Malnutrition alcoholics

Individuals with chronic alcoholism are prone to gastritis and have increased susceptibility to blood and plasma protein loss during drinking, which may contribute to anemia and protein malnutrition. Alcohol also reversibly injures the small intestine, leading to diarrhea, weight loss, and multiple vitamin deficiencies. 

Peripheral neuropathy is observed in 10-20% of patients given dosages greater than 5 mg/kg/d, but it is infrequently seen with the standard 300-mg adult dose. Peripheral neuropathy is more likely to occur in slow acetylators and patients with predisposing conditions such as malnutrition, alcoholism, diabetes, AIDS, and uremia. Neuropathy is due to a relative pyridoxine deficiency. Isoniazid promotes excretion of pyridoxine, and this toxicity is readily reversed by administration of pyridoxine in a dosage as low as 10 mg/d. Central nervous system toxicity, which is less common, includes memory loss, psychosis, and seizures. These may also respond to pyridoxine. 

On the other hand, a reassessment of the role of the AIDS virus (HIV) has been supplied by Peter H. Duesberg and Bryan J. Ellison of the Department of Cell Biology, the University of California, Berkeley. There are apparently reasons to suspect that the virus does not produce the AIDS disease. Instead, malnutrition, alcohol, drugs, and the routine use of antibiotics may cause the collapse of the immune system. (A partial counterargument is that AIDS also occurs among the... 

It is hypothesised that another condition which predisposes to the development of HOC is malnutrition. Alcohol can affect the blood levels and metabolism of a variety of other spedes important for biochemical synthesis and physiological function. DNA methylation can be affeded by diminished absorption and metabolism of micronutrients such as folate and vitamins B12 and Bg. ritamin A and P-carotene can also be present at below normal levels in alcoholics. 

Generally, nephrotoxicity is not a problem. Some cephalosporins, especially those with the 3-methylthiotetrazole side chain, such as moxalactam (48), show a tendency to promote bleeding. This appears to be due to a reduction in the synthesis of prothrombin and can be a problem especially in elderly patients, patients with renal insufficiency, or patients suffering from malnutrition (219). The same side chain seems to promote a disulfiramlike reaction in patients consuming alcohol following a cephalosporin dose (80,219). 

Risk factors for deficiency Pregnancy (neural tube defects in fetus may result) Alcoholism Severe malnutrition Risk fiictors for deficiency Pernicious anemia Gastric resection Chronic pancreatitis Severe malnutrition Vegan Infection with D. latum... 

A healthy diet usually covers average daily vitamin requirements. By contrast, malnutrition, malnourishment (e.g., an unbalanced diet in older people, malnourishment in alcoholics, ready meals), or resorption disturbances lead to an inadequate supply of vitamins from which hypovitaminosis, or in extreme cases avitaminosis, can result. Medical treatments that kill the intestinal flora—e. g., antibiotics—can also lead to vitamin deficiencies (K, Bi2, H) due to the absence of bacterial vitamin synthesis. 

The main acute effect is inebriation, which in turn spawns violence, spousal and child abuse, crime, motor vehicle accidents, workplace and home accidents, drowning, suicide, and accidental death. The chronic effects include alcoholism, liver disease, various forms of cancer, brain disorders, cardiovascular disease and other organ system effects, absence from or loss of work, family dysfunction, and malnutrition. 

Chronic excessive consumption of alcohol can result in physical dependence or alcoholism. There is often a steady progress in the need to drink, so that the person starts drinking early in the day to maintain blood alcohol levels and avoid withdrawal effects. Alcoholism often results in a variety of organ system effects, some of which are related to accompanying malnutrition. Treatment for alcoholism must address the withdrawal effects as well as associated vitamin deficiencies associated with malnutrition. 

