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Jozef De Dooy, MD, PhD
Paediatric Intensive care
Medical Aspects of Alcohol Intoxication in Young People
1. Definition, pharmacokinetics and pharmacology
Alcohol intoxication: definition
• Characterized by differences in consciousness, cognition, perception, affect, judgment, behaviour and other psychophysiological functions and responses
• Caused by acute pharmacological effects and learned responses to alcohol
• The differences resolve with time, with complete recovery, except from the tissue damage caused by the intake of alcohol
Binge Drinking
• Besides amount of alcohol intake, 3 other factors are of importance in the definition of binge drinking (Gill JS,
2002)• Gender: because of gender differences in pharmacology of
alcohol • Duration of consumption• Drinking frequency
=> NO “GENERAL” DEFINTION!
Gender differences in alcohol pharmacology
• Pharmacology in women:• Smaller first pass metabolism in the stomach• Higher alcohol elimination: oxidation in the liver• Slower gastric emptying• Smaller body distribution
=> Net effect: higher blood alcohol concentrations persist longer in women
Absorption and Elimination
• Absorption• Fast• Highest level serum: < 60 min when empty stomach• Ethanol : spasme of the pylorus
• Elimination• Constant• Independent of peak-level• Non-drinkers: drops 10 -25 mg/dl/h
(2.2 to 5.6 mmol/l/uur)• Chronic drinkers : drops 30 mg/dl/h
(6.7 mmol/l / uur)
Accumulation = toxic
2. Clinical presentation and diagnosis
Clinical presentation is influenced by:
• Quantity• Weight• Tolerance (age, gender)• % alcohol• Time of ingestion
Vonghia et al, 2008
Symptoms
• Metabolic• Hypoglycemia• Elektrolyte disturbances
• Cardiovascular• Tachycardia• Hypovolemic, VD• Hypothermia• Hypotension
• Cerebral embolism and AMI• Fibrinolysis• Clotting• Coronary spasms
Symptoms
• Respiratory• DEPRESSION OF RESPIRATION• Clearance mucus• Risk for aspiration
• Gastro-intestinal• Nausea, vomiting, diarrhea, gastritis, pancreatitis• Alcoholic hepatitis
Diagnosis
• Clinical signs• Blood
• alcohol
• others?
• Routine lab
• On indication• RX, ECG, CT
• Arterial blood gasses
• …
Alcohol % Severity
< 1.5 ‰ Mild
1.5-2.5 ‰ Moderate
> 2.5 ‰ Severe
3. Treatment
APLS/EPLS guidelines
• Airway and breathing• Airway assesment• Observation of respiratory function• Prevention of aspiration• Mechanical ventilation, if necessary
• Circulation• IV access• IV solution administration
• Correction hypoglycemia
• Corretion elektrolyte imbalances
• Thiamine! (multivitamins)
Further treatment
• Disability• Level of consciousness• Sedation if necessary
• Acceleration of elimination• metadoxine
• Watch out!• Trauma• Hypothermia• Hypoglycemia
4. Conclusion