How much can you drink alcohol. Lethal dose of alcohol

Content

Problems after drinking alcohol can overtake everyone, regardless of social status or the quality of the product consumed. Poisoning with alcohol and its surrogates requires competent detoxification of the body in order to avoid a long recovery period, the possible treatment of serious consequences. Symptoms of intoxication are approximately similar for everyone, there are differences in individual characteristics, which depend on the state of health and personal tolerance.

What is alcohol intoxication?

Alcohol poisoning (ICD code 10 - T51) is a depressing effect on the body of ethanol and its decomposition products (acetaldehyde) during processing. Disturbed physiological, behavioral and psychological reactions. In this case, alcohol poisoning is often perceived as the effect of large doses, but there are cases when a small amount of ethyl alcohol is enough to poison the human body.

Primary alcohol poisoning is the state of euphoria, which manifests itself in a violation of coordination of movements, altered perception of reality, and a change in the behavioral model. What is commonly called a hangover already refers to the secondary process of intoxication, when the body tries to independently remove the decay products.

Chronic

For people who do not consider themselves alcoholics, but drink alcohol daily, chronic alcohol intoxication is characteristic (the syndrome of “gastric fermentation” is not considered when ethyl is independently produced in excess). In practice, this is total damage to all internal organs from the digestive tract to the brain. The main problem of this condition is that the human body can no longer get rid of alcohol substrates on its own, and concomitant pathologies develop against this background:

• imbalance in body weight (both overweight and unnatural thinness are possible);
• early degree of arterial hypertension;
• constant tremor of limbs;
• redness of the skin;
• respiratory disorders;
• a feeling of intense chills or heat, which alternately wave-wise;
• anemia;
• peripheral nerve damage;
• excessive sweating.

Sharp

A single dose in a short period of 300-400 ml of ethanol or a proportional amount can be fatal, but in most cases acute alcohol intoxication occurs, which can be eliminated with timely medical attention. Typical signs of severe alcohol poisoning are considered to be: excessive salivation, cramps, intense redness of the face and palms, problematic breathing, loss of consciousness, or borderline condition.

Causes

If we take into account the psychological causes of poisoning, it should be noted that drinking alcohol against a background of altered emotional consciousness (stress or extreme joy) leads to an incorrect perception by the body of the effects of ethyl on the brain. In this case, intoxication does not occur for a long time, and the person continues to strive for it. At this rate, much more alcohol enters the body than the drinker often allows himself.

Poisoning with alcohol (acetaldehyde) can happen even when you use, for example, one glass of vodka. It all depends on the quality of the drink, personal tolerance of the body, duration and speed of consumption. In fact, alcohol intoxication is due to the decomposition of ethyl alcohol by the liver and the redistribution of the efforts of organs to get rid of the products of cleavage.

Separately, it is worth highlighting alcohol poisoning, not intended for ingestion: denatured alcohol, methyl alcohol and fakes of uncertain composition. In this case, fusel oils, frankly poisonous components that are not intended for consumption due to their toxic characteristics, enter the body.

How does alcohol affect the body

Exposure to small doses of alcohol in combination with proper nutrition will not cause poisoning of the body. The dosage of the permissible is determined by the person himself according to his own feelings. An increase in the amount taken leads to intoxication of the body and the appearance of the corresponding symptoms. The toxic effect of alcohol applies to all organs and systems:

1. Poisoning and death of cells. Pure ethanol actively kills living tissues, which is why it is used as a universal antiseptic. The widespread belief that alcohol kills brain cells is not entirely true. Exposure to acetaldehyde disrupts neural connections, but only in exorbitant amounts leads to cell death.
2. Sexual dysfunction. For the most part, this applies to men. Spermation occurs within 75 days. Exposure to alcohol disrupts normal spermatogenesis, leads to the development of defective sperm, so it is recommended to give up alcohol for about 3 months if you plan to conceive a child. Damage to the egg cells in women, although they are more reliably protected, occurs in chronic alcoholism, since the egg cell volume is present in the body from birth.
3. The fetus in pregnant women can develop with disorders due to malfunctioning of the organs and systems of the mother due to alcohol damage.
4. The brain loses its normal oxygen supply, neural connections are disrupted, which leads to a gradual degradation of mental capabilities, a decrease in intelligence, and the development of dementia.
5. The heart and blood vessels begin to wear out faster than calculated by nature. The consequences of chronic alcohol use are hypertension, heart rhythm disturbance, coronary artery disease, heart attacks.
6. The gastrointestinal tract suffers from the destruction of the mucous membranes by alcohol, peptic ulcers, gastritis develop, and the salivary glands are damaged.
7. The liver is the main organ where the body breaks down alcohol and begins to remove it from the systems. Ethyl disrupts normal functioning and leads to tissue death.
8. The kidneys lose their ability to normally excrete waste products. Their improper work leads to an excess of fluid with the remains of the breakdown of alcohol in the body.
9. CNS Depending on the intensity of the use of ethyl-containing substances, a whole range of problems can develop: from anemia, muscle dysfunction to complete or partial paralysis.
10. Immunity is weakened due to a decrease in the production of white blood cells and a general inhibition of the body's functions by alcohol.

