine is estimated with the formula:
q – concentration of alcohol in urine (in g/l)
and ‘a’, ‘p’ and ‘r’ are same
C. Breath: The patient is asked to blow into a rubber balloon. A
breathanalyzer then analyzes the breath and estimates BAC.
a= ¾ qpr

13. Opinion
The report should be written at that time, and at the end the
police should be informed about the doctor’s opinion. The
opinion can be drafted with any one of the following
statements:
 He/she has not consumed alcohol.
 He/she has consumed alcohol, but is not under the
influence of it.
 He/she has consumed alcohol and is under its influence.

14. THANK YOU