[9.1] 6131 LAB - Activity 9: Alcohol Poisoning

ALCOHOL, USP (ETHANOL)

Synonyms

Grain alcohol, Neutral spirit, Spiritus vini Rectificatus, Jaysol, Dehydrated alcohol

ALCOHOL, USP (ETHANOL)

Description

Has a very characteristic odor and sharp burning taste

ALCOHOL, USP (ETHANOL)

Preparation: chemical

Ethene hydration

ALCOHOL, USP (ETHANOL)

Preparation: fermentation

Carbohydrate fermentation

Ethene hydration

• CH₂=CH₂ –(H₂O, H₂SO₄)→ EtOH 

• Alkene (double bond) undergoes hydration which would form ethanol

Carbohydrate fermentation

• C₆H₁₂O₆ (Glucose) –(Zymase)→ EtOH

Zymase: digestive enzyme or yeast (brewer’s yeast) since the method of preparation is fermentation like in beer and whiskey.

Zymase:

digestive enzyme or yeast (brewer’s yeast) since the method of preparation is fermentation like in beer and whiskey.

ALCOHOL, USP (ETHANOL)

Types

•  depend on the percentage

• 99% (dehydrated) 

• 95% (absolute) 

• 70% (rubbing) 

• 50% (diluted) 

• Denatured alcohol

ALCOHOL, USP (ETHANOL)

• Contaminants:

• Methanol and Benzene

ALCOHOL, USP (ETHANOL)

Uses: industrial

• Available at home, in drug and cosmetic formulation, solvent 

ALCOHOL, USP (ETHANOL)

Uses: medical

Antiseptic or disinfectant, rubefacient, carminative, mild local anesthesia, refrigerant

ALCOHOL, USP (ETHANOL)

Uses: recreational

• In intoxicating beverages as CNS depressant 

  • Substance of abuse 

  • Distilled spirits 

    • e.g., Vodka, Gin, Brandy, Whiskey (30-50%)

Beer

4-5% (lowest percentage)

Malted barley

White/Red wine

10-14% (moderate)

Fruit juice (grapes, strawberry)

Brandy

35-60%

Wine spirit

Whiskey

40-60%

Malted grain

Rum

37.5-80% (highest)

Molasses

All mucous membrane absorb alcohol

very quickly and greater part is consumed in body

alcohol has _ Vd

low (0.5-0.7L)

toxicity of alcohol

• PRACTICALLY NON-TOXIC 

Lethal Dose:

300-400mL pure ethanol (99%); equivalent to 1 ½ - 2 pint of whiskey

ALCOHOL METABOLISM

Ethanol → converted by alcohol dehydrogenase (blocked by fomepizole) → acetaldehyde → converted by acetaldehyde dehydrogenase (blocked by disulfiram) → acetate

Alcohol Dehydrogenase

• Major metabolic pathway of EtOH

Alcohol Dehydrogenase

• metabolites

Acetaldehyde

Acetic Acid

Acetaldehyde

• Acute: Flushing, headache, tachycardia, N&V

• Chronic: Liver damage (free radical production

• Responsible for hang over

Acetic Acid

Further broken into CO₂ and H₂O

Microsomal Ethanol Oxidase Systems (CYP2E1)

Minor pathway

Acute (Low Dose)

• CNS Stimulation (concious), Euphoria, Boisterous 

• Mild incoordination 

• Coma (Ma’am is not sure why this is acute)

• Respiratory depression 

• Pulmonary aspiration

Chronic (High Dose)

• CNS Depression 

• Hypoglycemia 

• Hypothermia 

• Acid-base abnormalities 

• Lactic acidosis 

• Fatty liver 

• Cardiomyopathy

Wernicke Korsakoff Syndrome

• Altered mental status 

• Unsteady posture/ Gait

• Nystagmus

• Retinal hemorrhage

Wernicke Korsakoff Syndrome

• antidote

Vit B1 (Thiamine)

Fetal Alcohol Syndrome

• Microencephaly

• Intellectual growth retardation

• retarded psychomotor development

• “Precious moments doll”