Symptoms of Alcohol Poisoning

The main signs of alcohol poisoning are common to most people. Impaired functioning of the central nervous system has similar manifestations, regardless of gender, age and social status. The main critical factors in the degree of intoxication and the intensity of the symptoms are the quantity and quality of the drink. Standard manifestations of intoxication are as follows:

• euphoria and delusional states;
• hallucinations, visual impairment;
• decrease in body temperature;
• impaired coordination of limbs, perception of the position of the body in space;
• lowering the threshold of self-preservation instinct;
• incoherent speech, slowing down of thought processes;
• diarrhea;
• low blood pressure;
• dizziness;
• tremor of hands and feet;
• chills;
• blanching of the skin of the body, against a background of redness of the face;
• general malaise;
• frequent urination;
• pain in the right hypochondrium;
• nausea, vomiting.

Vodka

Vodka intoxication appears equally in all patients with variations depending on the individual characteristics of the body. Often manifested by aching, pulling pain in the abdomen, diarrhea, vomiting, fever with a sharp stop of alcohol intake, dizziness. In critical cases, vodka poisoning of the body leads to an alcoholic coma, which requires immediate hospitalization.

Ethyl alcohol

If we talk about alcohol products that are related to food products, then the symptoms of poisoning have been described above. In the future, it all depends on the person and type of alcohol. For example, the liver of an average adult male will completely neutralize 0.5l of beer in about 1 hour. Exceeding this dose already leads to the toxic effects of alcohol. Ethanol poisoning is manifested solely depending on the tolerance of the body, which depends on age, gender, body weight, nationality.

Surrogate Alcohol

Surrogates for alcoholic products include not only moonshine and low-quality drinks, but also technical liquids that contain ethyl, butyl, methyl and other alcohols. Poisoning with alcohol substitutes is dangerous because chemical combinations that are not natural for food products get into the body (fusel oils from home-brewing products can be called the “safest” ones).

Poisoning with such fluids brings increased symptoms: vomiting, headache, diarrhea, tinnitus. Added to this are total chemical damage to the kidneys, liver, heart, brain. In the case of methyl alcohol, often the result of poisoning is complete or partial blindness due to the characteristics of the exposure. It is important to remember that an attempt to consume alcohol substitutes increases the chances of death (even after a small dose) tenfold.

Isopropyl alcohol

Isopropanol belongs to moderately toxic liquids and is widely used in household or technical products. The most famous solution with its content is the popular "Non-freezing". Due to the characteristic alcohol smell, some individuals use it instead of alcohol. Isopropyl alcohol poisoning is similar to ordinary, but has characteristic features: a pronounced smell of acetone in breathing, continuous vomiting (sometimes with blood content).

What to do with alcohol poisoning

The first thing to do with a clear alcohol poisoning with severe symptoms is to call an ambulance. Most regular drinkers try to fight intoxication on their own, and they turn to doctors only in critical cases: zero reaction of the poisoned person to an external effect or the fact of using surrogates (fakes). First aid for alcohol poisoning before the arrival of doctors:

• stop drinking alcohol;
• give access to fresh air, facilitate breathing;
• clear the stomach of the remnants of alcohol that has not yet been absorbed into the blood;
• take any sorbent according to the instructions (activated carbon, Medichronal or similar drugs);
• give a salt laxative;
• feed enveloping food (jelly, viscous porridge like oatmeal).

How to remove alcohol intoxication at home

Folk remedies effectively relieve poisoning if they were taken in a timely manner. You do not need to go to the store for this - most of the ingredients for this kind of medicine are already in everyone's closet or refrigerator. Removing alcohol intoxication at home:

• provide fresh air to the room;
• induce vomiting to get rid of alcohol residues (for example, drink potassium permanganate solution, ammonia and anise drops or 1 tsp. mustard powder per 1 tbsp of water);
• give a smell of cotton wool moistened with ammonia (use the method carefully so as not to poison the victim);
• drink hot tea with a little sugar.

Dropper at home

A dropper from alcohol intoxication quickly removes acetaldehyde and associated decay products from the blood. The main thing is that next to the victim there should be a person with minimal paramedic education. The solution itself can be purchased at any pharmacy: 5-10% glucose + saline saline. In severe forms of alcohol poisoning, doctors use detoxifiers and hepatoprotectors.

