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PubMed1993

[Physiopathology of acute alcoholic intoxication and alcoholic withdrawal].

Ethanol blood levels are the result of alcohol absorption and the process of its distribution, metabolism and excretion. Kinetics are complex and not yet well known. They can be influenced by acquired factors (type of alcohol ingested, association with fasting or eating, induction or inhibition of ethanol metabolism) or by genetically determined differences in the activity of alcohol and of acetaldehyde dehydrogenase. The presence of ethanol in the organism leads to various consequences. On the one hand, hydropic changes on membranes modify their function and thus that of membrane proteins (particularly receptors); on the other, ethanol can affect neurotransmitter metabolism. Such modification of the major neurotransmitter systems (cholinergic, aminergic and GABA) in some cerebral regions explains the pharmacologic consequences of acute alcohol ingestion. In chronic alcohol dependence, adaptation phenomena occur, in both the membranes (increased rigidity) and the neurotransmitter systems. They are reflected by the hyperexcitability (catecholaminergic hyperactivity and GABA hypoactivity) observed after disappearance of the tranquilizing effect of ethanol and are clinically expressed by the withdrawal syndrome.

Alcohol Withdrawal Delirium↗
PubMed1990

Alcohol intoxication and alcoholism in acute male medical admissions.

In order to assess alcohol related morbidity in male hospital patients we studied all acute male admissions over a period of three months. 9.3% of patients were found to have detectable alcohol on admission (level greater than 4 mmol/l). A total of 28.3% of admissions were judged to be alcoholic by questionnaire (Michigan Alcohol Screening Test). These results suggest that acute intoxication in male hospital admissions is not as common as previously recorded. The prevalence of alcoholism, however, was disturbingly high and has significant implications for in-patient management.

Adolescent↗
PubMed1999

Detection of acute alcohol intoxication and chronic alcohol dependence by trauma center staff.

BACKGROUND: Trauma patients with acute alcohol intoxication or chronic alcohol dependence are at greater risk for morbidity and mortality. We hypothesized that relying on clinical suspicion to detect acute alcohol intoxication and chronic alcohol dependence in trauma patients is inaccurate, influenced by injury factors, and biased by race, gender, age, and socioeconomic status. METHODS: Trauma patients were screened with a blood alcohol concentration and with the Short Michigan Alcohol Screening Test and CAGE questionnaire. Before screening, physicians and emergency department nurses were asked whether the patient was acutely intoxicated (blood alcohol concentration > 100 mg/ dL) or had a chronic alcohol problem. Sensitivity, specificity, positive, and negative predictive values were determined by comparing responses with blood alcohol concentration, Short Michigan Alcohol Screening Test, and CAGE questionnaire results, stratified by injury and demographic factors. RESULTS: Clinical evaluations were obtained on 462 patients. Overall, 23% of acutely intoxicated patients were not identified by physicians. The miss rate increased to one third in severely injured, chemically paralyzed, or intubated patients. Specificity was also poor. Patients with a negative blood alcohol concentration were more likely to be falsely suspected of intoxication if they were either young, male, perceived as disheveled, uninsured, or having a low income (p < 0.05). Staff identified < 50% of patients with a positive Short Michigan Alcohol Screening Test or CAGE, and falsely identified 26% of patients as alcoholic. CONCLUSIONS: Formal alcohol screening should be routine because clinical detection of acute alcohol intoxication and dependence is inaccurate. Screening should also be routine to avoid discriminatory bias attributable to patient characteristics.

Acute Disease↗
PubMed1997

Clinical value of serum pancreatic enzymes in acute alcohol intoxication and acute alcoholic pancreatitis.

BACKGROUND AND AIMS: The aim of this study was to evaluate the incidence in the serum of elevated levels of amylase, pancreatic isoamylase, and lipase in acute alcohol intoxication among occasional drinkers and chronic alcoholics, and to assess the diagnostic ability of the three enzymes for acute alcoholic pancreatitis. PATIENTS AND METHODS: One-hundred and seventeen consecutive subjects with acute alcohol intoxication but no abdominal pain (47 occasional drinkers, 70 chronic alcoholics), and 17 with acute alcoholic pancreatitis were studied. For all subjects serum amylase, pancreatic isoamylase, and lipase were determined using commercially available kits. RESULTS: Among occasional drinkers, serum amylase levels were abnormally high in 6 subjects (13%), whereas serum pancreatic isoamylase and lipase were abnormally high in one, (2%). In chronic alcoholics without abdominal pain serum amylase and lipase were abnormally high in 10 subjects (14%) but serum pancreatic isoamylase in only 7 (10%). In patients with acute alcoholic pancreatitis, serum amylase and pancreatic isoamylase were abnormally high in 16 of the 17 patients (94%), whereas serum lipase was abnormally high in all. CONCLUSIONS: Chronic alcohol abuse, but not occasional alcohol intoxication, may cause pancreatic damage. Amylase, pancreatic isoamylase and lipase determinations in the serum are all equally useful in the diagnosis of acute alcoholic pancreatitis.

