Some Interesting Facts:
ALCOHOL
Or ManoJ Shrestha. MD resident
Forenstc Medictne. 10M
24-12-2010(X-mas Eve)
"God give you of the dew of the
sky, of the fatness of the earth and
plenty of grains and new wine"
Genesis 27:28, The Bible
Advertisements - Who are
they trying to attract?
• Low da•ly consumptJon of alcohol •s cardto
protect•ve for only older men and
postmenopausal women
• Wh1le consuming same amount of alcohol per
body wetght. blood alcohol level reaches htgher
1n women than m men
• The Lethallevelpf alcohot•s between 0 4% and
0 6"To0y volume •n the blood
• The damagmg effect of alcohol tends to be
greater for women than for men
• One mght of heavy dnnkmg can •mpa1r your ability 10
thmk abstract!') for up to 30 da~s. hmillng your ability
to relate textbook rcadmg 10 \vhat your professor says,
or to thmk through a football pia'
Why Alcohol use is so wide
spread?
• Use of alcohol is legaL
• Easy availability.
• Wide spread advertisement promote
the notion that use of alcohol is as
normal and safe as drinking fruit juice.
• Alcohol use has long traditional
history.
• Alcohol is often considered as social
drug/lubricant as it represses
inhibitions, strengthens extrovers1on
and leads to increased sociability.
(_ Alcohol Chemistry ...
• Some Familiar types of Alcohol..
L - Ethyl Alcohol
II. -Methyl Alcohol toxic industrial
solvent
Ill. -Isopropyl Alcohol: Shaving lotion.
antifreeze. anttsept1c etc.
r( Ethanol Methanol

H H H
I I I
H-C-C-OH H-C-OH
I I I
H H H Us melabohtes are very toxtc and
even small amount( 4 ml) can cause
blin<lness atfecttng reltna and B0-
Ethyl Alcohol Methyt Alcohol 150 mt ts fatal

Moonshine liquor claims 47 in India

Jupcrintenc!cnl of police. S.
Dav«bonDnasin-att.m.
IC Alcohol Chemistry ..
• Production of Alcohol:
-Fermentation - Sugar to Alcohol
-1 NYc aakcd my men tO 80 and Carbon dioxide
.around the vilJaacs 10--- them
d'w::n: will be noec:Uon c.bnapift!ft
lhan and lhey muse immecliatcly
nnh 10 ttw ~· hospitU.,- he
""""-Three allcced sc:Ucn of the C6 H 120 6 - . 2(CH 3 -CH 2-0H) + 2C0 2
~I br_.- haw: been wratc:d.
-T~-m-u:ntii.at~Pl4
.J1cd and 30 p~~:oplc were~
(suger) ( ethyl alcohol)
llo!>~nt,.Jiscd m T1.mil Nad1.1 afic~
t~· du.nk moonshmc '

His orical Development

History of Alcohol
J;. ~eer
• Alcohol is the part of human culture
10,000 years ago- accident from grain?
since the beginning of recorded
1100 AD guild formed devoted to brewing
history.
1722 - a nourishing drink for potters and
laborers created called Potter • Natural alcohol concentration limit
that can be produced by fermentation
r Wine is 12%-14% because beyond that limit
8,000 years ago - kills yeast.
5,000 years ago the vineyards
• Around 800 BC Arab Alchemists
2,000 BC - Hammurabi ruler of Babylon sets
rules for the sale and purchase of wine
introduced distillation technique that
1,500 BC Greek god of wine- Dionysus I
could produce alcohol upto 50% or
Bacchus higher. This made it easier for people
to nPt rln mk
;:J v Ethyl Alcohol
~~ • Beer-3.2-4% EtOH usually
• Table wines-7-14%
• Whisky-40-70% (80-140 proof)
• Vodka-40-50% (80-1 00 proof)
• Gin-40-85% (80-170 proof) One I -oz. shot One 5-oz. glass One 12-oz. mug
ofwhiske> of wine of beer
• Rum-40-95% (80-190 proof)
Approx1mare EqutvaJents m
Alcohol Content

I(
ALCOHOl.. ABSORPTION

Alcohol Physiology ....

