Alcoholism Intoxication

Because alcohol intoxication may be simulated by many pathologic conditions, including diabetic acidosis, the postconvulsive depression of epilepsy, uremia, head injuries, and poisonings by any other central nervous depressant and some stimulants (280), a diagnosis of acute alcoholism should not be made casually chemical testing of blood, urine, or expired air is always desirable. 

Some authorities question whether dmnkeimess can result from the inhalation of ethyl alcohol vapors. Experience has demonstrated that in any event such intoxication is indeed rare (281). There is no concrete evidence that the inhalation of ethyl alcohol vapor will cause cirrhosis. Liver function is definitely impaired during alcohol intoxication (282), making the subject more susceptible to the toxic effects of chlorinated hydrocarbons. 

The antianxiety drug s are contraindicated in patients with known hypersensitivity, psychoses, acute narrow-angle glaucoma, and shock. These drugp are also contraindicated in patients in a coma or with acute alcoholic intoxication with depression of vital signs. 

There are no available medications that can fully reverse the effects of alcohol intoxication. Caffeine and other stimulants can induce arousal and alertness, but they are less effective at... 

Apart from this paradoxical exception, it is clear that at higher doses alcohol intoxication is associated with impaired performance across a range of tasks involving psychomotor, attentional and memory processing. At moderate to high doses, alcohol impairs the formation of new memories and disrupts working memory. However, established memory is left relatively unimpaired, suggesting that... 

Summarise the cognitive and behavioural effects of alcohol intoxication. 

Signs and symptoms of alcohol intoxication are slurred speech, ataxia, sedation, nystagmus, unconsciousness, nausea, vomiting, hallucinations, delirium, and seizures. Signs and symptoms of alcohol withdrawal are tachycardia, diaphoresis, and hyperthermia. 

As implied above, acetaldehyde is toxic the accumulation of this metabolite leads to many of the deleterious consequences of alcohol intoxication because it is able to alter... 

Marks MJ, Grady SR, Collins AC (1993) Downregulation of nicotinic receptor function after chronic nicotine infusion, J Pharmacol Exp Ther 266 1268-1276 Maurer P, Jennings GT, Willers J, Rohner F, Lindman Y, Roubicek K, Renner WA, Muller P, Bachmann MF (2005) A therapeutic vaccine for nicotine dependence preclinical efficacy, and Phase I safety and immunogenicity. Eur J Immunol 35 2031-2040 Mayo-Smith ME (1998) Management of alcohol intoxication and withdrawal. Principles of addiction medicine, 2nd edn. American Society of Addiction Medicine, Chevy Chase, MD, pp 431 40... 

During the initial evaluation, providing for the safety of the patient is of paramount importance. The severity of intoxication and potential for withdrawal must be quickly and accurately determined. Extreme alcohol intoxication can be fatal either by the production of cardiac arrhythmias, aspiration (the inhalation of stomach contents that are vomited), or other causes. We have all seen reports of college students dying from alcohol poisoning. Likewise, up to 10% of patients in severe alcohol withdrawal can die without treatment. Fortunately, most patients do not experience the most severe forms of alcohol withdrawal such as the DTs. Mild withdrawal can be managed in the outpatient setting with appropriate support and patient adherence, but severe withdrawal requires an inpatient hospitalization. See Section 6.5 for further discussion of the initial evaluation. 

Psychiatric medications do not currently play a prominent role in the treatment of cocaine-dependent patients (see Table 6.4). Although researchers have labored to find medications to treat cocaine addiction, there have not been any notable breakthroughs. As with other substance use disorders, the presence of a psychiatric disorder for which medication is indicated (i.e., depression, anxiety disorders, bipolar affective disorder, or schizophrenia) should prompt appropriate treatment. Similar to the presence of alcohol intoxication, deferring a diagnosis for a day or two in a new patient with no past history is often the more prudent course. 

Opioid agonists act first and foremost on /t-receptors. It is essential to know that use of compounds of this class should be avoided in the event of cranial trauma, bronchial asthma and other hypoxic conditions, severe alcohol intoxication, convulsive conditions, and severe pain of organs in the abdominal cavity. 

Never give disulfiram to a patient in a state of alcohol intoxication or without the patient s full knowledge. Instruct the patient s relatives accordingly. 

Inhaled substances may be associated with practices and equipment that may lead to suffocation. Commonly abused inhalants include model glue, spray paints, cleaning fluids, gasoline, liquid typewriter correction fluid, and aerosol propellants for deodorants or hair sprays. Most inhalants produce a rapid high that resembles alcohol intoxication. If sufficient amounts are inhaled, nearly all solvents and gases produce a loss of sensation, and even unconsciousness. Adverse effects may include severe organ damage. 

Xanthines, primarily as the intramuscularly administered combination of caffeine and sodium benzoate, have been used in the treatment of CNS depressant overdosage. Black coffee has been used to physiologically antagonize alcohol intoxication, although many physicians believe that this ineffective therapy simply produces a wide-awake drunk. 

Ethanol produces central nervous system depression over a wide range of doses. Its effects are additive or sometimes more than additive with other central nervous system depressants. Symptoms often associated with acute alcohol intoxication include increase in self-confidence, loss of inhibitions, euphoria, and loss of judgment. With increasing doses motor and intellectual impairment become prominent. Chronic abuse of ethanol leads to severe liver impairment (see Chapter 35). 

Contraindications Acute alcohol intoxication with depressed vital signs, acute angle-closure glaucoma, concurrent use of itraconazole or ketoconazole, myasthenia gravis, severe COPD... 

Contraindications Acute alcohol intoxication, acute angle-closure glaucoma... 

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