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ALCOHOL

ALCOHOL. INTRODUCTION. ALCOHOL. THE TERM ALCOHOL IN POPULAR USE REFERS TO ETHYL ALCOHOL [ ETHANOL ] WHICH IS PRESENT IN VARIOUS FERMENTED AND DISTILLED BEVERAGES. ALCOHOL IS TRANSPARENT, COLORLESS, VOLATILE LIQUID HAVING A SPIRIT LIKE ODOUR AND BURNING TASTE.

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ALCOHOL

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  1. ALCOHOL

  2. INTRODUCTION

  3. ALCOHOL THE TERM ALCOHOL IN POPULAR USE REFERS TO ETHYL ALCOHOL [ ETHANOL ] WHICH IS PRESENT IN VARIOUS FERMENTED AND DISTILLED BEVERAGES. ALCOHOL IS TRANSPARENT, COLORLESS, VOLATILE LIQUID HAVING A SPIRIT LIKE ODOUR AND BURNING TASTE.

  4. IT IS THE ACTIVE INGREDIENT OF MANY SOCIAL BEVERAGES SUCH AS WINE BEER WHISKEY BRANDY ITS APPROXIMATE %AGE IN SUCH BEVERAGES IS

  5. PROOF SPIRIT THIS INDICATES A MIXTURE THAT CONTAINS 57.10 % BY VOLUME OF ABSOLUTE ALCOHOL. OR 49.28 % BY WEIGHT OF ABSOLUTE ALCOHOL.

  6. ARRACK This is an eastern name for any country liquor. It is distilled from Coco-palm Rice Sugar Its strength may be as high as that of whisky. It is commonly fortified [to gain extra kick] with Potassium bromide Chloral hydrate Dhatura bhang

  7. COUNTRY LIQUOR This although more intoxicating but will have the same clinical effects as ethyl alcohol. SERIOUS TOXIC EFFECTS ARE COMMON WHEN The liquor is adulterated by denatured spirit which contains methyl alcohol. The so called country liquor is prepared from toxic preparations like varnish and French polish containing methyl alcohol. INCIDENCE OF DEATH IS QUITE COMMON WITH THIS TYPE OF LIQUOR.

  8. METABOLISM OF ETHYL ALCOHOL

  9. METABOLISM OF ETHYL ALCOHOL ETHYL ALCOHOL IS RAPIDLY ABSORBED FROM GIT esp SMALL INTESTINES. The rate of absorption depends upon Concentration of the alcohol in the fluid imbibed. Presence / absence of food in the stomach. Condition of stomach wall [gastrectomy, chronic gastritis]. Rate of drinking. Quantity of alcohol ingested. Weight of the person. Development of the person.

  10. METABOLISM [CONTD] approximately 90% of the absorbed alcohol is oxidized in the liver. remaining 10% being excreted mainly by kidney and lungs. NORMAL BODY METABOLISM OF ALCOHOL IN AN HOUR IS ½ fluid ounce of absolute alcohol. One fluid ounce of whisky. [ one drink ] 12 ounces of beer. IF THE INTAKE EXCEEDS THIS QUANTITY THE SUBJECT MANIFESTS SIGNS AND SYMPTOMS OF DRUNKENNESS UNLESS TOLERANCE HAS BEEN DEVELOPED.

  11. ACUTEETHYL ALCOHOL POISONING

  12. ETHYL ALCOHOL POISONING ethyl alcohol depresses the central nervous system irregularly in descending order from cortex to medulla. It first depresses the higher centres which control judgment and behavior. [ stage of excitement-blood alcohol 30-100 mg% ] Then it depresses the motor centres [ stage of incoordination -blood alcohol 100-300 mg% ] Finally the vital centres in the medulla are depressed [ stage of narcosis-blood alcohol over 300 mg% ] The breath smells alcohol throughout.

  13. STAGES OF ETHYL ALCOHOL POISONING STAGE OF EXCITEMENT. STAGE OF INCOORDINATION. STAGE OF NARCOSIS.

  14. STAGE OF EXCITEMENT THIS IS A FEELING OF WELL BEING AND PLEASURE RESULTING FROM INHIBITION OF THE HIGHER CENTRES. THE PERSON converses well. Laughs and smiles readily. Or may become angry easily. May disclose secrets easily. May behave in an obscene manner or talk in vulgar language. Sexual desire may be aroused.