Acute Disease↗
PubMed1977

Intravenous fructose treatment of acute alcohol intoxication. Effects on alcohol metabolism.

This study was designed to determine the efficacy of the intravenous administration of fructose in the treatment of acute alcohol intoxication. The study was prospective and double-blind, with glucose serving as the control. Treatment with glucose and fructose was determined by random selection. Fructose administration did not alter the clinical status or rate of alcohol metabolism as reflected by the decline in serum concentration. In addition, a significant elevation (P less than .05) in serum uric acid and lactate levels occurred in the patients receiving fructose. The results indicate that fructose is of no value in the treatment of acute alcohol intoxication, and produces metabolic abnormalities that could be harmful to the patient.

Adolescent↗
PubMed1993

The effect of acute alcohol intoxication and chronic alcohol abuse on outcome from trauma.

OBJECTIVE: To determine the effect of acute alcohol intoxication and chronic alcohol abuse on morbidity and mortality from trauma. DESIGN: Prospective cohort study. PATIENTS: Blunt or penetrating trauma patients at least 18 years of age admitted to one trauma center or dying at the injury scene. MAIN OUTCOME MEASURES: Mortality, complications (infection, pneumonia, respiratory failure, or multiple organ failure), and length of hospital stay. RESULTS: Acute intoxication had no effect on risk of dying--at the injury scene, within the first 24 hours of hospitalization, after the first 24 hours, or overall. Acute intoxication also did not increase the risk of complications and was associated with shorter lengths of stay. Patients with both biochemical and behavioral evidence of chronic alcohol abuse had a twofold increased risk of complications, particularly pneumonia and any infection, compared with those with no evidence of chronic alcohol abuse. CONCLUSIONS: Chronic, but not acute, alcohol abuse adversely affects outcome from trauma. Attention to the problem of chronic alcohol abuse in trauma patients is necessary, and screening trauma patients for chronic alcohol abuse appears to be warranted.

Adult↗
PubMed1978

Alcohol intoxication and the alcohol withdrawal syndrome.

Although acute alcohol intoxication can cause death, hepatic metabolism of ethanol is usually rapid, and in most cases general supportive care of the intoxicated patient is all that is required. Abrupt cessation of prolonged excessive alcohol intake gives rise to the alcohol withdrawal syndrome. The fundamentals of treatment are careful assessment of the patient and judicious use of a benzodiazepine.

Alcoholic Intoxication↗
PubMed1994

Synaptic membrane responses to acute and chronic alcohol intoxication in high alcohol sensitive (HAS) and low alcohol sensitive (LAS) selectively bred rats.

HAS (high alcohol sensitive) and LAS (low alcohol sensitive) lines of rats have been selectively bred based on their differences in ethanol-induced sleep time. In the present study, the two lines were compared to examine another central effect of acute alcohol intoxication: namely, hypothermia. As the disturbances in membrane microorganization have been associated with the nervous system's sensitivity and tolerance to ethanol, the synaptic plasma membrane fluidity and acute sensitivity to ethanol were also evaluated by fluorescence polarization of DPH probes in the HAS and LAS rats. The two lines did not differ in the magnitude of their hypothermic response after acute injection of ethanol (3 g/kg body wt, i.p.). Although membranes in the HAS line were slightly more rigid than in the LAS line, the level of membrane disordering after acute ethanol addition was identical for the two lines in the region examined with the DPH probe. Following the chronic intoxication of the rats, the two lines developed tolerance to the hypnotic and hypothermic effects of ethanol. In the same way, a membrane resistance (i.e. tolerance) to the disordering effect of acute ethanol addition developed in the region probed with DPH. In general, the LAS line showed a more pronounced level of tolerance than the HAS line at both the functional and membrane level. These results suggest that different measures used to assess the depressant action of ethanol, such as sleep time, hypothermia or membrane disordering, may not be related and could indicate different genetic origins.(ABSTRACT TRUNCATED AT 250 WORDS)

Alcoholic Intoxication↗
PubMed1993

[Severe somatic complications of acute alcoholic intoxication].

