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PubMed2004

Comparison of consciousness level assessment in the poisoned patient using the alert/verbal/painful/unresponsive scale and the Glasgow Coma Scale.

STUDY OBJECTIVE: We determine how the alert/verbal/painful/unresponsive (AVPU) responsiveness scale (alert, responsive to verbal stimulation, responsive to painful stimulation, and unresponsive) corresponds to the Glasgow Coma Scale (GCS) when assessing consciousness level in the poisoned patient. METHODS: Consciousness level was assessed using the AVPU responsiveness scale and the GCS in all patients admitted to the hospital during a 6-month period with deliberate or accidental poisoning. An AVPU responsiveness scale algorithm and details of the individual components of the GCS were provided. Data were recorded prospectively on admission to the toxicology ward by nursing staff in the majority of cases and from case records for the small number of patients admitted directly to the ICU. Nursing staff also recorded any difficulty assessing consciousness level using either scoring system. RESULTS: Of the 1,384 patients studied, 1,138 patients were alert, 114 patients responded to a verbal stimulus, 87 patients responded to a painful stimulus, and 15 patients were unresponsive. The median GCS scores with interquartile ranges (IQR) for each AVPU responsiveness category were 15 (IQR 15), 13 (IQR 12 to 14), 8 (IQR 7 to 9), and 3 (IQR 3), respectively. There was a degree of overlap between the range of GCS scores for each category. Nursing staff recorded more difficulty using the GCS than the AVPU responsiveness scale. Alcohol-intoxicated patients proved to be the most difficult to assess. All patients who were unresponsive required intubation. No patient with a GCS score greater than 6 was intubated. CONCLUSION: Each AVPU category can be shown to correspond to a range of GCS scores. The AVPU responsiveness scale appears to provide a rapid simple method of assessing consciousness level in most poisoned patients, but difficulty was still observed in assessing alcohol-intoxicated patients.

Cohort Studies↗
PubMed1986

[Surgical treatment of chronic pancreatitis. Retrospective study of 221 cases].

221 patients have been operated for chronic pancreatitis, secondary to alcoholic intoxication in 92% of cases. Surgery was performed for a complication of the disease (69%), for intractable pain (30%), or for a false diagnostic of cancer; 265 operations were done, among which 41% of resections, 18.5% of internal derivations, and 14.3% of external derivations. Post-operative morbidity was 23.4% and hospital mortality was 6.4%. Late mortality was 35.5%, pancreatitis being responsible for more than half of those deaths during the first three post-operative years. Iterative surgery was necessary in 37 cases. The risk of diabetes was multiplied by 3.2 after resection. Results were good in 50% of cases after 5 years. An important factor was the arrest of alcoholic intoxication. There was no significant difference between resection and derivation. Internal drainage should be preferred when possible. Surgery must be reserved to grave or invalidating complications of chronic pancreatitis.

Adult↗
PubMed1984

Rhabdomyolysis and acute renal failure in chronic alcoholics with myopathy, unrelated to acute alcohol ingestion.

Rhabdomyolysis leading to acute renal failure necessitating hemodialysis is described in three chronic alcoholics. In each case an acute medical or surgical event, but not alcoholic intoxication, was implicated. Renal biopsies demonstrated acute tubular necrosis with intraluminal deposits consisting of Tamm-Horsfall protein and myoglobin. After recovery all three patients were demonstrated to have proximal muscle weakness with similar electromyographic abnormalities but nerve-conduction was impaired in only two. Muscle biopsies showed mixed, but predominantly type II fiber atrophy and reduced muscle phosphorylase levels. In the one patient tested the lactate response to forearm muscle ischemia was abnormal. It is postulated that chronic alcoholics may be predisposed to rhabdomyolysis and acute renal failure following acute medical and surgical stress as well as acute alcohol abuse. The muscle damage in these patients may be due to impaired intra cellular glycogen metabolism.

Acute Kidney Injury↗
PubMed1982

[Neurophysiologic organization of the pathologic craving for alcohol].

The authors examined the functional shifts occurring at various levels of the non-specific activation system of the brain in positive (euphoria in the state of alcoholic intoxication) and negative (anxiety in the period of abstinence) emotional states. An analysis of the EEG, as well as the EMG of the articulation muscles gives one grounds to suppose that the euphoria is accompanied by a weakening of the activation on the part of mesencephalon, and, at the same time, an intensification of the diencephalo-limbic activation processes. On the contrary, the anxiety is accompanied by mesencephalic hyperactivation which is, probably, eliminated after taking a dose of alcohol.

Adult↗
PubMed1985

[Alcohol and the lung. Anatomical and functional consequences].