  15. STAGE OF INCOORDINATION THERE IS INCOORDINATION OF thought speech Action MANIFESTED BY impaired judgment confusion slurred speech staggering gait

  16. STAGE OF INCOORDINATION THE DRUNK PERSON MAY • Suffer from hiccups • May be untidy in appearance

  17. STAGE OF INCOORDINATION THE PERSON MAY DEPICT INHERENT EMOTIONS LIKE Remorse Euphoria Irritability SIGN AND SYMPTOMS Nausea Vomiting Dilated pupils

  18. STAGE OF INCOORDINATION IMPAIRED JUDGMENT MAY LEAD TO MOST OFFENCES LIKE • Accidents • Sexual excesses • Violence • crime

  19. STAGE OF NARCOSIS The patient passes on to deep sleep and responds only to strong stimuli. Pulse is rapid. Temperature subnormal. Breathing is stertorous.

  20. STAGE OF NARCOSIS MCEWAN'S SIGN • Pupils may be contracted. • However on pinching the neck or face, they dilate initially and slowly return to their original size. • This sign is helpful to differentiate alcoholic coma from other comatose conditions.

  21. STAGE OF NARCOSIS [ contd ] If this stage lasts for more than 12 hours Death may ensue from paralysis of Cardiac centre respiratory centre Or Later from effects of pulmonary edema.

  22. ACUTE ALCOHOLISM Death from acute alcoholism is not common. Recovery occurs with acute depression and gastrointestinal irritation, which continues for 24 hours or longer.

  23. Hang-over • Headache is also present as a hang-over effect, which is caused by cerebral edema. • hang-over means a temporary state of indisposition usually following recovery from drunkenness.

  24. CLINICAL MANIFESTATIONS

  25. BLOOD ALCOHOL LEVEL AND CLINICAL MANIFESTATIONS

  26. CLINICAL MANIFESTATIONS SELECTIVE IMPAIRMENT. Increase in reaction time. Impairment of complex skills. [ driving ] Detectable only on detailed examination. SLIGHT IMPAIRMENT. Flushed face. Dilated / sluggish pupils. Euphoria. Loss of restraint.

  27. CLINICAL MANIFESTATIONS • UNDER THE INFLUENCE. • Face flushed. • Dilated and sluggish pupils. • Euphoria. • Loss of restraint. • Test errors. • Stagger on sudden turning. • DRUNK • Face flushed. • Dilated/ sluggish/ inactive pupils. • Clouding of intellect. • Incoordination of thought, speech, and action. • Staggering gait with reeling and lurching while making sudden turns.

  28. CLINICAL MANIFESTATIONS VERY DRUNK Flushed or pale face. Pupils inactive dilated [ may be contracted.] Mental confusion. Marked incoordination of thought, speech, and action. Staggering, reeling gait with tendency to lurch and fall. Vomiting. Amnesia. SPECIAL NOTE. These manifestations appear in persons who are not regular and excessive drinkers. Recovery has been recorded after blood alcohol levels of 780 mg% and above.

  29. FATAL DOSEFATAL PERIODCAUSE OF DEATH

  30. FATAL DOSE THIS DEPENDS ON THE Age. Habit of the person. Strength of the liquor taken. Death usually occurs from large dose taken in short period. FATAL DOSE. 0.35 % [350 mg%] and above, concentration of blood alcohol is usually sufficient to cause death. USUALLY IT IS 12-24 HOURS ALTHOUGH DEATH MAY BE DELAYED FOR 5-6 DAYS FATAL PERIOD

  31. CAUSE OF DEATH DEATH IS DUE TO DEPRESSION OF THE RESPIRATORY CENTRE. ALCOHOL MAY BE LETHAL AT RELATIVELY LOWER BLOOD LEVELS WHEN Combined with other central nervous system depressants, such as Barbiturates Carbon monoxide Morphine Or in the presence of some natural heart or lung disease.