Where patients are at risk of Wernicke s encephalopathy - for example, because of chronic alcohol abuse, hyperemesis gravidarum, or malnutrition - they should be given thiamine. In many countries no intravenous preparation of thiamine alone is available, and the compound preparations that are available are prone to cause anaphylactoid reactions, so they should be given by slow infusion, and with adequate facilities for resuscitation. A high potency preparation (Pabrinex ) that contains thiamine 250 mg in 10 ml with ascorbic acid, nicotinamide, pyridoxine and riboflavin, can be given by intravenous infusion over 10 min. 

Depressive disorders can lead to death in other ways (Table 6-9). For example, depressed individuals are more prone to accidents that result from their impaired concentration and attention. They also often attempt to self-medicate, particularly with alcohol or other sedative agents, which may lead to death as a result of organ toxicity, as well as accidents. Psychotic depressive patients may act irrationally, putting themselves at greater physical risk. Although rare today, patients have died of severe malnutrition secondary to catatonic symptoms that precluded the ability to care for their basic needs. Depression can also contribute to a higher morbidity and mortality rate in patients with co-morbid medical disorders. For example, a large database indicates that depression may predispose to the development of ischemic heart disease and increase the risk of cardiac-related death ( 51). 

Malnutrition from dietary deficiency and vitamin deficiencies due to malabsorption are common in alcoholism. 

Hoyumpa AM, Schenker S. Major drug interactions effect of liver disease, alcohol and malnutrition. Annu Rev Med 1982 33 113. 

Detoxification refers to the clearing of alcohol from the body and the readjustment of all systems to functioning in the absence of alcohol. The alcohol withdrawal syndrome at the mild end may include only headache and irritability, but about 5% of alcoholic patients have severe withdrawal symptoms manifested by tremulousness, tachycardia, perspiration, and even seizures (rum fits). The presence of malnutrition, electrolyte imbalance, or infection increases the possibility of cardiovascular collapse. 

The tools for nutritional assessment include medical history and screening aides, physical examination and anthropometric measurements, biochemical assessment, and tests of immune function. A general health assessment and medical history are required to rule out causes of secondary malnutrition such as poor oral health, chronic illness, disease, and medication. Malnutrition is influenced by lifestyle, which includes alcohol usage in adults, food preference, eating habits, social interactions, and economic status. Various screening tools, such as the DETERMINE checklist (White et al., 1991), are available to assess the risk of malnutrition. 

Q13 Magnesium is a major intracellular cation which acts as a co-factor in many intracellular enzyme reactions. Plasma concentration is normally 2 mg dl-1. This ion is abundant in the diet, and hypomagnesaemia is relatively uncommon, unless there is malabsorption or excessive loss via the kidney. However, when present, hypomagnesaemia can lead to hypoparathyroidism. Adjustment to the levels of magnesium can shift the function of the parathyroid glands back to normal. Chronic alcoholism, malnutrition, malabsorption, renal tubular dysfunction and excessive use of diuretics, such as loop and thiazide diuretics, may lead to hypomagnesaemia. Symptoms of magnesium deficiency include depression, confusion, muscle weakness and sometimes convulsions. 

Inflammation of the pancreas, pancreatitis, can be a consequence of excessive alcohol intake and causes severe pain. In chronic pancreatitis the exocrine cells which produce enzymes are damaged and smaller quantities of enzyme are released into the gut so that a major portion of the diet remains undigested and is not absorbed. Patients suffer malnutrition and weight loss. 

Non-alcohol steatohepatitis Fat build-up in the liver eventually causes scar tissue associated with diabetes, protein malnutrition, obesity and coronary artery disease. Treatment with corticosteroid medications. Biopsy is needed for full diagnosis. 

Hepatotoxicity from paracetamol overdose can occur with single doses as low as 10-15 g. The risk factors for hepatotoxicity in excessive doses include induction of cytochrome P450 enzymes malnutrition or fasting, due to reduced glutathione stores and reduced glucuronidation chronic alcohol use and age over five years [8, 13]. 

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