S62 - Toxic Alcohol

Question 1

Alcohol abuse a leading cause of morbidity and mortality

Answer 1

true

Question 2

Ethanol, Clinical Effects:

Answer 2

CNS depression
Augments GABA-A receptor transmission
Inhibits glutamate at NMDA receptor
Hypoglycemia
Cardiotoxicity – “Holiday Heart Syndrome”

Question 3

Wernicke’s encephalopathy

Acute neuropsychiatric syndrome resulting from thiamine deficiency

Answer 3

Treatment: replete thiamine, usually IV or IM first

Give WITH glucose if patient is hypoglycemic

Question 4

Ethanol –Alcohol Dehydrogenase–> Acetylaldehyde –aldehyde dehydrgenase–> Acetate –> Acetyl CoA

Answer 4

true

Question 5

Processes requiring NAD+ (reduced)
Gluconeogenesis leads to hypoglycemia/fatty acid metabolism
Pyruvate entering Kreb’s cycle

Answer 5

true

Question 6

Processes requiring NADH (increased)
Pyruvate conversion to lactate leads to lactic acidosis
Ketone formation

Answer 6

true

Question 7

ehtanol toxicity management

Answer 7

thiamine/folate/multivitamin
“banana bag”
+/- magnesium

Question 8

Autonomic Hyperactivity
(12 – 24 h)
Hallucinations
(24 – 48 h)
Neuronal Excitation
(24 – 48 h)
Delirium Tremens
(48 – 96 h)

Answer 8

true

Kindling effect

Question 9

Withdrawl effects can last 10 days

Answer 9

true

Question 10

What are the treatment options?

Answer 10

anything that has GABAnergic activity such as
Benzodiazepines
Barbituates – maybe
Ethanol – treatment of last resort

Question 11

Benzodiazepines used for management of ethanol withdrawl
Lorazepam (Ativan)
Diazepam (Valium)
Chlordiazepoxide (Librium)

Answer 11

true

Question 12

Alcohol Withdrawal Assessment

Answer 12

Clinical Institute of Withdrawal Assessment – revised (CIWA-Ar)
Not as helpful if unable to communicate