• Absorption. distribution and
Metabolism ...
IC 05-1%

.-..--~
( to lhe Sbnadt.,ld ~
- ..... a. htUlelh:i ard 10.20
%
--~
The_ ....._
;--··
. ' ab5ioflltiDnishuppir'

Alcohol Physiology contd .. ol Physiology cond ..

• Factors that speedup the absorption of • Factors Slowing the absorption:
alcohol are
• Eating before or while drinking( esp
-Increasing the amount drunk or drinking
meat. milk. fatty food)
rate.
-Drinking on empty stomach. • Diluting alcohol with ICE. water, or fruits
- Using h1gh alcohol concentrations in
drinks
- Dnnkmg carbonated drinks. such as
champanes.
-Warming the alcohol.
- Women absorb more alcohol during
premenstrual penod then at other times
 Alcohol Metabolism ...
• Alcohol Acetaldehyde
1
Alcohol
I
Oehydrogenas 1"'- Acetaldehyde Oehydrogena
e I

Acetic Acid
• gm of alcohol provtdes
7Jcal of energy C02. H20, and
- cohol dehydrogenase and
a etaldehyde dehydrogenase energy
a ma1nty found tn hver - ')r--e.:t<nt. :'c"",
- etabohsm occurs at r""'oounle:'S - D'..
c nstant r-ate -TI'lle<:dlor~<;

O::OWYri<s

Dis ribution Elin~ination

) Uniformly distributed throughout Urinary Excretion

tissues and body fluids
> Readily crosses placenta, to Exhalation
exposure fetus Metabolism

Alcohol and neurotransmitters

I( oender Differences

• Serotonin: Alcohol initially ~levates

mood by causing the release of emales higher blood alcohol levels
serotonin then depletes it with excess
than males

y
use;Scarcity causes depression.
• Met-enkephalin release by drinking
.
reduces pain. '

• Dopamine- surge of pleasure. .

• GABA-Iowers psychological mhibitions
and eventually slowing down all the
brain process.
 For Example: hy Do Women Get Drunker After
Aft ~r consuming two drinks in one hour... D inking the Same Amount as Men?

A 2001b male will have a

BAC of -.035 Body Size
Body Composition
A 1501b female will have a
BAC of -.06! Enzymes
Hormones
~er blood alcohol concentration is almost
tlltice his blood alcohol concentration after
they've had the same amount to drink'

Body Composition

. r general, women have a greater percent of

.....
IH
ody fat and a smaller percent of muscle 0 01 0'c~
ssue than men_ • • 0 r.o,J

• 0 ......TE'!
ecause women have less muscle tissue,
hey also have less body water in which to
Men Women
istribute consumed alcohoL ,,. ~
,~()
(~

Enzymes Hormones
• Women have lower levels of alcohol strogen slows the metabolism of alcohoL
dehydrogenase, an enzyme involved in
• ntoxicating effects of alcohol are most
~e metabolism of alcohol.
)OWerful when a woman's estrogen levels
• ~ven if a man and a women have the same 3re highest- i.e right before her period.
~ody size and composition, the women will
• Nomen on birth control pills metabolize
~till have a BAG about 1/3 higher than the
~lcohol more slowly throughout their cycle_
man if they drink the same amount!
Gender difference
• It takes less alcohol consumption for
women to become dependant on
alcohoL "'II. ;>men have come a long way over the past
• The course of alcohol addiction 20 ears, but in substance abuse and addiction
progresses at a faster rate among women have come the wrong way."
women than men.
- Joseph Calitano. Center on AddlClton
• Death rates for female alcoholics are 50 and Substance Abuse, Columb1a
- 100 percent higher than for male
alcoholics
• 55% of female students involved in
acquaintance rape had been drink1ng
or using drugs at the time.
• 60% of colle e w~ectw1th

IC Desired effects of low to

evels of alcohol use are:
moderate dose alcohol. ..
• Produce the feelings of warmth since the
Social/Recreational use. vessels dilate and mcrease the blood flow to
the subcutaneous tissue.
Habituation. • Local disinfectant, pain reliever, for certain
Abuse. nerve related pains, ? To prevent premature
labour, systemically ethanol is used to treat
Addiction. methanol and ethylene glycol poisoning.
• Reduces the incidence of heart disease and
plaque formation by increasing HDL.. and
lowers risk for stroke by acting as
anticoagulant. But higher dose increase the
risk of stroke.
• Sleep
• Psychosocial effect