Acute alcohol ingestion can affect life expectancy and is directly responsible for 3,500 deaths per year. Acute lung diseases are mainly caused by pneumococci, Gram negative bacilli and anaerobic germs, and are often due to multiple microbes. In this case, evolution toward abscess can be feared. Septicaemia and enterobacterial peritonitis are frequently observed in cirrhotic patients. Ethanol, hypokaliemia and hypophosphoraemia also lead to rhabdomyolysis. Rhabdomyolysis can be complicated with acute renal failure and hyperkaliaemia. Alcoholic ketoacidosis and the hypoglycaemia favored by prolonged inadequate nutrition, are corrected by infusion of glucose solutions. Hyponatraemia can be complicated by convulsions and central pontine myelinolysis. Minor forms of alcoholic hepatitis remiss after stopping alcohol intoxication. The major forms can evolve toward fatal encephalopathy; treatment with corticosteroids improves the prognosis in severe hepatitis. The cardiac failure with lactic acidosis in shoshin beriberi rapidly evolves to collapsus; treatment is based on emergency administration of vitamin B1. Management of patients in acute alcohol episodes requires great vigilance. Careful clinical examination and biological tests should eliminate severe somatic complications before concluding to simple alcoholic intoxication.

Alcoholic Intoxication↗
PubMedDate not supplied

[Changes in catalytic properties of membrane-bound monoamine oxidases in alcoholic intoxication].

Chronic alcohol intoxication was accompanied by qualitatively new deamination reactions of cadaverine or glucosamine in dialyzed fraction of rat liver tissue homogenate. The rate of reactions was considerably more distinct in human liver and brain tissues obtained post mortem from patients with chronic alcoholism. At the same time, impairments were observed both in deamination of biogenic monoamines by membrane-bound monoamine oxidases and in ascorbate-dependent lipid peroxidation. The qualitative modifications in catalytic properties of membrane-bound monoamine oxidase, related to reactions of deamination and lipid peroxidation, appear to be of importance in chronic alcoholism and acute lethal alcohol intoxication.

Alcoholic Intoxication↗
PubMedDate not supplied

Forensic considerations on the comparison of "serum gamma-glutamyltranspeptidase" ("gamma-GT) activity in experimental acute alcoholic intoxication and in alcoholic car drivers who caused road accidents.

The authors studied blood alcohol levels and serum gamma-GT activity in 18 drivers who caused car accidents while intoxicated, and in 20 young volunteer subjects without any hepatic damage, in which an acute alcoholic intoxication was present. In most of the drivers the serum gamma-GT activity was significantly higher than in the volunteers, which strongly suggests a chronic alcoholic intoxication. In the 20 volunteers, who were occasional drinkers, the serum gamma-GT activity did not show pathological values even in a state of heavy intoxication. According to the authors, the serum gamma-GT determination could be made obligatory by law, in order to differentiate between acute or chronic alcoholic intoxication. Should an intoxicated driver be found guilty of an offense, this fact could aggravate the circumstances. Furthermore serum gamma-GT activity determination could be used as an evaluating parameter in granting driving licences.

Accidents, Traffic↗
PubMed1976

Management of potentially fatal alcohol intoxication.

Severely alcohol intoxicated patients pass through all stages of anesthesia according to the Guedel classification. Additional illnesses or injuries might be present, however. These require careful investigation. Blood alcohol levels are no criterion for the degree of intoxication. The treatment varies and is based on clinical symptoms. In our series of more than 100 alcohol intoxicated patients the treatment generally consisted o Apomorphine, unless unconsciousness was present, and peripheral vasopressors, if necessary. Occasionally endotracheal intubation was required. On gastric aspiration via nasogastric tube only minimal amounts of alcohol could be recovered. With correct diagnosis and effective treatment the cure rate of acute alcohol intoxication should be as high as that of other intoxications.

Adolescent↗
PubMedDate not supplied

[Enzyme characteristics of the rat liver in ontogeny in chronic alcohol intoxication].

Chronic alcohol intoxication led to an increase in activity of alcohol dehydrogenase and to decrease -- of aldehyde dehydrogenase and the microsomal ethanol oxidizing system (MEOS) with simultaneous activation of cytochrome P-450 in liver tissue of rats during ontogenesis. Ethanol, which did not affect the enzymatic status of lysosomes within ontogenesis (alpha- and beta-glucosidases, alpha- and beta-galactosidases, alpha-mannosidase, beta-N-acetylglucosaminidase, beta-xylosidase, beta-glucuronidase, beta-N-acetyl galactosaminidase acid RNAase, arylsulfatases A and B, cathepsin D), activated the majority of hydrolases in both embryonal and postnatal periods of development. Distinct increase in lipoperoxidation was detected under conditions of chronic alcohol intoxication.

Alcoholism↗