Chronic alcoholics

C10H20N2S4, Et2NC(S)S-SC(S)NEt2. Drug used in treating chronic alcoholism. 

Several nonoccupational health problems have been traced to cobalt compounds. Cobalt compounds were used as foam stabilizers in many breweries throughout the world in the mid to late 1960s, and over 100 cases of cardiomyopathy, several followed by death, occurred in heavy beer drinkers (38,39). Those affected consumed as much as 6 L/d of beer (qv) and chronic alcoholism and poor diet may well have contributed to this disease. Some patients treated with cobalt(II) chloride for anemia have developed goiters and polycythemia (40). The impact of cobalt on the thyroid gland and blood has been observed (41). 

Beri-beri or clinically manifest thiamin deficiency exists in several subforms infantile beri-beri and adult beri-beri. Infantile beri-beri occurs in exclusively breastfed infants of thiamin-deficient mothers. Adults can develop different forms of the disease, depending on their constitution, environmental conditions, the relative contribution of other nutrients to the diet as well as the duration and severity of deficiency. First of all, there is a so called dry or atrophic (paralytic or nervous) form, including peripheral degenerative polyneuropathy, muscle weakness and paralysis. Second, a wet or exudative (cardiac) form exists. In this form, typical symptoms are lung and peripheral oedema as well as ascites. Finally, there is a cerebral form, that can occur as Wernicke encephalopathy or Korsakoff psychosis. Tli is latter form mostly affects chronic alcoholics with severe thiamin deficiency. 

Acetaminophen causes few adverse reactions when used as directed on the label or recommended by the primary health care provider. Adverse reactions associated with the use of acetaminophen usually occur with chronic use or when the recommended dosage is exceeded. Adverse reactions to acetaminophen include skin eruptions, urticaria (hives), hemolytic anemia, pancytopenia (a reduction in all cellular components of the blood), hypoglycemia, jaundice (yellow discoloration of the skin), hepatotoxicily (damage to the liver), and hepatic failure (seen in chronic alcoholics taking the drug). 

Acute acetaminophen poisoning or toxicily can occur after a single 10- to 15-g dose of acetaminophen. Dosses of 20 to 25 g may be fatal. With excessive dosages die liver cells necrose or die Death can occur due to liver failure The risk of liver failure increases in patients who are chronic alcoholics. 

Acetaminophen may alter blood glucose test results, causing falsely lower blood glucose values. Use with the barbiturates, hydantoins, isoniazid, and rifampin may increase the toxic effects and possibly decrease the therapeutic effects of acetaminophen. The effects of the loop diuretics may be decreased when administered with acetaminophen. Hepatotoxicity has occurred in chronic alcoholics who are taking moderate doses of acetaminophen. 

Several studies conducted in experimental animals have demonstrated that diets deficient in protein exacerbate the oral toxicity of endosulfan (Boyd 1972 Boyd et al. 1970 Das and Garg 1981). These results suggest that people who consume low-protein diets, such as chronic alcoholics, dieters, food faddists, various cults, some ethnic groups, the elderly, and some people living in depressed areas or underdeveloped countries, may be more susceptible to the toxic effects of endosulfan. 

Abnormalities of the glycosylation of transferrin occur in the congenital disorders of glycosylation (Chapter 47) and in chronic alcohol abuse. Their detection by, for example, isoelectric focusing is used to help diagnose these conditions. 

There are pharmacological, social and legal issues to consider in this context of drug dependence and, of course, drug users and abusers vary enormously. A chronic alcoholic is very different from a weekend user of cannabis and any consideration of the topic has to consider legal and social issues as well as pharmacological effects of the drugs. 

The myopathy associated with chronic alcohol abuse has also been associated with increased free-radical activity (Martin and Peters, 1985) as have various other toxicity syndromes affecting muscle, such as cocaine toxity (Kloss et al., 1983). Little work appears to have been undertaken on the possible role of free radicals in the inflammatory myopathies, although, by analogy with other inflammatory disorders, this is likely to be an area worthy of further study. 

The problems of alcohol dependence and alcoholism are dealt with in Chapter 10. Suffice it to say here that problem drinkers risk numerous psychological problems, such as anxiety and depression, and may experience physical withdrawal symptoms. There are also numerous medical problems related to heavy, chronic alcohol consumption these include increased risk of coronary heart disease, liver cirrhosis, impotence and infertility, cancer and stroke (Chapter 10). It is estimated that alcohol plays a part in up to 33,000 deaths per year in the UK (DoH, 2001). Within the last year 1 in 4 adults will have experienced loss of memory following an alcoholic binge, injured themselves or... 

The Wernicke-Korsakoff syndrome follows years of chronic alcohol abuse. However, alcoholics who do not develop this condition typically display a range of other cognitive impairments (Grant et al., 1987). Deficits in performance have been... 

Kokavec A and Crowe SF (1999). A comparison of cognitive performance in binge versus regular chronic alcohol misusers. Alcohol and Alcoholism, 34, 601-608. 

Cirrhosis A liver disease commonly associated with chronic alcohol misuse and characterised by the replacement of once-healthy hepatocytes with abnormal connective tissue. 

Korsakoff s syndrome A dementia commonly associated with chronic alcohol misuse. 

Buck KJ and Harris RA (1991). Neuroadaptive responses to chronic alcohol. Alcoholism Clininical and Experimental Research, 15, 460-470. 

Alcohol intake Induction of liver-metabolism during chronic alcohol intake... 

Montoliu C, ValiJs S, Renau-Piqueras J, Guerri C. Ethanol-induced oxygen radical formation and lipid peroxidation in rat brain effects of chronic alcohol consumption. J Neurochem 1994 63 1855-1862. 

A 50- year-old male chronic alcoholic ingests methanol. Which of the following findings is associated with acute methanol ingestion ... 

The answer is d. (Hardman7 pp 1681-1682. Katzung, pp 392-393J Acute intoxication with methanol is common in chronic alcoholics. Headache, vertigo, vomiting, abdominal pain, dyspnea, blurred vision,... 

Thiamine deficiency results in early decreases in activity of the mitochondrial enzyme a-ketoglutarate dehydrogenase in brain. Wernicke s encephalopathy, also known as the Wernicke-Korsakoff syndrome is a neuropsychiatric disorder characterized by ophthalmoplegia, ataxia and memory loss. Wernicke s encephalopathy is encountered in chronic alcoholism, in patients with HIV-AIDS and in other disorders associated with grossly impaired nutritional status. The condition results from thiamine deficiency. 

Acetaminophen is recommended by the ACR as first-line drug therapy for pain management of OA. The dose is 325 to 650 mg every 4 to 6 hours on a scheduled basis (maximum dose 4 g/day maximum 2 g/day if chronic alcohol intake or underlying liver disease). Comparable relief of mild to moderate OA pain has been demonstrated for acetaminophen (2.6 to 4 g/ day) compared with aspirin (650 mg four times daily), ibuprofen (1,200 or 2,400 mg daily), and naproxen (750 mg daily). However, some patients respond better to NSAIDs. 

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