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![Page 1: Roberta Agabio, M.D. Department of Biochemical Sciences Section of Neuroscience University of Cagliari, Italy Acute Alcohol Intoxication (AAI) © AMSP 2012.](https://reader036.fdocuments.in/reader036/viewer/2022062515/56649cc35503460f9498c48f/html5/thumbnails/1.jpg)
Roberta Agabio, M.D.Department of Biochemical Sciences
Section of Neuroscience University of Cagliari, Italy
Acute Alcohol Intoxication
(AAI)
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Alcohol Use & Problems
• 90% Ever drink
• 14% Drinkers have 1+ problem:
Accidents
Violence
Mood swings
Physical illness© AMSP 2012 2
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AAI: Lecture Focus
1) Alcohol’s drug class
2) Alcohol's brain effects
3) AAI signs and symptoms
4) Evaluation and treatment of AAI
5) Unhealthy alcohol consumption
1) Alcohol’s drug class
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Drug Classes Based on Effects
• Depressants
• Stimulants
• Opioids
• Cannabinols
• Hallucinogens
• Inhalants
• Others
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Depressants Include
Class ExampleBenzodiazepines DiazepamBz-like meds ZolpidemBarbiturates SecobarbitalOthers Chloral hydrate
Alcohol
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Effects & DangersEffects
↓ Anxiety Anesthesia ↑ Sleep ↓ SeizuresMuscle relaxation
DangersSedation Drug
interact ↓ Memory
Dependence↓ Coordination
Intoxication© AMSP 2012 6
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Intoxication Medical problems ↓ Vital signs, coma, risk of death
Temporary psychiatric syndromes Cognitive disordersPsychosis
AnxietyDepression
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AAI: Lecture Focus
1) Alcohol’s drug class
2) Alcohol's brain effects
3) AAI signs and symptoms
4) Evaluation and treatment of AAI
5) Unhealthy alcohol consumption
2) Alcohol’s brain effects
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Alcohol ↑ dopamine transmission
Reward Brain System
→ Pleasurable effects © AMSP 2012 9
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Inhibition Excitation
1. Homeostasis
Alcohol's Brain Effects
3. Chronic use (tolerance)
Inhibition Excitation
ALCOHOLOPPOSITE CHANGES
Inhibition
Excitation
OPPOSITE CHANGES
4. Withdrawal
Inhibition
ExcitationALCOHOL
2. Acute use
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Blood Alcohol Concentration (BAC)
• Standard drink = ~12 g alcohol
• ↑ BAC with:
• Female
• ↓ Weight
• Drink without food
• 1 drink → BAC = ~15 mg% (0.015 g/dl)
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BAC’s Effects
≤ 50 (1-3 drinks)
BAC (mg%)
Well-being, ↓ inhib
≤ 100 Sleepiness, ↓ coordination
≤ 200 Anger, moody, confusion
≤ 300 Difficulty to awaken
> 300 ↓ Vital signs, coma, death
Effects
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AAI: Lecture Focus
1) Alcohol’s drug class
2) Alcohol's brain effects
3) AAI signs and symptoms
4) Evaluation and treatment of AAI
5) Unhealthy alcohol consumption
3) AAI signs and symptoms
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Definition of AAI (DSM-IV)Recent ingestion
Behavior changes (e.g. aggression)
Nystagmus
1+ Slurred speech
↓ Coordination
Unsteady gait
Nystagmus
↓ Attention or memory
Stupor or coma
Nystagmus
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AAI Medical Problems↓ Vital signs
• Body temperature
• Respiratory rate
• Blood pressure
↑ Risk of death • BAC > 300 mg%
• Opioids or other depressants
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AAI Temporary Psychiatric Symptoms
Cognitive problems
Psychosis
Depression and/or anxiety
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AAI Cognitive Problems
Confusion
↓ Memory
↨ Alertness
↓ Judgment
Disorientation© AMSP 2012 17
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AAI Psychosis
Suspiciousness
Hallucinations
Paranoid thoughts
All without insight
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Sad all day
Every day for 2+ weeks
Can be suicidal
AAI Depression
AAI Anxiety Syndromes Meet criteria for anxiety disorders
(e.g., panic disorder)© AMSP 2012 19
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AAI: Lecture Focus
1) Alcohol’s drug class
2) Alcohol's brain effects
3) AAI signs and symptoms
4) Evaluation and treatment of AAI
5) Unhealthy alcohol consumption
4) Evaluation and treatment of AAI
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AAI Evaluation • Other med/psych illness
• Toxicological screen
• Other intox/withdrawal • Smell of alcohol • AAI signs & symptoms • Laboratory tests
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Check BAC & use of other drugs
Toxicological Screen
• BAC > 300 mg% → potential death
How to do• Draw ~ 50 cc blood sample• Collect ~ 50 ml urine sample
• Opioids or other depressants ↑ risk
• BAC ↓ by ~15mg%/h
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Bleeding
Shock
Electrolyte disturbances
Cardiac disorders
Infections
Consequences of brain trauma
Rule Out Other Problems
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Use a fingerstick
If ↓ administer
• 50 cc of 50% glucose IV &