The noxious effects of alcohol on the body are multiple. The lung is also a target organ in chronic alcoholic intoxication. The effects on the respiratory system may be divided into two groups: lowering of the defense functions of the respiratory system, especially to micro-organisms and a general depression of the immune system; decreased respiratory function sometimes associated with pronounced hypoxemia and decreased affinity of haemoglobin for oxygen especially during exercise. These patients have been shown to have an increased cardiac output, decreased pulmonary artery pressures and increased alveolar-capillary oxygen gradients, suggesting a porto-pulmonary shunt. From a practical point of view, hypoxemia in the alcoholic patients should not be misdiagnosed, since they can be functionally improved by domiciliary oxygen therapy.

Alcoholic Intoxication↗
PubMed1983

Visual evoked potentials in alcoholics.

Visual evoked potentials were obtained in nineteen patients during the early phase of alcohol intoxication. Out of the thirty-eight responses recorded in the nineteen patients, 13% were found to be abnormal (5 responses). Repeated testing was done in all patients with abnormal responses at three to four week intervals following treatment with vitamins and balanced diets. In three patients the major positive peaks returned to normal after treatment.

Adult↗
PubMed2001

A comparison of the predictive validity of four sets of baseline ASI summary indices.

This study compared the long-term predictive validity of original and new baseline Addiction Severity Index summary scores in methadone patients. The indices included the original Interviewer Severity Ratings (ISRs) and the new Clinical Indices (CIs), which use both lifetime and recent problem information, and the original Composite Scores (CSs) and Evaluation Indices (EIs), based on recent problems only. Outcomes were medical hospitalization, employment, alcohol intoxication, drug hospitalization, and psychiatric hospitalization in Months 7-24 poststudy entry and criminal charges in Months 0-24. Hierarchical logistic regression analyses were used in which 1 index was entered first and the other in the 2nd step. The reverse order of entry was used in a 2nd analysis. A final analysis set compared the best predictor from each of the 2 prior analysis sets. The CIs were superior to the other indices in predicting 3 of 6 outcomes (psychiatric hospitalization, drug hospitalization, and criminal charges); the EI was the best predictor of alcohol intoxication, and the CS the best predictor of unemployment.

Adult↗
PubMed1983

Inebriation and mortality.

Three experiences familiar to heavy drinkers were related to mortality over a 12-year and 23-year follow-up period. Weibull survival models were used to test the significance of associations and to produce estimates of relative risk. Age and marital status were controlled for by including them into the models, and social class by analysing the data separately for the 462 upper and 1614 lower social group males. The experiences studied were the occurrence of alcohol intoxication, that of hangover, and that of hangover drinking. All three had some prognostic value. Significant associations were found for mortality from pulmonary tuberculosis, cancer of the lung, digestive cancer, coronary heart disease, respiratory diseases, gastrointestinal diseases, injuries, and all causes of death. The number of significant associations found over the 23-year follow-up period was smaller than over the 12-year follow-up period.

Adult↗
PubMed1977

Methyl alcohol poisoning. IV. Alterations of the morphological findings of the retina and optic nerve.

The ocular morphological findings of three methyl alcohol-intoxicated rhesus monkeys with optic disc swelling was investigated with light and electron microscopy in conjunction with intravascular horse radish peroxidase. Alterations observed in the optic nerve head were confined to the axons and consisted of swelling and clustering of the mitochondria, disruption of the neurotubules, the formation of vesicles, and enlargement of the axon segments in the prelaminar region. Swelling of the oligodendroglial cytoplasm in contact with the axons and of the astrocytes was seen in the retrolaminar optic nerve and the intraorbital optic nerve. Alterations were not observed in the retina. It is hypothesized that the alterations in the axons are the result of disrupted axoplasmic flow. Possible mechanisms relating methyl alcohol intoxication to disruption of axoplasmic flow are discussed.

Animals↗
PubMed1988

Activation peaking in intoxicated and detoxified alcoholics during visuospatial learning.

Physiologic activation response patterning, termed activation peaking, and visuospatial learning performance were examined to understand the effects of chronic alcohol use on complex information processing. A total of 18 alcoholic male inpatients in an alcoholism treatment unit served as participants. Nine persons were seen while intoxicated (mean blood alcohol level [BAL] = 18.0mg/dl) at time of admission to the unit. The second group of nine persons were seen detoxified after 4 weeks in the treatment unit (BAL = 0 mg/dl). Skin conductance and heart rate were measured before and during learning. Learning consisted of a paired-associate paradigm requiring participants to learn the distinct spatial positions of six randomly presented "nonsense" shapes. The visuospatial learning of the intoxicated alcoholics was superior to that of the detoxified alcoholics. The physiological patterning of intoxicated alcoholics clearly and correctly tracked their learning performance, while the detoxified alcoholics displayed no clear pattern. The results indicated that the detoxified alcoholic may suffer a disruption in attentional mechanisms related to visuospatial information processing, providing support for theory that alcohol ingestion may serve to balance information processing in the alcoholic.

