Ethanol poisoning

• Ethanol is a small, water-soluble molecule that becomes distributed evenly throughout the body water; it passes easily across the blood–brain barrier and has a profound depressant effect upon the cerebral function.
• absorption of alcohol takes place in the stomach, duodenum and first part of the jejunum; the latter two are the most effective areas of absorption, partly because the gastric mucosa contains an alcohol dehydrogenase.
• Individuals with rapid stomach emptying or a gastrojejunostomy may absorb alcohol unusually rapidly and this will produce a higher peak blood-alcohol concentration (BAC).

Alcohol  abuse  can cause

1. alcohol  intoxication,
2. alcohol  withdrawal  and
3. chronic  complications.

A) Acute  intoxication:

Ethyl alcohol  depresses the  CNS irregulary  in  descending  order from  cortex  to  medulla.  Acute  alcohol  intoxication has  following  stages :

1) Stage  of excitment  :

• This  is  due to  depression  of inhibitory  centers.
• There is  feeling  of well being  and  euphoria.

2) Stage of incoordination:

• Incoordination  of  thought,  speech  and action  which manifest  as  impaired  judgment,  confusion.
• Slurred speech  and  staggering  gait. Pupils  are  dilated.

3) Stage  of narcosis  :

• There is  deep  sleep, with rapid  pulse,  hlpothermia  and  sternous  breathing.
• Pupils  are constricted,  but on pinching  the  neck/face,  they  dilate  and slowly  return  to  their  original  size, i.e. Macewan’s  sign.
• Death  may occur from  respiratory  depression.

NOTE: All individuals  with  a  blood  alcohol  level  of 140 mg%  are  considered intoxicated  to  the  point  where  they  cannot  deal with  un usual,  emergency  or non – customary  problems

• 150-250  ml of  absolute  alcohol  comsuned  in  an  hour is fatal.
• The  most cotnmon  withdrawal  syndrome  is  hangover on  next  morning.
• Symptoms include alcoholic seizures  (rumfits),  alcoholic  hallucinosis,  and  delerium  tremens.

Chronic  complications:

1. Wernicke’s-Korsakoffs  syndromeà due to  thiamine  defciency.
2. Wernicke’s encephalopathtyà  characterized by  classical triad  of  global confusion,  ophthalmoplagia’  and ataxia.
3. Korsakoff’s  psychosis  is  characterized by  amnesia  with  confabulation.
4. Marchiafava-bignami  disease  (MBD) : epilepsy, ataxia,  spastic  paralysis,  hallucinations  and  impaired  intellectual  functions.
5. Depression,  suicide,  anxiety  disorders,  morbid  (pathological) jealousy , dementia and psychosis.

Tests for  alcohol

1. For alcohol  in  blood and tissues:  Widmark’s formula

2. For alcohol  blood and  urine levels  :

1. Alcohol  dehydrogenase (ADH)  method.
2. gas chromatography
3. kozelka  and  hine  test,
4. cavett test,
5. breath  analysis/drunkometer  (it  is  screening  method,  based  on henery’s  law.

Laws:

• The  statutory  limit  of alcohol  level  in  blood  in India  while driving  beyond  which  driving  is  considered  as offence  is  30mg%.
• It is  covered  under  Sec. 185 Motor Vehicle  Act  1988.
• The punishment  for  first offence  is  fine  upto  Rs. 2000/- or 6 months  of imprisonment  or  both.
• For  second  or subsequent  offence  fine  upto  Rs. 3000/-  or imprisonment  upto  2 years  or both

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