My Doctor said "Only l glass of

alcohol a day··. I can live "~th that.
. (J, /High dose use of alcohol..
\.._ ) ( _ • Binge dnnk 1s defined as consuming 5 or
more drink at one sitting for male and 4 or
more for females.
• Heavy drinking is defined as 5 or more drinks
in one sitting at least 5 times a months
• One standard drink is:
• 3 to 4 ounces unfortified wine
• 1 0 ounces w1ne cooler
• 12 ounces regular beer
• 1 'h ounces hard liquor (60 proof)
 High dose use of alcohol
contd.
• Results:
( • Hangover condt.:
-Due to dehydration of brain and
-Alcohol poisoning( over dose) other tissues.
BAC > 0.4. -Due to loss of K+, Mg++
-Due to accumulation of
-Black outs. acetaldehyde.
-Hangover -Due to acute withdrawal response
(especially in alcoholics)
Tx: enough fluid, electrolytes. PCM+ caffine.
but actual better feelings come with rest and
sufficient recovery time. If hangover IS due to
withdrawal, taking some alcohol actually
helps.

/t

( Driving Under Influence ..

• Directly related to the BAC.
( Measuring BAC ..
• A breathalyzer-- measures deep lung
air and provides a rough estimate of
• There are some skills that are even
the amount of alcohol in your system,
impaired at 0.02 BAC; such as ability
based on a scientific formula .. which
to divide attention between two or is not very precise. So your Blood
more visual inputs. Alcohol Content may vary somewhat,
• BAC vs Chances of being killed in a either more or less, if it is measured
sinale vehicle crash ... by other means (such as a blood or
I BAC(gmsldl) Chances of being killed l urine test).
!002-004 1 4 times normal I • Blood and Urine: By using Ethanol test
1o os.o og
~1-014
0 1 5 and above
11 tsmes normal
48 times normal
380 bmes nonnal
=1l kits.

~el(OI!fUIIICOhOI~,
. ; and innamea dle,~
p.,.cn.t:tu.
lining
6olh ChfOfW: and acute

.. ,
l EmoUon811md aoclal
Emodonat. soctal. and economic pmbtema
are aBSOda&ed wttth heavy dnoiung
··- ~--·-.
...........
Heavy dfinkef:s often haw
poor diets and may bleed
~·,
i...hJ
\
Cancv
ExoePIIIcoho11no'9eMti
_ thO ft9: or gutrok\l.esdnat
tiver. and breastcancera.
Smoking fu"ttrllr lnCfltaMII
from the mge:stiva tract
~. theSe nsks
\\\:~
Brain
Ao.Jte effects. ate
d<unl<- LOng,lenn
' oflecls ofchrooicalcohol.
/ ~are dGmenlfa.
' memotY iQN,.and -

l =:"'~·:•t;z Ost~t.
p.,fph-.1 neuropetfty
Painful neiYO ln!lemma'tion
He&"'Y G-lnking oontrlbOteS • on haOda. arms, feel. anr:1
'Gastrlb
Continued contad. with
'• '
_...,.._
to bone loss, espedaly In
-Is"""""'""'""""
llme neavv ak:oho1 oeetS
• excess alcohol tmtales
 T . . LOCKHORNS/Bill Hoest
f~';-p Jcoholics and Malnutrition
1 por diet
~lcohol - energy but no nutrients
~ o

I conomic factors
. ack of interest in food; Gl problems
0

• E: )dy weight
• nconsistent effect of alcohol calories on weight
•\i tamin deficiencies
fl.lcohol interferes with vitamin metabolism
. olate. thiamm.
o

vitamin~

If,
......._
lcoholics and Malnutrition
Alcohol and Pregnancy ..
• Fetal Alcohol syndrome( FAS).
·~ ineral deficiencies Alcohol related neurodevelopment
• Inadequate diet and fluid losses disorders, Alcohol related birth
·Calcium, magnesium. iron, zinc defects.
• Some mineral levels are elevated • Not all the children who drink heavily
•r acronutrients during pregnancy bear children with
·!Alcohol interferes with amino acid absorption FAS.
·!Alcohol raises blood levels of fats • Since brain is among the first organs
to develop and last to finish it appears
to be vulnerable throughout
pregnancy.
"

l( Fetal Alcohol syndrome ...