Adult↗
PubMed1992

Alcohol exacerbates behavioral and neurochemical effects of rat spinal cord trauma.

Acute alcohol intoxication may exacerbate the consequences of central nervous system trauma, although the mechanism is uncertain. Effects of acute ethanol administration on behavioral and neurochemical changes were examined in rats after traumatic spinal cord injury. Survival rates were reduced and posttraumatic neurologic function worsened in ethanol-treated as compared with saline-treated controls. Ethanol-treated rats had significantly lower tissue levels of excitatory amino acids and higher levels of free fatty acids, thromboxane, and lactic acid than did controls. Tissue magnesium concentration was significantly reduced by trauma and recovered more slowly in ethanol-treated rats. Enhanced phospholipid hydrolysis with free fatty acid and thromboxane accumulation, increased release of excitatory amino acids, and decreased tissue magnesium levels may each serve to worsen secondary tissue damage and diminish neurologic recovery after spinal cord injury associated with acute alcohol intoxication.

Amino Acids↗
PubMed1989

Injuries due to deliberate violence in areas of Denmark. I. The extent of violence.

As part of a transcultural investigation of violent behavior in Denmark and South America an analysis was made during a one year period of the incidents involving deliberate violence as registered at 3 Danish emergency wards, and at the Institute of Forensic Medicine in Copenhagen. In the three emergency wards a total of 1316 victims of deliberate violence were observed corresponding to a rate of about 3.3/1000 per year in a provincial/rural district, the catchment region of Holbaek County Hospital, 5.5/1000 per year in a mainly middle income area of the metropolis Copenhagen, the catchment region of Frederiksberg Hospital, and 7.6/1000 per year in a mainly low income area of Copenhagen, the catchment region of the Rigshospital. The highest risk, 28/1000 per year, was found for young men between 15 and 19 years of age living in the low income area of Copenhagen. The risk was low for people greater than or equal to 60 years of age in all three areas investigated, ranging from 0 (men) to 1.3/1000 per year (women). Skilled and unskilled workers were greatly over represented as victims of violence, considering their share of the background population. Seventy percent of the victims were men. At least 44% of the men and 32% of the women were alcohol intoxicated when arriving in the emergency ward. The incidents took place in restaurants or in the vicinity of restaurants for 30% of the male and 11% of female victims respectively, while 45% of the women had been subject to deliberate violence at home. The rate of fatal cases of deliberate violence in the Eastern part of Denmark, the catchment area for the Institute of Forensic Medicine in Copenhagen, was found to be 0.02/1000 per year. The risk of becoming a victim of deliberate violence has not increased during the last 4 years comparing with similar investigations from other parts of Denmark. However, the rate of homicide seems to have increased, and so has the severity of the injuries caused by deliberate violence. The pattern of deliberate violence appears to be associated with socio-economic and cultural factors, and to be closely linked with alcohol intoxication.

Adolescent↗
PubMed1992

Positional asphyxiation in adults. A series of 30 cases from the Dade and Broward County Florida Medical Examiner Offices from 1982 to 1990.

Over a 9-year period, 30 cases of positional (or postural) asphyxia were identified in the Dade and Broward County (Florida) Medical Examiner Offices. The victims had an average age of 50.6 years with no significant sex or racial differences as compared with the general medical examiner population. Chronic alcoholism or acute alcohol intoxication was a significant risk factor in 75% of cases and these had an average postmortem ethanol concentration of 0.24 g%. Signs of mechanical asphyxiation (petechiae and/or combined lung weights greater than 900 g) were present in 93% of cases. Victims were commonly (43%) found in a restrictive position producing hyperflexion of the head and neck. Two deaths involved restraint vests ("poseys") in elderly, demented, wheel-chair-confined victims. Scene photographs of the undisturbed decedent are extremely helpful in confirming a suspicion of postional asphyxia.

Adolescent↗
PubMedDate not supplied

Chlorpromazine and ethanol intoxication: an underlying mechanism.

The in vitro effect of chlorpromazine on hepatic alcohol dehydrogenase (L-ADH) was studied as a function of sex and species. The presence of chlorpromazine, 50 muMol, in reaction mixture noncompetitively inhibited rat L-ADH in a dose dependent fashion in the concentration range between 5 X 10(-5) Mol and 10(-4) Mol. This drug concentration also inhibited L-ADH of albino mice of both sexes, but chlorpromazine-produced a decrease in Km which was greater in the female than in the male mouse. Likewise, chlorpromazine, 50 muMol, noncompetitively inhibited mouse L-ADH of C57BL/6J, a mouse strain with ethanol preference, but without a concomitant change in the apparent Km. The KI50 determination indicates 3.5 fold lower concentration requirement of the drug in the C57BL mouse strain compared to that of the albino rat liver preparation. The results suggest that the inhibitory action of the drug on L-ADH and the genetic factor involved may influence the legal limit of serum ethanol concentration during alcohol intoxication in subjects under psychotropic medications. A medical forensic implication is suggested.

