Alcoholism
Introduction
Introduction to alcoholism Alcoholism is commonly referred to as drunkenness. Alcohol (ethanol) drinking a large amount of alcoholic beverages at one time will have an excitatory and post-inhibitory effect on the central nervous system. Severe poisoning can cause respiratory and heartbeat inhibition and death. basic knowledge The proportion of illness: 0.006% Susceptible people: long-term drinkers Mode of infection: non-infectious Complications: ataxia hyponatremia dementia coma
Cause
Cause of alcoholism
Cause:
Alcohol is a neurotropic substance that has an inhibitory effect on the central nervous system. After drinking, there is relaxation, warm feeling, elimination of tension, lack of relief and relief of discomfort or pain. A large amount of alcohol can cause drunkenness. It is a common acute alcoholism and long-term heavy drinking. Can cause cerebral cortex, cerebellum, pons and corpus callosum degeneration, liver, heart, endocrine gland damage, malnutrition, enzyme and vitamin deficiency, etc., all kinds of alcohol can be dependent, but alcoholic beverages with high alcohol concentration are easier Addiction, the dependence on alcohol is slower. Generally, the formation of chronic alcoholism often has a long-term drinking history of more than 10 years. Alcohol and sedative hypnotics may be cross-tolerant. Some alcohol dependent people may be accompanied by Hypnotic sedative dependence.
Pathophysiology
1. Absorption, distribution, metabolism and discharge of ethanol
Ethanol is completely absorbed in the stomach and small intestine within 30min - 3h, distributed in all watery tissues and body fluids in the body, including brain and alveolar gas. The concentration of ethanol in the blood can directly reflect the concentration of the whole body. Ethanol is excreted from the kidney and lungs. 10% of the total amount, 90% in the liver metabolism, decomposition, ethanol is first oxidized in the liver by alcohol dehydrogenase to acetaldehyde, acetaldehyde is oxidized to acetic acid by aldehyde dehydrogenase, acetic acid is converted to acetyl-CoA into trihydroxy acid The cycle is finally metabolized to CO2 and H2O. The metabolism of ethanol is a rate-limiting reaction. The ethanol clearance rate is 2.2 mmol/kg.h (100 mg/kg.h). Adults can remove 7 g of ethanol per hour (100% ethanol 9 ml). The rate of decline in blood alcohol concentration is about 0.43mmol/h (20mg/dl.h). Although the degree of elevated blood alcohol concentration is affected by personal tolerance, there is no difference in lethal concentration of blood ethanol, generally 87-152mmol/L ( 400-700mg/dl).
Second, the poisoning mechanism
(1) Acute effects
1. Central nervous system inhibition Ethanol is ester-soluble, can quickly penetrate the nerve cell membrane in the brain, and acts on certain enzymes on the membrane to affect cell function. The inhibition of ethanol on the central nervous system increases with dose. From the brain mechanism down, through the limbic system, the cerebellum, the reticular structure to the cerebral ventricle, a small dose of excitatory action, due to the action of ethanol on the postsynaptic membrane benzodiazepine-r-aminobutyric acid receptor in the brain, Thereby inhibiting the inhibitory effect of r-aminobutyric acid (GABA) on the brain, increasing the concentration of ethanol in the blood, acting on the cerebellum, causing ataxia, acting on the reticular structure, causing drowsiness and coma, and extremely high concentration of ethanol inhibiting the cerebral ventricle The center causes respiratory and circulatory failure.
2, metabolic abnormalities ethanol metabolism in the liver to produce a large number of NADH, so that the intracellular reduction and oxidation ratio (NADH / NAD) increased, even up to 2-3 times normal, alcohol poisoning, depending on NADH / NAD than normal metabolism can be Abnormalities such as increased lactic acid, accumulation of ketone bodies leading to metabolic acidosis, and gluconeogenesis may cause hypoglycemia.
(2) Tolerance, dependence and blunt syndrome
1. Tolerance and stimulating sensation after tolerant drinking. After drinking, the tolerance is produced, the effect is reduced, and the amount of alcohol consumed is needed to achieve the original effect.