Blood-Alcohol Concentration in non-tolerant individuals (BAC: mg/dL)

<50

CNS stimulation, Euphoria

Blood-Alcohol Concentration in non-tolerant individuals (BAC: mg/dL)

50-100

CNS depression (sedation, slow rxn times)

Blood-Alcohol Concentration in non-tolerant individuals (BAC: mg/dL)

100-200

Impaired motor function, slurred speech, ataxia

Blood-Alcohol Concentration in non-tolerant individuals (BAC: mg/dL)

200-300

Emesis, stupor

Blood-Alcohol Concentration in non-tolerant individuals (BAC: mg/dL)

300-400

Coma

Blood-Alcohol Concentration in non-tolerant individuals (BAC: mg/dL)
>400

Respiratory depression, death

Acute Alcoholism

Enzyme inhibitor

Chronic Alcoholism

Enzyme inducer

Additive

• 1 + 1 = 2

• Alcohol + CNS depressant → Sedation

Synergistic

• 1 + 1 = 3

• Alcohol + CCl₄ 

• Cephalosporin/Metronidazole + Alcohol → Disulfiram-like reactions 

Alcohol + CCl4

increase risk of liver cirrhosis, necrosis and fibrosis

Cephalosporin/Metronidazole + Alcohol → Disulfiram-like reactions

Flushing vomiting, tachycardia, headache, severe hypotension

Gastric lavage

With warm water or sodium bicarbonate

Ipecac syrup

Induce vomiting

Mineral oil

Demulcent

Caffeine

Stimulant, physiologic antidote

Methylphenidate

Useful awakening agent

Oxygen

Respiration aide, as needed

Intravenous fluids

NSS or sodium lactate solution for circulatory collapse, dehydration and acidosis

Glucose

If with hypoglycemia

Thiamine or Vitamin B-complex

to prevent Wernicke-Korsakoff Syndrome or for acute alcoholism

NaHCO3

Treatment for metabolic acidosis

Hemodialysis

Corrects fluid and electrolyte imbalance/ acid-base disturbance

Paracentesis

Drain ascitic fluid in peritoneal cavity

Fomepizole (Antizol®)

• Alcohol DH (dehydrogenase) inhibitor

• Orphan drug for MeOH and ethylene glycol poisoning

Disulfiram (Antabuse®)

• Acetaldehyde dehydrogenase inhibitor

• Ensure abstinence in the tx (treatment) of alcohol dependence

Contraindicated

• Activated charcoal- cannot be adsorbed

Chromic acid/ Jones test

• Utilized in alcohol breath test

• Principle: REDOX

• R-OH + K dichromate –(H₂SO₄)→ R-CHO

(+) Color change form orange/red to blue/green solution with chico odor

METHYL ALCOHOL

• Wood alcohol, Denatured alcohol, Methanol 

• Colorless liquid with pungent taste and odor not very different from ethanol 

Upon oxidation, yields formaldehyde and formic acid

METHYL ALCOHOL

• uses

• solvent, varnishes, anti-freeze in automobiles

METHYL ALCOHOL

MECHANISM OF TOXICITY

• Metabolism to formic acid or formaldehyde which injure retinal cells 

  • Virtual disturbances due to ocular lesions – may cause permanent blindness 

• CNS depression due to acidosis and cerebral edema 

• Absorbed from the GI and respiratory tracts

METHYL ALCOHOL

• toxicity

slightly toxic

METHYL ALCOHOL

• lethal dose

60 to 250 mL

METHYL ALCOHOL

SIGNS AND SYMPTOMS

• Headache, anorexia, weakness, leg cramps, vertigo

• Nausea, vomiting, violent abdominal pain, back pain, leg pain

• Dimness of vision followed by translucent or permanent blindness

• Breathing rapid and shallow, acidosis

• Weak, rapid pulse, hypotension, cyanosis

• Death due to respiratory failure or circulatory collapse

Whisky (50% Ethanol in water)

To correct acidosis

NaHCO₃ PO

q15 until pH is normal

Morphine

For abdominal pain

Hemodialysis

In severe cases