Alcohols, Aldehydes and Ketones. Introduction 3 most common alcohol poisonings are: ethanol,...
-
Upload
kristina-hancock -
Category
Documents
-
view
219 -
download
0
Transcript of Alcohols, Aldehydes and Ketones. Introduction 3 most common alcohol poisonings are: ethanol,...
![Page 1: Alcohols, Aldehydes and Ketones. Introduction 3 most common alcohol poisonings are: ethanol, methanol and isopropanol. Alcohol ingestions account for.](https://reader036.fdocuments.in/reader036/viewer/2022062308/56649da65503460f94a91425/html5/thumbnails/1.jpg)
Alcohols, Aldehydes and Ketones
![Page 2: Alcohols, Aldehydes and Ketones. Introduction 3 most common alcohol poisonings are: ethanol, methanol and isopropanol. Alcohol ingestions account for.](https://reader036.fdocuments.in/reader036/viewer/2022062308/56649da65503460f94a91425/html5/thumbnails/2.jpg)
Introduction• 3 most common alcohol poisonings are: ethanol,
methanol and isopropanol.• Alcohol ingestions account for 14/1000 hospital admins• Up to 72% of trauma patients were + for alcohol in their
blood• 1998 ethanol accounted for 33,269 exposures reported
to PCC, 973 were major toxicities and 42 resulted in death
• 1998, isopropanol, 19,301 reported, 83 major toxicity, 3 deaths
• 1998 methanol, 1041 reported, 24 major, 10 deaths
![Page 3: Alcohols, Aldehydes and Ketones. Introduction 3 most common alcohol poisonings are: ethanol, methanol and isopropanol. Alcohol ingestions account for.](https://reader036.fdocuments.in/reader036/viewer/2022062308/56649da65503460f94a91425/html5/thumbnails/3.jpg)
Introduction, cont.
• Acute intoxication with any alcohol may result in:– coma
– death due to respiratory depression
– CV collapse due to CNS depression
– aspiration of vomitus
• Children under the age of 5 - have high incidence of exposure
• Recreational misuse very high among teens and young adults
![Page 4: Alcohols, Aldehydes and Ketones. Introduction 3 most common alcohol poisonings are: ethanol, methanol and isopropanol. Alcohol ingestions account for.](https://reader036.fdocuments.in/reader036/viewer/2022062308/56649da65503460f94a91425/html5/thumbnails/4.jpg)
Alcohols• Ethyl alcohol - grain alcohol - C2H5OH• Derived from fermentation of sugars in fruits, cereals
and vegetables• Present in aftershaves, colognes, perfumes, OTC meds,
mouthwashes, and a myriad of alcoholic beverages• Colorless, flammable, volatile liquid, toxin• Proof = twice the per cent by volume; gun powder
was soaked in an alcoholic beverage and ignited, if it exploded then it was “100 proof” is was at least 50% alcohol
• a direct CNS depressant - both motor and sensory
![Page 5: Alcohols, Aldehydes and Ketones. Introduction 3 most common alcohol poisonings are: ethanol, methanol and isopropanol. Alcohol ingestions account for.](https://reader036.fdocuments.in/reader036/viewer/2022062308/56649da65503460f94a91425/html5/thumbnails/5.jpg)
Ethanol, cont.• Uses
– preservative– solvent– vehicle for other drugs (tinctures, elixirs, spirits)– disinfectant– hardens the skin– cools the skin– injectable nerve block– stimulates appetite and aids in digestion
![Page 6: Alcohols, Aldehydes and Ketones. Introduction 3 most common alcohol poisonings are: ethanol, methanol and isopropanol. Alcohol ingestions account for.](https://reader036.fdocuments.in/reader036/viewer/2022062308/56649da65503460f94a91425/html5/thumbnails/6.jpg)
Ethanol• Rapidly absorbed from stomach and sm intestine• Peak levels reached in 30-90 minutes post ingestion• Metabolism by liver by alcohol and aldehyde
dehydrogenases• ethanol - acetaldehyde - acetic acid - C02 + H20• Primary source of ingested ethanol is alcoholic
beverages• Associated problems with ethanol ingestion:
hypoglycemia, heqad trauma, carbon dioxide narcosis, hypoxia
![Page 7: Alcohols, Aldehydes and Ketones. Introduction 3 most common alcohol poisonings are: ethanol, methanol and isopropanol. Alcohol ingestions account for.](https://reader036.fdocuments.in/reader036/viewer/2022062308/56649da65503460f94a91425/html5/thumbnails/7.jpg)
Ethanol, cont.• Metabolism - you metabolize about 1
drink/hr.– 13-25mg alcohol/deciliter/hour– in alcoholics this rate increases to
30-50mg/dL/hr• 12 oz. beer = 3 oz wine = 1 oz whiskey = 15 ml of
ethanol
• New Texas State law has lowered legal limit to 0.08% (so 0.8 ml 90% ethanol/kg = 0.08% BAC)
![Page 8: Alcohols, Aldehydes and Ketones. Introduction 3 most common alcohol poisonings are: ethanol, methanol and isopropanol. Alcohol ingestions account for.](https://reader036.fdocuments.in/reader036/viewer/2022062308/56649da65503460f94a91425/html5/thumbnails/8.jpg)
To calculate BAC• 1 ml 90% ethanol/kg BW gives BAC 0.1 %
• so for a 220 lb. Male
• convert to kg.