2. Dependence In order to obtain the special pleasure after drinking, eager to drink alcohol, this is psychological dependence. Physical dependence refers to repeated physiological drinking, which causes some physiological and biochemical changes in the central nervous system, so that alcohol needs to be continuously present in the body to avoid A special condition called withdrawal syndrome occurs.
3, withdrawal syndrome has been formed after long-term drinking, once stopped drinking or reduce the amount of alcohol consumption, there may be symptoms opposite to alcoholism, the mechanism is generally abstinence to alcohol inhibition of GABA significantly reduced, while plasma in the armor The concentration of adrenaline is elevated and sympathetic excitation symptoms appear.
3 The role of long-term alcohol abuse
1. Nutritional Lack of Alcoholic Beverages Ethanol can supply 29.3kJ (7kcal) of calories, but does not contain essential nutrients such as vitamins, minerals and amino acids. Therefore, wine is a high-calorie and non-nutrient-flavored beverage. Can cause obvious nutritional deficiencies, lack of vitamin B1 can cause Wernicke-Korsokoff syndrome, peripheral neuropathy, some people have the genetics of increased demand for vitamin B1, may also be the cause of the disease, folic acid deficiency can cause giant cell anemia, long-term When hunger and sugar supply are insufficient, fat decomposition predominates, and a considerable part of acetyl CoA in the liver is synthesized into ketone bodies.
2. Toxicity Ethanol has a stimulating effect on mucosal and gland secretion, which can cause esophagitis, gastritis, pancreatitis, and ethanol to produce free radicals during metabolism in the body, which can cause cell membrane ester peroxidation and cause liver damage.
Prevention
Alcoholism prevention
1. Carry out propaganda and education against alcoholism, create alternative conditions, and strengthen cultural and recreational activities.
2. Do a good habit of drinking without getting drunk when drinking alcohol. Do not use alcohol as a medicine to relieve irritability, loneliness, depression and work stress.
3, drinking should not disturb the law of eating, must not "take wine as a meal", so as not to cause malnutrition.
4, once addicted, should quickly stop drinking, the withdrawal syndrome should be carefully cared for, the severe must be admitted to hospital. Anti-alcoholic drugs, such as alcohol and sulphur, can be used to stop drinking, which can cause disgust to wine. It can also be applied subcutaneously with apomorphine during drinking, causing aversive conditioning and abstinence.
5. After alcoholism and symptoms of alcoholic psychotic patients have improved significantly, they should help them solve interpersonal problems and enable them to achieve social rehabilitation.
Complication
Alcoholism complications Complications, ataxia, hyponatremia, dementia, coma
Alcoholism can be complicated by Korsakoff syndrome and Wernicke encephalopathy.
Alcoholism (like other malnourished patients) can cause cerebellar degeneration. Its pathology and clinical features may be the same as Wernicke encephalopathy. Posture and gait ataxia can start slowly in a few weeks or months, or it can suddenly start. CT showed atrophy of the upper temporal and cerebellar lobes. The use of thiamine and other vitamins B can improve symptoms.
Marchiafava-Bignami disease is a rare demyelinating disease of the corpus callosum that occurs in chronic alcoholism cases and is mainly found in men. Originally found in Italy, it was thought to have started from drinking a natural red wine, but it was later found to occur in many other countries and involved in a variety of other alcoholic beverages. It has been speculated that the disease is related to the nutritional cause, but the exact nature is unknown. Pathology and the pathogenesis of the disease are linked to demyelinating central debridement, which may be a variant of the latter (hyponatremia). The patient showed agitation, confusion, and progressive dementia with signs of frontal function release. Some patients recover after a few months, while others have convulsions and coma, and finally die.
Pathological drunk is a relatively rare syndrome. It is characterized by repeated spontaneous movements, extreme excitement, and unreasonable behavior that is aggressive or uncontrollable after drinking a small amount of alcohol. Each episode lasts for a few minutes to a few hours, followed by a longer period of sleep, and after waking up, it loses memory of the pathological manifestations.
Symptom
Symptoms of Alcoholism Common Symptoms Ambiguous Mental Disorders Breathing Air for Wine Uncontrollable Drinking Impulsive Blinking Coma Vision Deformation Illusion Nausea Alcohol Addiction Alcohol Toxic Illusion
The World Health Organization has proposed the concept of alcohol dependence syndrome and the following characteristics (1977):
1, can not restrain the impulse of drinking.
