ETOH2- 17B

Question 1

Define the standard drink

Answer 1

• standard drink = 14 g ETOH
• 12 oz of beer (5%)
• 5 oz of wine (12%)
• 1.5 oz of spirits (40%)

Question 2

What are the AMA Alcohol Consumption Guidelines

Answer 2

• females: up to 1 drink/d
• males: up to 2 drinks/d
• for adults of legal drinking age
• females: <7 per week or no more than 4 per day
• males: <14 per week or no more than 5/d

Question 3

Define binge drinking

Answer 3

• females: 4 or more drinks consumed within 2h

- males: 5 or more drinks consumed within 2 h

Question 4

Prevalence of alcohol use

Answer 4

Any alcohol disorder: 6.2 %, 15.2 million

Question 5

Rates of long-term abstinence

Answer 5

• without formal treatment or self-help groups: 20% chance of long-term abstinence
• with treatment: 50-60% maintain abstinence for 1 year

Question 6

When is delirium tremens the most likely to develop within the intoxication withdrawal cycle?

Answer 6

3-10 days after the last drink

Question 7

Name the behavioral/psychological changes associated with alcohol intoxication

Answer 7

• inappropriate sexual/aggressive behavior
• poor judgement
• mood lability

Question 8

Signs and symptoms of alcohol intoxication

Answer 8

-slurred speech
-incoordination
-unsteady gait
-nystagmus
-impaired attention or memory
-stupor or coma
REMEMBER: Alcohol can be deadly in intoxication or withdrawal

Question 9

Changes in which of the hepatic enzymes is more specific to alcohol use

Answer 9

-AST

Alcoholism SUCKS!

Question 10

What is Carbohydrate-deficient Transferrin

Answer 10

• CDT
• detects heavy alcohol consumption
• measured in the blood stream
• elevated levels of CDT in the blood indicate heavy alcohol use

Question 11

Differential for elevated blood CDT

Answer 11

• heavy alcohol use
• liver disease
• pregnancy

Question 12

What is Ethyl Glucuronide (EtG)?

Answer 12

• metabolite of alcohol formed by glucuronidation
• tested in the urine
• detected in urine up to 5 days after last drink
• however, present in the urine from alcohol from NON-beverage sources leading to false positives (mouthwash, OTC medications, topical use)

Question 13

Criteria for Alcohol Withdrawal

Answer 13

-cessation or reduction in alcohol use
-2 or more symptoms within hours to days
-autonomic hyperactivity (sweating, inc HR)
etc.

Question 14

Describe the features of alcohol withdrawal seizures

Answer 14

-peak incidence at 24 hours of cessation/decrease
-Generalized (tonic-clonic) or partial
-can repeat in 3-6 hours
-STATUS EPILEPTICUS IS RARE
-30-50% progress to DTs
-treatment/prevention “Out The Liver”
oxazepam/temazepam/lorazepam
benzos with extra-hepatic metabolism

Question 15

What is alcohol withdrawal delirium

Answer 15

-it’s Delirium Tremens dummy!

Question 16

Describe the presentation of alcohol withdrawal delirium

Answer 16

• onset 2-10 days after last drink usually preceded by early withdrawal symptoms
• it is a medical emergency with mortality of 20%

Question 17

Describe the treatment of DT’s

Answer 17

• sympathetic hyperactivity

- prevention: benzo’s hydration, neuroleptics

Question 18

Predictors of alcohol withdrawal delirium

Answer 18

• prior history of severe withdrawal symptoms of DTs
• high blood levels without signs of intoxication
• concurrent use of sedative-hypnotics
• greater number of days since last drink
• older age, hypokalemia, thrombocytopenia, elevated blood homocysteine

Question 19

What is Alcohol-induced Persisting Neurocognitive Disorder (NCD)

Answer 19

-Wernicke (early) Korsakoff’s (late) nsyndrome

Question 20

Features of Wernicke’s encephalopaty

Answer 20

• delirium due to thiamine deficiency (B1)
• reversible with treatment
• rare before age 35y
• confusion + ataxia, nystagmus, ophthalmoplegia
• EARLY STAGE NCD

Question 21

Features of Korsakoff’s syndrome

Answer 21

• anterograte amnesia in an alert, responsive pt with OR without confabulation
• chronic condition
• 20% recovery rate
• daily thiamine for 3-12 months

Question 22

Brain lesion associated with Alcohol induce persisting NCD

Answer 22

• mammillary bodies
• atrophy, gliosis, hemorrhage
• associated with THIAMINE DEFICIENCY (B1)