  32. TREATMENT OF ETHANOL POISONING.

  33. TREATMENT GASTRIC LAVAGE The stomach should be lavaged with care with 5 % solution of sodium bicarbonate in warm water. GENERAL MEASURES The patient should be kept warm. HYPOGLYCEMIA Isotonic solution with 5 % glucose [preferably fructose] may be required. INCREASED INTRACRANIAL PRESSURE. This often occurs and is to be treated with Saline purges and Intravenous hypertonic glucose solution

  34. TREATMENT RESPIRATORY DEPRESSION Artificial respiration may be required along with oxygen inhalation. SERIOUS LIFE THREATENING EMERGENGENCY MAY NEED peritoneal dialysis Haemodialysis

  35. POST –MORTEM APPEARANCE

  36. POST MORTEM APPEARANCE CLOTHES. Torn and disorderly. Stained with blood and vomitus. MISCELLANEOUS. Tongue may be furred. Rigor mortis lasts longer. Bruises are found on various parts of the body. Other injuries may be present.

  37. POST MORTEM APPEARANCE ON OPENING UP THE BODY. Odour of alcoholic beverages is often evident. Blood is fluid and dark. BRAIN is slightly edematous. Shrinkage of the cerebral cortex [grey mater] is common in chronic alcoholics. In individuals who sustain head injury with subdural / epidural hemorrhage and survive for hours to days VITREOUS. Vitreous analysis will reveal alcohol level in all the cases.

  38. POST MORTEM APPEARANCE GASTROINTESTINAL TRACT FINDINGS Edema of the larynx. Café coronary. [ bolus of food obstructing the larynx.] Fatty liver. Acute hemorrhagic pancreatitis. Stomach shows signs of alcoholic gastritis to a varying degree. Mucus membrane of the small intestine is edematous but not ulcerated.

  39. CHEMICAL EXAMINATION VISCERA SENT FOR THE CHEMICAL ANALYSIS ARE Stomach and its contents. Small intestine. Piece of liver, spleen, kidney. Vitreous fluid. Cerebrospinal fluid. Blood collected from a peripheral vein.

  40. MEDICOLEGAL ASPECTS

  41. MEDICOLEGAL ASPECTS POISONING BY ALCOHOL Although it is comparatively common but death directly due to its ingestion occurs in a far smaller number of cases. LIABILITY TO FATAL COMPLICATIONS MAY OCCUR SUCH AS Head injuries. Serious bleeding from trivial injuries. Café coronary leading to suffocation. Drowning. A STRONG RELATIONSHIP EXISTS BETWEEN ALCOHOL, CRIME, AND VIOLENCE.

  42. CHRONIC ALCOHOLISM

  43. ALCOHOL ADDICTION This results from the continued use of alcohol. IT IS CHARACTERISED BY GRADUAL DETERIORATION OF Physical health. Moral values. Mental intellect. Also known as ALCOHOLIC DEMENTIA.

  44. PHYSICAL DETERIORATION THIS IS MANIFESTED BY Lack of personal hygiene. Loss of appetite. Chronic gastroenteritis. Wasting. Peripheral neuropathies. Impotence. Sterility. Fatty changes in liver and heart.

  45. HEPATOTOXICITY OF ALCOHOL ALCOHOL IS A HEPATOTOXIC POISON. Cirrhosis of liver is common. A useful index of liver damage is level of enzyme GAMMA -GLUTAMYL TRANSPEPTIDASE, in the serum, the normal level being less than 36 units.

  46. MORAL DTERIORATION This manifests as crimes which the addict commits to get the drink. Mental degeneration results in dementia. The person may hit the family members and have an aggressive attitude.

  47. COMMON CLINICAL SYNDROMES RESULT FROM CHRONIC ALCOHOLISM DELERIUM TREMENS KORSAKOFF’S PSYCHOSIS. ACUTE HALLUCINOSIS FETAL ALCOHOL SYNDROME.

  48. DELERIUM TREMENS This is a state of excitement with hallucinosis which lasts 3-4 days. THIS RESULTS FROM. Unusual bout of drinking. Sudden withdrawal of alcohol. Acute infection, e.g. pneumonia or influenza. Shock from injury e.g. fracture of bone. Exposure to cold.

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