Alcoholism

Acute Alcohol Intoxication

The symptoms of acute alcoholism are in co-ordination, fall in blood pressure; fall in body temperature and respiratory depression. Approximately 600 ml pure alcohol can produce a fatal effect.

Treatment consist of gastric lavage, oxygen inhalation, general nursing care, I.V. glucose 50% 50ml, I.V.thiamine 100mg and I.V. magnesium sulphate 2 to 4 gm over 1 to 2 hours.

Chronic Alcoholism

The manifestation of chronic alcoholism is atrophic changes in G.I.T, degeneration changes in the liver and nerves. Also addiction and withdrawal symptoms may develop even with moderate drinking. There is no single explanation for why people drink. Alcohol can make people happy as well as sad, curious as well as mean talkative as well as silent, friendly as well as hostile. Heavy drinking is often associated with nutritional deficiencies, because food is addition to impaired mental and physical performance, polyneuritis, pellagra, tremors, seizure, CHF, hypertension, cirrhosis of liver.

Treatment:

Treatment of alcohol dependence can be divided into

Detoxification: It can be activated by using following drugs –

  • Aversion drugs – Disulfiram, citrated calcium cyanamide (CCC)
  • Opioid antagonists – Naltrexone, nalmephene.
  • Dopaminergic antagonist –tiapride.
  • Miscellaneous – acamprosate.
  • Supporting Drugs – Lithium carbamazepine.

Rehabilitation:

  • Psychotherapy
  • Institutional therapy

 

DISULFIRAM (Tetra Ethyl Thiuram Disulphide)

Disulfiram is an antioxidant which blocks the oxidative metabolism of ethyl alcohol. Ensure that alcohol has not been consumed for at least 12 hours, before initiating the disulfiram therapy. Treatment is initiated with 800 mg as a single dose on the first day.

Mechanism of Action:

The drug inhibits the enzyme aldehyde dehydrogenase and thereby blocks the oxidation of acetaldehyde formed during the metabolism of alcohol. This raises the blood level of acetaldehyde which acts directly on the cardio vascular system. Disulfiram also inhibits dopamine Beta-oxidase and thus interferes with the synthesis of nor-adrenaline. When alcohol is ingested after taking disulfiram, the concentration of acetaldehyde in tissues and blood raises and a number of distressing symptoms (aldehyde symptoms) are produced. These are flushing, burning sensation, throbbing, headache, perspiration, uneasiness, tightness in chest, dizziness, vomiting, mental confusion and circulatory collapse. Duration of syndrome 1 to 4 hours.

Pharmacokinetics:

The drug is rapidly and completely absorbed form the gut. The elimination is slow and the drug is excreted in the urine.

Uses:

Disulfiram is used in the adjunctive treatment of chronic alcoholism with proper motivation and counseling.

Adverse Effect:

Rashes, metallic taste, nervousness, malaise and abdominal upset.

Contra Indication:

Pregnancy, cardiac failure, drug addiction, coronary artery disease.

Special Precautions:

Diabetes, epilepsy, renal hepatic or respiratory disease.

Dosage:

1gm on 1st day, 0.75gm on 2nd day, 0.5 gm on 3rd day, 0.25 gm subsequently daily for 1 – 2 weeks.

Brand Name:

ANTADICT, CHRONOL, DIRAM, TYFUSIN, SOBEROL, ESPERAL, ANTABUSE.

 

METHYL ALCOHOL (Ch3OH)

Methanol or wood alcohol is the simplest aliphatic alcohol is widely used commercially as an industrial solvent. It is also added to rectified spirit to render it unfit for drinking. It is sometimes consumed accidentally or as a substitute for ethanol.

Manifestations of methanol poisoning are vomiting, headache, epigastric pain, uneasiness bradycardia, hypotension, acidosis, blindness, coma and death.

Treatment  of methanol poisoning:

  • Keep the patient in a quiet dark room and protect the eyes from light.
  • Gastric lavage with sodium bicarbonate.
  • Supportive measures to maintain ventilation and blood pressure.
  • Combat acidosis by i.v sodium bicarbonate injection.
  • Ethanol (10% in water) is administered through a nasogastric tube. It saturates alcohol dehydrogenase and retards methanol metabolism.
  • Haemodialysis clears methanol and formate.
  • 4- methyl pyrazole is a specific inhibitor of alcohol dehydrogenase is given by slow i.v infusion (100 mg).
  • Calcium leucovorin injected repeatedly to reduce blood formate levels by enhancing its metabolism.
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