Effects of Prenatal Alcohol
I( • Growth Retardation. Small head
!
• Facial deformities.
• CVS and extremites problem.
• CNS involvement- delayed intellectual
development. neurological anomaly,
behavioral problems. visual problems,
hearing loss
 ~lcohol Blood Levels and Brain
Blood alcohol
concentration
Kesponses
Blo d Level Brain Response
Frontal kX>e seaanon - reasonmg
o.os~. 0 0~ Judgment impaired
"""JUdgement impaired
F rental lobe
0 1( Emotional control impaired
Speed'l aod vtSIOI1 cenret sedation-
0.10'>.
trnpr;wed coordinabon, VISK>O, driW19
01 IMuscle coordination. reflexes
VOitrltary musde control ~ed - 0.2( ,impaired
015% staggering gart. slurred speed>.
blurTed "VlSion 0.3( Vision impaired
0.20% lnabiloly to wal~ 0.3 Drunk, lacking control
030"1> Stt4u. oonluSion 0 5( 1--0 60 In a stupor
ILoss of consciousness. death
;O,,~~~>· ;~~~" ..

I "'

~c holism - Alcohol Dependence Alcohol Dependency Syndrome

I~ Characterized by the following: • Includes four or more of following

symptoms..
raving: A strong need, or compulsion, to drink.
o 1.Narrowing of drinking repertoire
oss of control: The inability to limit one's drinking
n any given occasion. o 2.Salience of drink seeking activity

hysical dependence: Withdrawal symptoms, such o 3.1ncreased tolerance

~ nausea, sweating, shakiness, and anxiety, occur
o 4.Repeated withdrawal symptoms
hen alcohol use is stopped after a period of heavy
o S.Relief drinking
rlnking.
olerance: The need to drink greater amounts of • 6. Awareness of compulsion to drink
lcohol in order to "get high." (Dispositional, o ?Rapid reinstatement after abstinence
harmacologic, behavioral, select)

~.
Withdrawal lcohol vs. Injuries and suicides.
Among the alcoholics suicide rates are twice
ndrome Clinical Findings Onset as high as for the general population.
IM.I ~ Tremulousness, mild anxiety, l6-36h Causes: Social, familial, interpersonal. Health
headache, diaphoresis,
problems.
palpitations. anorexia, Gl
upset
I~ ~ Generalized, tonic-<:lonic 6-48h
seizures. status epilepticus
(rare)
-~ ~ I
Visual, auditory, and/or tactile 12-48 h
Ha ucinosis halluconations1
i

[lli; ill!!!! Delirium. tachycardia. f4s:-96h--

,rr, ~ hypertension. agitation. fever. 1
diaphoresis I
 IC
Drugs used in the treatment of
alcohol problems
• Drugs used in withdrawal
~ Chlorchazepoxtde {Ubnum)
" Chlormethtazole (Hem•nevenn)
" Otazepam
• Drugs used in relapse prevent1on
" Disulfiram (Antabuse)
• Acamprosate (Campral)
• Nallrexone
• Vitam1n replacement
~ Th•amtne
• Vttamtn B complex
" Pabnnex

Naltrexone therapy improves treatment

outcomes when added to other components
of alcoholism treatment. For patients who
IC HowdoesCamp~lwo~?

Acamprosate (Campral) reduces the

craving for alcohol by inhibiting a
chemical in the brain called gamma
are motivated to take the medication.
naltrexone is an important and valuable
aminobutyric acid (GABA). Several
tool. In many patients. a short regimen of studies have indicated that it may help
naltrexone will provide a critical period of drinkers remain abstinent
sobriety, during which the patient learns to
stay sober without it.

!(:
•
•
onpharmacological Treatment

UJet env1ronment
utrition and hydration:
IC Referances:
• Drugs and Society- Hanson. Venturelli
and Fleckensten. 2008.
;... Oral th1amine (prevents Wemicke-Korsakoff) I foJ1c actd • Uppers. downers and allrounders-
:r- Oral fluids I electrolytes lnaba and Cohen. 2009.
• rientation to reality, social and psychological • Internet- www.hinari.org.
~ ~pport. • Associate Prof. Dr. H. Wasti. MD.
• I rief interventions I motivate to change Msc. LLB.
eferral to AA I relapse prevention tx.