• 100 mg vit. B1 (IV or IM) if needed
Test for blood sugar
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Medical Treatment
If↓vital signs =
EMERGENGY PROBLEM
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NO MEDS until are sure they are needed
• Airway• Breathing • Circulation
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ABCs Of Emergency Care
Support Vital SignsMeasure vital signs frequently
Address life-threatening problems =
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Assure adequate ventilation
Airway & Breathing
• Remove obstructions in mouth
• Straighten head (if no neck injury)
• If needed intubate
• Use respirator (~12 breaths/min)
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Maintain adequate blood pressure
Circulation
• Start IV line
• Use large-gauge needle
• Use a slow drip until know if need
fluids
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Other Drugs: ↓ Absorption
Patient awake & stable pulse
Gastric lavage
Inducing vomiting (oral ipecac syrup)
Patient not awake
Took drugs within 12 h
Not corrosive, kerosene, strychnine, oils
If comatose, only after intubation© AMSP 2012 29
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Gastric Lavage: How to do
• Sample of washings for drug analysis
• Nasogastric tube
• Patient on his/her left side
• Head slightly over the edge of the table
• Evacuate stomach
• Isotonic saline lavage until fluid clear
• Repeat up to 10-12 times
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BDZ → flumazenil
Specific Drugs: AntidotesOpioids → naloxoneMonitor possible opioid abstinence syndrome
Monitor possible seizures & ↑ intracran press
Atropine-like drugs→ physostigmine
Barbiturates → No antidoteForced diuresis & alkalinization of urine
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Should improve < 1 month
AAI Psychiatric Symptoms Medical Treatment
Meds should be avoided
Protect & reassure
Consider inpatient Observe & provide general support
BDZ or antipsyc meds for sedationNo antidepressants
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AAI: Lecture Focus
1) Alcohol’s drug class
2) Alcohol's brain effects
3) AAI signs and symptoms
4) Evaluation and treatment of AAI
5) Unhealthy alcohol consumption 5) Unhealthy alcohol consumption
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Unhealthy Drinking
Consider this in all patients
1) Alcohol Abuse andDependence
k
2) At-risk Drinking
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Abuse1+
• Role failure
• Risk of harm
• Run-ins with law
Dependence3+
In same 12 months
• Relationship
trouble
• Tolerance• Withdrawal• Unable to limit
• Unable to cut down
• ↑ Time with alcohol
• ↓ Time elsewhere
• Use in spite of problems
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At-Risk Drinking
> 7 drinks per week≥ 4 drinks per occasion
> 14 drinks per week≥ 5 drinks per occasion
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ID Unhealthy Drinking 1) Ask• How many drinks per occasion?
• How many drinks per week?
2) Blood markers*MCV
> 90 µ3
GGT > 35 U/lCDT > 2.0 U/l ALT > 35 U/l AST > 33 U/l
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Questionnaires
• CAGE
• AUDIT (Alcohol Use Disorders Identification Test)
Cut downAnnoyed Guilty Eye-opener
10 items about Alcohol consumption
Drinking behavior
Alcohol-related problems© AMSP 2012 38
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1st step: Intervention
2nd step: Detoxification
3rd step: Rehabilitation
Rx Abuse/Dependence
Rx At-Risk DrinkersHelp patients ↓ drinking
Brief Intervention© AMSP 2012 39
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1st Step: InterventionHelp patients to
• Recognize problems
• ↑ Motivation to change
• ↓ Future difficulties
Motivational interview
Brief intervention© AMSP 2012 40
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Motivational Interview
•Feedback
•Responsibility
•Advice
•Menu
•Empathy
•Self-efficacy
Brief Intervention
• Education
• Dangers
• Suggest ↓ alcohol use
• Avoid risky situations
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~ ½ Patients need it
Reassurance temporary nature
Meds • Oral multivitamins • Benzodiazepines for ~1 week
2nd Step: Detoxification
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Help patients to• Keep motivation high• A lifestyle free of alcohol • ↓ Risk of relapse
3rd Step: Rehabilitation
Counseling
Self-help groups (AA)
Meds© AMSP 2012 43
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Rehabilitation Meds
1. Disulfiram
2. Oral naltrexone
3. Slow release naltrexone
4. Acamprosate
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AAI: Lecture Focus
1) Alcohol’s drug class
2) Alcohol's brain effects
3) AAI signs and symptoms
4) Evaluation and treatment of AAI
5) Unhealthy alcohol consumption
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Conclusions on AAI
2) Other depressants ↑ risk of death
1) May be a life-threatening
5) Evaluate unhealthy alcohol use
3) May → temporary psych symptoms
4) Rx: support vital signs until
• Alcohol has been metabolized
• Psych symptoms disappear
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