Alcohol

• Alcoholic definition?

  DSM–5 integrates alcohol abuse and alcohol dependence, into alcohol use disorder (AUD) mild, moderate, or severe subclassifications. 
• Alcoholic?

  a primary, chronic disease characterised by impaired control over drinking, preoccupation with the drug alcohol, use of alcohol despite adverse consequences and distortions in thinking 
• Dependence?

  needs 3 of 7 conditions over 12 months: tolerance; withdrawal symptoms; ingestion in larger amounts; persistent desire; expenditure of increasing time in drinking / recovering; abandoning social/work activities; continued ingestion despite problems 
• Alcohol measures ?

  • labelling regulations = %ABV (alcohol by volume)
  • Forensice measures = mg% (%abv x 0.78 = g alcohol/100ml)
  • Public/medical measures = units 
• Calculating units of alcohol?

  ABV value tells how many units of alcohol there are in a litre of the liquid.

  75cl of 12% ABV wine = 12 units per litre = so 3/4 of a litre = 9 units of alcohol 
• Absorption of alcohol ?

  • duodenum jejunum absorbas over 80%
  • Via simple diffusion due to particles small size 
  • Rate of absorption is concentration dependent as well as related to stomach emptying 
• Distribution of alcohol?

  • Rapid distribution (rich blood supply = faster effect)
  • Crosses blood brain barrier easily 
  • Vc roughly equal to total body water ((0.6 L/kg) 
  • Higher effect on woman 
  • Fatter people = higher relative blood concentration
• Metabolism of alcohol ?

  
  

  ethanol ------> acetaldehyde ---------> acdetate + CO2 + H2O

  ADH ALDH

  • 98% metabolised by above step
  • Alcohol dehydrogenase is a rate limiting step 
  • Kinetics are principally zero order 
  • Is subject to may different genetic variations 
• ADH stands for ?

  Alcohol Dehydrogenase
• ALDH stands for?

  Acetaldehyde Dehydrogenase 
• What is the clearance rate of alcohol

  6 grams/ hour
• Excretion of alcohol?

  small amount not metabolised s are excreted unchaged

  occurs in urine and breath
• Pharmacological effects of alcohol ?

  • CNS depressant (apparent stimulatory effects result from depression of inhibitory control mechanisms in brain) 
  • GABA-A potentiation (a major inhibitory neurotransmitter) 
  • NMDA Antagonist causing glutamate inhibition (major excitatory neurotransmitter) 
  • Effects on serotonin, opioid and dopaminergic neurotransmission (reward centres) 
• V high levels of alcohol in the body can shut down critical areas of the brain that control breathing, HR, body temp, resulting in death
• Alcohol reacts with CNS drugs to cause ?

  • drowsiness
  • sedation

  Examples: benzodiazepines, tricyclic antidepressants, antihistamines
• Alcohol reacts with CV and antihypertensive drugs to cause ?

  enhanced hypotensive effect
• Alcohol reacts with warfarin and


  • major changes in consumption of alcohol may affect anticoagulant control with coumarins
• Metronidazole / Ketoconazole interactions

  inhibit aldehyde dehydrogenase to give a disulfiram like reaction
• Disulfiram reactions ?

  • certain drugs inhibit ALDH = accumulation of acetaldehyde
  • disufiram used as version therapy
• Acute alcohol intoxication ?

  • associated with violence, injuries, suicide
  • common to aspirate vomit or die from trauma
  • associated hypoglycaemia esp in kids
• Neurological consequences of chronic misuse ?

  • cerebral haemorrhage
  • wernickes encephalopathy
  • dementia
  • peripheral neuropathy
• hepatic consequences of chronic misuse ?

  • liver cancer
  • fatty change
  • cirrhosis
• GI consequences of chronic misuse ?

  • gastritis
  • pancreatitis
  • oesophageal cancer
  • oseophagitis
• respiratory consequences of chronic misuse ?

  • pneumonia
  • pulmonary tuberculosis
• skin consequences of chronic misuse ?

  • spider naevi
  • palmar erythema
• cardiac consequences of chronic misuse ?

  • cardiomyopathy
  • hypertension
  • arrhythmias
• MS consequences of chronic misuse ?

  • myopathy
  • fractures
• Endocrine and metabolic ?


  • pseudo cushings syndrome
  • gout
  • hypoglycaemia
• reproductive consequences of chronic misuse ?

  • hypogonadism
  • Fetal alcohol syndrome
  • impotence
  • infertility
• PH considerations ?

  • cost of cancer, injury Tx
  • societal costs due to accidents and violence
  • work absences
  • lost years of life
  • cost of chronic condition Tx eg. liver transplant
• Alcohol withdrawal

  = stopping or sudden reduction in alcohol intake after heavy drinking

  • can be fatal
  • symptoms = anxiety, tremors, sweating, neurological issues
  • benzo misused in HCP to control daytime shakes
• Dx of alcohol issues ?

  • alcohol diary inc. units
  • amount spent vs. weekly income
  • CAGE or FAST questionnaire
  • binge drinking
• Binge drinking amounts?

  male = >8

  female = >6

  at once
• Alcohol Use Disorder Identification Test – Consumption?

  An overall total score of 5 or above is AUDIT-C positive and may indicate hazardous or harmful drinking
• Physical exam ?

  • usually no findings
  • smell of alcohol
  • chronic liver disease signs
  • parotid enlargement
  • rhinophyma
  • peripheral neuropathy
  • withdrawal signs
• Lab test diagnosis ?

  • Full Blood Count = Macrocytosis
  • Urea and Electrolytes = Low Urea
  • Liver Function Tests = Raised Transaminases
  • Gamma GT = Elevated
  • INR = Prolonged