2, there are daily drinking patterns.
3. More than all other activities are required for drinking.
4. Increased tolerance to alcohol.
5, repeated withdrawal symptoms.
6, only continue to drink alcohol can eliminate withdrawal symptoms.
7, after withdrawal, often old addiction and heavy dyeing.
In terms of clinical manifestations, the most common early symptoms are acute tremors of the extremities and trunk. Patients can not sit still or hold the cup stably, are prone to excitement and startle, fear facing others, common nausea, vomiting and sweating. Symptoms quickly disappear, otherwise it will last for several days, further development, there may be a temporary illusion of illusion, distortion of the object, unclear or screaming, followed by seizures, tremors can occur after 48 hours.
Chronic alcoholism often changes personality, becomes selfish, embarrassed, irresponsible for work and family, alcoholism all day long, often lying, stealing and other disciplinary behaviors, patients often accompanied by physical disorders, including chronic gastritis, liver Hardening, malabsorption syndrome, peripheral neuritis and myocardial damage, etc., common mental disorders of chronic alcoholism have the following types:
First, the tremors (delirium tremens)
Acute mental disorders that occur after sudden alcohol withdrawal in patients with chronic alcoholism, confusion, excitement, panic and illusion, fever, excessive sweating, elevated blood pressure, tachycardia, large tremors of the lips and limbs, and pupil dilation Large, severe convulsions can occur, laboratory tests can be seen increased white blood cells, increased erythrocyte sedimentation rate and liver function damage, the episode usually lasts 3 to 4 days, the symptoms are exacerbated at night, ending with asleep, can be fully recovered after waking up, can not Recollections, generally supported by treatment can be quickly improved, severe paralysis patients can be injected with chlorpromazine intramuscular or intravenous drip, a small number of patients can die of heart failure, or converted to Korsakov syndrome.
Second, Korsakov syndrome
For the sequelae of chronic alcoholism, the clinical features are near memory and disorientation, misconfiguration and fiction, judgment disorder and emotional euphoria. The syndrome caused by alcoholism is considered to be caused by insufficient nutrition and thiamine deficiency. However, after treatment with B vitamins, it is rarely fully recovered.
Third, alcoholic hallucinosis (alcoholic hallucinosis)
It is often a long-term drinker who suddenly stops after drinking, and produces an insulting or threatening auditory hallucination in a state of clear consciousness. It is anxious and restless for several weeks, months or more. The cause of this disease is quite controversial. Most people think that true alcohol toxic hallucinations are rare.
Fourth, alcoholic paranoid state (alcoholic paranoidstate)
Chronic alcoholism patients have suspicions about their spouses, often expressed as delusions, but also can be seen in the suspicion of the victim. Some people think that this type of case is chronic schizophrenia, just a coincidence with chronic alcoholism.
Examine
Alcoholism check
Laboratory inspection
1. Serum ethanol concentration: The concentration of ethanol in the breath during acute poisoning is equivalent to the concentration of serum ethanol.
2, arterial blood gas analysis: mild metabolic acidosis can be seen in acute poisoning.
3. Serum electrolyte concentration: hypokalemia, hypomagnesemia and hypocalcemia can be seen in acute and chronic alcoholism.
4. Serum glucose concentration: Hypoglycemia can be seen in acute alcoholism.
5, liver function test: liver function abnormalities can be seen in chronic liver disease.
6, ECG examination: visible arrhythmia such as myocardial damage.
Diagnosis
Diagnosis and identification of alcoholism
diagnosis
Diagnosis can be based on medical history, clinical symptoms, and laboratory findings.
Differential diagnosis
First, acute poisoning, mainly differentiated from diseases that cause coma, such as sedative hypnotic poisoning, carbon monoxide poisoning, cerebrovascular accident, and craniocerebral trauma.
Second, withdrawal syndrome, mainly with mental illness, epilepsy, asphyxiating gas poisoning, hypoglycemia and other differentiation.
Third, chronic poisoning mental disorders and personality changes, should be identified with other causes of dementia, liver disease, cardiomyopathy, anemia, peripheral neuropathy, should also be differentiated from other related diseases.