• 100 kg
• so 100 ml or approx. 3 1/2 ounces of 90% or 180 proof.
• New Texas Law = 0.08 so revised formula 0.8 ml 90% ethanol/kg BW = BAC 0.08%
![Page 9: Alcohols, Aldehydes and Ketones. Introduction 3 most common alcohol poisonings are: ethanol, methanol and isopropanol. Alcohol ingestions account for.](https://reader036.fdocuments.in/reader036/viewer/2022062308/56649da65503460f94a91425/html5/thumbnails/9.jpg)
Ethanol, cont.• Short term effects - intoxication and mood
alteration
• Long term effects– hepatic cirrhosis– esophageal cancer– pancreatic disorders– Wernicke’s syndrome– B vitamin deficiencies– malnutrition
![Page 10: Alcohols, Aldehydes and Ketones. Introduction 3 most common alcohol poisonings are: ethanol, methanol and isopropanol. Alcohol ingestions account for.](https://reader036.fdocuments.in/reader036/viewer/2022062308/56649da65503460f94a91425/html5/thumbnails/10.jpg)
Ethanol, cont.
• Alcohol should never be taken with other CNS depressants
• Treatment– keep patient from injuring themselves through
falls, etc.– protect and maintain airway
![Page 11: Alcohols, Aldehydes and Ketones. Introduction 3 most common alcohol poisonings are: ethanol, methanol and isopropanol. Alcohol ingestions account for.](https://reader036.fdocuments.in/reader036/viewer/2022062308/56649da65503460f94a91425/html5/thumbnails/11.jpg)
Alcohols, cont.
• Methanol - methyl alcohol, wood alcohol• Sources - no medicinal use, used in industry and
cleaning fluids, solvents, paints, varnishes, Sterno Fuel, gasohol, windshield washer fluid (30-40% methanol), and “moonshine”, etc.
• Fatal dose is between 30 and 240ml• Metabolism
methanol - formaldehyde - formic acid - CO2 + H2O• CNS depressant• Profound metabolic acidosis and blindness
![Page 12: Alcohols, Aldehydes and Ketones. Introduction 3 most common alcohol poisonings are: ethanol, methanol and isopropanol. Alcohol ingestions account for.](https://reader036.fdocuments.in/reader036/viewer/2022062308/56649da65503460f94a91425/html5/thumbnails/12.jpg)
Methanol, cont.• Formic acid inhibits cytochrome oxidase in the
fundus of the eye– disrupts axoplasmic flow
– axons swell causing visual impairment
– edema of optic disc
– degradation of formic acid is folate dependent
• Visual disturbances seen in 50% of cases of toxicity– blurred vision
– yellow spots
– snowstorm like vision
– photophobia
![Page 13: Alcohols, Aldehydes and Ketones. Introduction 3 most common alcohol poisonings are: ethanol, methanol and isopropanol. Alcohol ingestions account for.](https://reader036.fdocuments.in/reader036/viewer/2022062308/56649da65503460f94a91425/html5/thumbnails/13.jpg)
Methanol, cont.