Alcohol Oxidoreductases↗
PubMed1990

[The therapeutic needs and possibilities of persons in detention assessed immediately after release].

Immediately before release, all detainees in Slagelse were assessed with the object of providing relevant therapeutic offers on the basis of the established therapeutic system. This investigation comprised 24 placements in detention of 20 individuals. The persons who had been placed in detention were mainly young single men with unstable employment histories. 33% were placed in detention in order to protect themselves because they were unable to take care of themselves on account of alcohol intoxication. These should rather have been observed by health staff. 67% were placed in detention because they were committing a breach of the place. It was obvious that there was a great need for supportive measures and treatment of addiction but only two out of 20 desired a therapeutic offer. These two were already in touch with the therapeutic system. Three persons considered that they were in an acute crisis. On the basis of assessment of the personalities of the persons in detention and their lack of motivation to commence a therapeutic programme, it is concluded that the existing therapeutic system could not provide further measures as regards long-term treatment. In this investigation one individual was placed in detention three times. For him detention had the nature of a "social braking function", which must be criticised.

Adult↗
PubMed1997

The kinetics of methanol elimination in alcoholics and the influence of ethanol.

Methanol concentrations were studied during the end phase of ethanol elimination and for about five hours afterwards in 12 alcoholics admitted with alcohol intoxication for acute care. The rate of ethanol elimination (beta 60) ranged from 0.114 g/kg/h to 0.270 g/kg/h (mean 0.178 +/- 0.045 g/kg/h). The methanol concentration was found to remain almost steady as long as ethanol levels were relatively high, and changed only to an extent that could be explained by the combined opposing influences of methanol excretion and endogenous synthesis. There was no significant relationship between the rate of ethanol elimination and the methanol level. The methanol concentration began to decrease when the ethanol concentration had fallen to under 0.2 g/kg. When the ethanol concentration had fallen to base levels, methanol was eliminated at a rate characterized by an elimination constant (kel) of 0.212-0.481 h-1, and a half life of 1.44-3.27 h. There was a positive correlation between the rate of ethanol elimination and the rate of methanol elimination (r = 0.642; p < 0.05).

Adult↗
PubMed1992

The involvement of NMDA receptors in acute and chronic effects of ethanol.

Recent evidence indicates involvement of excitatory amino acid receptors sensitive to N-methyl-d-aspartate (NMDA) in the action of ethanol (EtOH). Pronounced inhibition of NMDA receptor function is seen in vitro with concentrations of EtOH corresponding to those present during alcohol intoxication in humans. The present study was devoted to investigate the role of NMDA receptors in the action of EtOH in rats. Acute experiments showed antagonism by EtOH of convulsions induced by intracerebroventricular injection of NMDA. A similar effect was seen with a high dose of diazepam. Convulsions induced by an agonist of another excitatory amino acid receptor subtype, kainate, were also inhibited by EtOH. An uncompetitive antagonist of NMDA receptors, 5-methyl-10,11-dihydro-5H-dibenzocyclohepten-5,10-imine maleate (MK-801), potentiated EtOH-induced loss of righting, but attenuated the hypothermic action of EtOH. Moreover, MK-801 inhibited audiogenic convulsions in EtOH withdrawn rats. At the same time the effect of a proconvulsive dose of NMDA was not enhanced. Tolerance to the myorelaxant action of both EtOH and MK-801 upon repetitive administration was seen. Also some degree of cross-tolerance was observed. Moreover, MK-801 failed to modify EtOH preference in rats. The present results support involvement of NMDA receptors in expression of some acute and subchronic actions of EtOH and in expression of EtOH withdrawal.

Alcohol Drinking↗
PubMed2006

Alcohol and adult neurogenesis: roles in neurodegeneration and recovery in chronic alcoholism.

The concept of "structural plasticity" has emerged as a potential mechanism in neurodegenerative and psychiatric diseases such as drug abuse, depression, and dementia. Chronic alcoholism is a progressive neurodegenerative disease while the person continues to abuse alcohol, though clinical and imaging studies show that some recovery may occur with abstinence. The neural plasticity observed in chronic alcoholism coupled with conflicting reports on alcohol-induced hippocampal neuropathology make this disease ripe for reconsideration in terms of the phenomenon of adult neurogenesis. This review describes opposing neurogenic processes that occur with alcohol intoxication and abstinence following alcohol dependence and how these opposing events relate to neurodegeneration and recovery from chronic alcoholism.

Alcohol-Induced Disorders, Nervous System↗