Lecture 10 Symposium 3 Alcohol and Health

Question 1

Define Harmful Use during acute intoxication presentation

Answer 1

Pattern of use causing damage to physical or mental health >1 month or repeatedly over 12 months

Question 2

Define Dependence during acute intoxication presentation

Answer 2

Cravings
Difficulty controlling use
Primacy
Increased tolerance
Physiological withdrawal symptoms

Question 3

What is the Alcohol Withdrawal State

Answer 3

Tremor
Weakness
Nausea
Vomiting
Anxiety
Seizures
Confusion
Agitation
Delirium Tremens

Question 4

What are the symptoms of Delirium Tremens

Answer 4

Profound confusion
Tremor
Agitation
Hallucinations
Delusions
Sleeplessness
Autonomic over-activity

Question 5

What causes Wernicke’s encephalopathy and Korsakoff’s Psychosis

Answer 5

Thiamine deficiency

Question 6

What are the symptoms of Wernicke’s encephalopathy

Answer 6

Confusion
Ataxia
Ophthalmoplegia
Nystagmus

Question 7

What is Korsakoff’s Psychosis

Answer 7

– Prominent impairment of recent and remote memory, preservation of immediate recall, no general cognitive impairment, retrograde and anterograde memory, impaired learning and disorientation, may exhibit nystagmus and ataxia

Question 8

Name 4 screening tools for alcohol use

Answer 8

CAGE
PAT
FAST
AUDIT

Question 9

How is Wernicke-Korsakoff syndome prevented

Answer 9

Thiamine parental

Question 10

What medication can be given to manage alcohol withdrawal

Answer 10

Benzodiazepines, commonly Chlordiazepoxide

Question 11

What medication can be used to aversion and deterrent

Answer 11

Disulfiram (Antabuse)

Question 12

What medication can be administered for anti-craving

Answer 12

• Acamprosate (Campral)
• Naltrexone
• Nalmefene
• (Baclofen)

Question 13

What is the progression of liver disease

Answer 13

Fatty Liver Disease
Liver Cirrhosis
Hepatic Liver Disease

Question 14

What is the formula to work out the osmolal gap

Answer 14

(2XNa + urea + glucose) =

Question 15

What does the osmolal gap determine

Answer 15

An increase in the osmotic gap (greater than 10) indicates the presence of other substances such as toxic alcohols, aspirin, or mannitol.

Question 16

How do you work our the anion gap

Answer 16

(Na + K) - (HCo3 + Cl)

Question 17

What does the anion gap determine

Answer 17

The anion gap blood test is used to show whether your blood has an imbalance of electrolytes or too much or not enough acid

Question 18

What is the pathophysiology of Alcohol Ketoacidosis

Answer 18

Excess alcohol is metabolised and drives NADH+ production
This drives ketone production
This impairs glucose neogenesis and metabolism of lactate

Question 19

What are the 2 consequences of Alcohol Ketoacidosis

Answer 19

Hypoglycaemia

Acidosis

Question 20

How do you stabilise d patient that is experiencing Wernicke-Korsakoff’s syndrome

Answer 20

IV fluids

IB formation of vitamin B1 (pabrinex)

Question 21

How does alcohol affect thiamine

Answer 21

Alcohol blocks the duodenal uptake of thiamine

Question 22

Thiamine deficiency can lead to a build up of what

Answer 22

Lactacte

Question 23

If you ever see an unexplained lactic acidosis what should you administer

Answer 23

Thiamine

Question 24

In Fatty Liver Disease what is the level of bilirubin, ASE/ALT and Gamma GT

Answer 24

Hyperbilirubinaemia and mild elevation of transaminases (AST/ALT). Gamma GT is elevated in a majority of patients.

Question 25

In Alcoholic Hepatitis what is the ration of AST:ALT

Answer 25

> 2

Question 26

In chronic alcohol misusers what would the magnesium and phosphate levels look like

Answer 26

Low due to malnourishment