• Clinical presentation of ingestion– headache– vertigo– nausea, vomiting and diarrhea– painful, tender abdomen– colic and gastritis– dyspnea and tachypnea - Kussmaul’s respiration– ocular signs
![Page 14: Alcohols, Aldehydes and Ketones. Introduction 3 most common alcohol poisonings are: ethanol, methanol and isopropanol. Alcohol ingestions account for.](https://reader036.fdocuments.in/reader036/viewer/2022062308/56649da65503460f94a91425/html5/thumbnails/14.jpg)
Methanol, cont.
• Treatment of methanol ingestion– provide airway, breathing support– folic acid (potentiates the folate-dependent
metabolism of formic acid to CO2 and H2O)– ethanol - tie up enzyme system– supportive care
![Page 15: Alcohols, Aldehydes and Ketones. Introduction 3 most common alcohol poisonings are: ethanol, methanol and isopropanol. Alcohol ingestions account for.](https://reader036.fdocuments.in/reader036/viewer/2022062308/56649da65503460f94a91425/html5/thumbnails/15.jpg)
Alcohols, cont.• Isopropyl alcohol - rubbing alcohol (70% isopropanol)• Second most commonly ingested alcohol• Sources
– rubbing alcohol, window cleaners, antifreeze, detergents, jewelry cleaners, solvents, disinfectants
• Ingestion typically seen in chronic alcoholics, children (can be secondary to inhalation or topical absorption from sponge baths) and suicide attempts
• Lethal dose is 240 ml • Metabolized much slower than ethanol
![Page 16: Alcohols, Aldehydes and Ketones. Introduction 3 most common alcohol poisonings are: ethanol, methanol and isopropanol. Alcohol ingestions account for.](https://reader036.fdocuments.in/reader036/viewer/2022062308/56649da65503460f94a91425/html5/thumbnails/16.jpg)
Isopropyl alcohol, cont.
• Clinical presentation of ingestion– headache, dizziness– ataxia– nystagmus– abdominal pain, nausea, vomiting, hematemesis– patient is intoxicated but no smell of alcohol to
breath (breath may smell fruity like acetone - Isopropanol metabolized to acetone by ADH)
![Page 17: Alcohols, Aldehydes and Ketones. Introduction 3 most common alcohol poisonings are: ethanol, methanol and isopropanol. Alcohol ingestions account for.](https://reader036.fdocuments.in/reader036/viewer/2022062308/56649da65503460f94a91425/html5/thumbnails/17.jpg)
Isopropyl alcohol, cont.
• Treatment– gastric lavage– activated charcoal– maintain airway– supportive care
![Page 18: Alcohols, Aldehydes and Ketones. Introduction 3 most common alcohol poisonings are: ethanol, methanol and isopropanol. Alcohol ingestions account for.](https://reader036.fdocuments.in/reader036/viewer/2022062308/56649da65503460f94a91425/html5/thumbnails/18.jpg)
Ethylene glycol• Clear, colorless, odorless, viscous fluid with a
bittersweet taste• Sources - antifreeze (has fluorescein dye added to show
leaks)• About 500 cases reported a year in humans• Ethylene glycol by itself is relatively non toxic but its
metabolites are highly toxic
ethylene glycol + alcohol dehydrogenase - glycoaldehyde + aldehyde dehydrogenase - glycolic acid - glyoxalate - oxalate (combines with calcium to form calcium oxalate crystals)
![Page 19: Alcohols, Aldehydes and Ketones. Introduction 3 most common alcohol poisonings are: ethanol, methanol and isopropanol. Alcohol ingestions account for.](https://reader036.fdocuments.in/reader036/viewer/2022062308/56649da65503460f94a91425/html5/thumbnails/19.jpg)
Ethylene glycol, cont.
