Alcohol: Ethanol

Ethanol

• causes the rapid onset of dose-related CNS depression

• is commonly ingested during deliberate self-poisoning

• 375 mL beer can (3.5%)

• 100 mL glass of wine

• 30 mL shot of spirit

Standard drinks containing 10 g ethanol (3)

respiratory depression

co-ingestion of other CNS depressants increases risk of ______

seizures

_____ may occur in the setting of ethanol intoxication or withdrawal

• hypoglycaemia

• CNS depression.

Ingestion of even small amounts of ethanol in children can result in significant _____ and _____

• GABA_A

• glutamate

• N-methyl-D-aspartate (NMDA)

• serotonin (5-HT3).

MOA of ethanol is mediated by stimulation of inhibitory ____ receptors but multiple other neurotransmitters are also affected, including _____, _____, and _____

• hypoglycaemia

• ketoacidosis

• gluconeogeonesis

• fatty acid oxidation

Metabolic effects of ethanol intoxication include _____ and _____, resulting from impaired ______ and ______

• lactate

• pyruvate

• NADH:NAD⁺

Hyperlactataemia occurs due to impaired conversion of _____ to _____ following an increase in the _____ ratio

• cardiovascular depression

• vasodilatation

Ethanol causes direct, dose-dependent ______ and vasodilatation

• rapidly

• 0.6-0.7

Ethanol is ____ absorbed following oral administration. It distributes readily across total body water (volume of distribution _____ L/kg).

• cytosolic & microsomal

• acetaldehyde

• acetate

Ethanol is oxidised by _____ and _____ alcohol dehydrogenases to form _____, which in turn is metabolised by aldehyde dehydrogenase to _____

• 4 (20)

• zero

Above a serum ethanol concentration of ____ mmol/L ( ___ mg/dL), metabolism changes to ____ order kinetics,

• 2-4

• 6-12

Improvement in conscious state is usually seen within ____ hours, but ____ hours may elapse before patients are ambulant.

• 12-lead ECG

• BGL

• paracetamol level

Screening tests for deliberate self-poisoning (3)

10%

Whole blood concentrations are approximately ____ lower than corresponding serum concentrations

Breath ethanol estimation

provides a convenient bedside estimation of blood ethanol concentration but the result is influenced by minute ventilation

Basic resuscitative measures

ensure the survival of the vast majority of patients.

• 100-300

• PO (mouth) or IV tds (3xday)

Give thiamine ___ mg ____ or ____ to patients with potential thiamine deficiency.

Activated charcoal

does not bind ethanol and is not indicated.

haemodialysis

Elimination of ethanol is enhanced by ______

blood ethanol concentration

confirms the diagnosis of ethanol intoxication but does not exclude other causes of CNS depression