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Toxicology > Alcohol > Flashcards

Alcohol Flashcards

1
Q

Which is more toxic, methanol or ethanol?

A

methanol

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2
Q

Source of ethanol is…

A

Fermentation of sugar

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3
Q

3 uses of ethanol…

A

Beverages (wine & whisky)
Mouth wash
Hair sprays

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4
Q

Pharmakokinetics of ethanol…

A

Absorption: 80% in small intesine, 20% in stomach and large intestine
Distribution: All tissues and body fluids, can cross placenta and BBB
Metabolism: 90-98% in liver, small amount in kidney
Excretion: 2-10% excreted unchanged through breath, urine and other secretions like sweat, tears, gastric juice and bile

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5
Q

3 MOA of ethanol…

A

-CNS:Inhibits Na-K ATP in neurons which causes CNS depression
-Peripheral: vasodilation giving false sensation of heat
-Ethanol metabolism causes secrease in NAD/NADH ratio in liver causing hypoglycemia due to inhibition of gluconeogenesis, inhibits glycogen metabolism causing accumulation of fat in liver, and accumulation of lactic acid causing metabolic acidosis

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6
Q

Toxic dose of ethanol is…

A

0.7g/kg produces 100mg/dL considered legally intoxicated
300mg/dL could cause coma in novice drinker but chronic drinkers can stay awake with 500-600mg/dL or higher

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7
Q

3 stages of toxicity blood %…

A

Mild 0.05-0.15%
Moderate 0.15-0.3%
Severe >0.3%

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8
Q

Clinical presentation of each stage of ethanol toxicity…

A

-Mild (excitatory stage): euphoria, talkative, inhibition of behabioral centers
-Moderate (incoordination): drunkard (staggering) gate, slurred speech, motor skill issue, tremors of hand, hiccups due to sudden diaphragm contraction, diplopia, flushing of skin due to vasodilation
-Severe (coma & seizures):
Coma, seizures, McEwen sign (constricted pupil that becomes dilated when face/neck pinched), alcholic breath, decrease temp. Due to vasodilation and rapid weak pulse due to shock, depression of medullary centers causing respiratory depression

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9
Q

3 investigations for ethanol toxicity…

A

Rapid tests: walk in straight line, finger nose test, button unbutton test.
Chemical analysis: detect ethanol in breath, urine and blood
Blood chemistry: ketoacidosis

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10
Q

Cause of death in ethanol overdose…

A

Central asphyxia

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11
Q

5 treatment methods for ethanol overdose…

A

-Supportive: respiratory most important
-GI decontamination: gastric lavage with sodium bicarbonate and leave strong coffee in stomach. Activated charcoal useless cuz doesnt bind to ethanol
-Elimination of absorbed: forced alkaline diuresis and hemodialysis
-Antidote: no specific antidote but vit B6 accelerates ethanol metabolism by stimulation of alcohol dehydrogenase
-symptomatic: sodium bicarbonate for metabolic acidosis, hypoglycemia dextrose, hypothermia warm patient, shock fluid

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12
Q

Source of methanol is…

A

Distillation of wood

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13
Q

Other name of methanol is…

A

Wood alcohol

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14
Q

3 Uses of methanol include…

A

Aldulterate ethanol (cheap)
Household cleaning
Fuel

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15
Q

Pharmakokinetics of methanol…

A

Absorption: rapidly and completely absorbed from GIT. Inhalation and cutaneous absorption also
Distribution: same as ethanol, mainly to optic nerve
Metabolism: 90% in liver
Excretion: mainly through liver, others inckude kidney and lung

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16
Q

Methanol is metabolized & excreted…..than ethanol

A

Slower

17
Q

Which is more toxic, ethanol or methanol?

A

Methanol

18
Q

4 clinical presentation of methanol overdose…

A

-Visual: occular pain, blurred vision, irreversible blindness
-Metabolic acidosis: due to toxic metabolite of methanol which is formic acid, causes tachypnea and air hunger to increase CO2 excretion and also life threatening hyperkalemia
-CNS: disorientation and confusion due to formic acid in CSF. Respiratory depression following air hunger due to inhibition of respiratory center caused by acidosis. Vasomotor center depression due to acidosis causing vasodilation and shock.
-GIT: vomitting

19
Q

4 MOA of methanol…

A

-CNS depressant (more than ethanol) due to inhibition of Na-K ATP
-Metabolic acidosis due to decrease NAD/NADH ratio
-Ocular toxicity due to inhibition of cytochrome oxidase by formic acid
-GIT irritation

20
Q

Cause of death of methanol…

A

Central asphyxia

21
Q

3 investigations of methanol overdose…

A

Serum methanol level
Fundus examination
Arterial blood gas and electrolyte for hyperkalemia and acidosis

22
Q

Treatment of methanol overdose…

A

-Supportive: ABC
-GIT Decontamination: gasrric lavage with sodium bicarbonaye, activated charcoal not used cuz doesnt bind
-Elimination: forced alkalime diuresis and hemodialysis indicated if ingested methanol >30mg (0.4mg/kg) or blood levels >20mg/dL or if there is visual manifestations or severe metabolic acidosis
-Antidote: Ethanol cuz competes for alcohol dehydrogenase and has higher afinity, 4-Methyl pyrazole which inhibits alcohol dehydrogenase
- Folinic acid and folic acid which breaks down formic acid to CO2+H2O
-Symptomatic: same as ethanol

Toxicology (14 decks)

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