• Basis of toxicity– lethal dose in an adult = 100 ml– tissue destruction - precipitation of calcium
oxalate in tissues, especially in the renal cortex, brain, liver, lungs, blood vessels and pericardium
– severe metabolic acidosis(glycolic acid)
![Page 20: Alcohols, Aldehydes and Ketones. Introduction 3 most common alcohol poisonings are: ethanol, methanol and isopropanol. Alcohol ingestions account for.](https://reader036.fdocuments.in/reader036/viewer/2022062308/56649da65503460f94a91425/html5/thumbnails/20.jpg)
Ethylene glycol, cont.Clinical presentation• Phase I - 30 min - 12 hrs post ingestion, patient
may appear inebriated, nauseated, vomiting, ataxia, no alcohol smell on breath
• Phase II - 12 -14 hours later, tachycardia, elevated BP, pulmonary edema, tachypnea, cardiac failure, secondary to deposition of calcium oxalate crystals in the vascular tree, lungs and heart
• Phase III - 24-72 hours after ingestion, flank pain, costovertebral angle tenderness, oliguric acute renal failure
![Page 21: Alcohols, Aldehydes and Ketones. Introduction 3 most common alcohol poisonings are: ethanol, methanol and isopropanol. Alcohol ingestions account for.](https://reader036.fdocuments.in/reader036/viewer/2022062308/56649da65503460f94a91425/html5/thumbnails/21.jpg)
Ethylene glycol, cont.
• Diagnosis– drunk patient with NO alcohol smell on their
breath– calcium oxalate crystals in the urine– clinical evidence of renal failure– Kussmaul’s respiration
![Page 22: Alcohols, Aldehydes and Ketones. Introduction 3 most common alcohol poisonings are: ethanol, methanol and isopropanol. Alcohol ingestions account for.](https://reader036.fdocuments.in/reader036/viewer/2022062308/56649da65503460f94a91425/html5/thumbnails/22.jpg)
Ethylene glycol, cont.• Treatment
– treat acidosis– ethyl alcohol (blocks metabolism of EG by binding
ADH)– Thiamine (Thiamilate) - Vitamin B-1 is water-
soluble and utilized in many cellular functions that involve energy formation and utilization. Promotes conversion of glyoxalate to a nontoxic metabolite, alpha-hydroxy-beta-ketoadipate.
– water-soluble vitamin B-complex (a cofactor in conversion of glycolic acid to non-oxalate compounds)
![Page 23: Alcohols, Aldehydes and Ketones. Introduction 3 most common alcohol poisonings are: ethanol, methanol and isopropanol. Alcohol ingestions account for.](https://reader036.fdocuments.in/reader036/viewer/2022062308/56649da65503460f94a91425/html5/thumbnails/23.jpg)
Aldehydes
• Formaldehyde– Uses - adhesives for plywood and veneers and
preservatives (formalin - 50% solution)– Irritating to mucous membranes
• Levels of 0.5 - 1 PPM - detectable by odor
• 2-3 PPM - mild irritation
• 4-5 PPM - intolerable to most people
– Levels of 1 PPM common in new homes
![Page 24: Alcohols, Aldehydes and Ketones. Introduction 3 most common alcohol poisonings are: ethanol, methanol and isopropanol. Alcohol ingestions account for.](https://reader036.fdocuments.in/reader036/viewer/2022062308/56649da65503460f94a91425/html5/thumbnails/24.jpg)
Formaldehyde, cont.• Clinical presentation
– runny nose– sore throat– headache– cough– drying and redness of skin– can cause cancer in mice and rats, no evidence of
human carcinogenesis
• Treatment - give fresh air and wash off skin
![Page 25: Alcohols, Aldehydes and Ketones. Introduction 3 most common alcohol poisonings are: ethanol, methanol and isopropanol. Alcohol ingestions account for.](https://reader036.fdocuments.in/reader036/viewer/2022062308/56649da65503460f94a91425/html5/thumbnails/25.jpg)
Ketones• Acetone
– Sources - component of industrial glues, solvents, fingernail polish remover
– Relatively non toxic - ingestion of 200 - 400 ml may not be serious
– Has a characteristic odor and narcotic like properties (CNS depressant)
– Threshold limit is 1000 PPM for workers exposed to 8 hours/day
![Page 26: Alcohols, Aldehydes and Ketones. Introduction 3 most common alcohol poisonings are: ethanol, methanol and isopropanol. Alcohol ingestions account for.](https://reader036.fdocuments.in/reader036/viewer/2022062308/56649da65503460f94a91425/html5/thumbnails/26.jpg)
Acetone, cont.• Clinical signs
– with inhalation - cough, bronchial irritation, headache, fatigue
– with ingestion - vomiting and nausea, metabolic acidosis, CNS depression (in severe cases)
• Treatment– give fresh air– give emetic– treat acidosis and maintain airway