Gastric lavage

All methods are allowed here to flush the body - from enemas to provocation of vomiting by pressing on the root of the tongue. Gastric lavage during alcohol poisoning is intended for one thing - to remove alcohol from the stomach until it is absorbed into the blood. One way is to drink as much water as possible in a short period of time. The main thing is to induce vomiting. Gag reflex is a natural reaction of the digestive tract to alcohol poisoning. Its absence during prolonged use of ethyl can be an alarming factor that the body disables the function of self-preservation.

Alcohol poisoning pills

The most common and affordable drugs are drugs and pills for alcohol poisoning:

• Activated carbon;
• Aspirin;
• No-shpa;
• Enterosorbent;
• Ethylene glycol;
• Polysorb;
• Biotredin;
• Limontar;
• Yantavit;
• Methadoxyl;
• Glycine;
• Tserukal.

Folk remedies

What does detoxification look like with folk remedies (if there is no obvious threat to the patient and you only need to remove the symptoms):

1. Honey water. Fructose will help sober up and get rid of the symptoms of poisoning. The total mass of diluted honey should be approximately 150 grams. Concentration should be chosen so that a person can drink without gagging.
2. Diuretic teas.
3. Milk.
4. A solution of soda (1 tsp. Per 1 glass of water).
5. After cleaning the stomach of alcohol, an antiemetic soothing saffron infusion is best suited: 1 tsp. in a glass of boiling water. Once cooled, drink in small sips. In addition, this will help stop gagging.
6. Apple cider vinegar - 1 tsp half a glass of water. One sip every 10-15 minutes.
7. Best of all, the effects of drinking alcohol help pickled cabbage pickle.

How long does alcohol intoxication last?

The duration of the poisoning period directly depends on the type of alcohol, personal tolerance (tolerance), snacks during the feast. Rapid elimination of alcohol from the body using the above methods will allow you to lift a person to his feet after about 4-5 hours. At the same time, echoes of the symptoms of poisoning will remain, but the condition will improve significantly, and consciousness will be cleansed.

If nothing is done, the body will remove the products of the decay of alcohol for several days. The process takes 1-3 days. Symptoms of poisoning may return in waves. It is highly not recommended to treat yourself with alcohol - a new dose will give a temporary impression of improvement, but will increase the period of natural organ cleansing.

1. The general toxic effect of alcohol is characterized by the following metabolic changes:

Decreased gluconeogenesis in the liver and impaired glucose oxidation in tissues

- increased gluconeogenesis and activation of anaerobic glycolysis in tissues

Decreased protein synthesis and the development of dysproteinemia

The development of fatty liver

- increased protein anabolism and decreased blood ammonia

Increased lipogenesis and the development of hypercholesterolemia

2. The toxic effects of alcohol on the nervous system are characteristic of:

- inhibition of the release of catecholamines from the presynaptic structures of the hypothalamus and midbrain

Stimulation of the release of catecholamines from the presynaptic structures of the hypothalamus and midbrain

Inhibition of acetylcholine synthesis and its release from presynaptic brain structures

- stimulation of the synthesis and release of acetylcholine from presynaptic brain structures

GABAergic brain system activation

- inhibition of the GABAergic system of the brain

Activation of the opioidergic system of the brain

- inhibition of the opioidergic system of the brain

3. Indicate the changes in the main cortical nervous processes often observed in chronic alcohol intoxication:

The weakening of the process of internal cortical inhibition

- strengthening the process of cortical inhibition

- intensification of the excitation process

Weakening the excitation process

Pathological inertia of inhibition processes

- pathological inertness of the excitation process

4. Select the correct statement:

- acetaldehyde is a product of ethanol oxidation, which has a significantly lower toxicity compared to it

Acetaldehyde (an intermediate product of the oxidation of ethanol) is the main reason for the development of toxic effects when drinking alcohol

5. Indicate the correct answer: the cytotoxic membranotropic effect of ethanol is associated with:

- decrease in fluidity and permeability of cell membranes

Impaired function of surface receptors and membrane-bound enzymes

Decreasing viscosity and increasing cell membrane permeability

6. Physical dependence on ethanol in typical cases is manifested:

Persistent irresistible craving for alcohol

- periodically arising desire to drink, which is not necessarily realized

The development of withdrawal symptoms after the termination of multi-day drinking

Hard drinking

Drinking alcohol in cases where it is contrary to social and ethical standards or detrimental to a career, reputation, family relationships

Alcohol use, despite a high risk of exacerbation of chronic somatic disease

- willingness to refuse to drink alcohol if circumstances interfere with this

7. Alcohol withdrawal syndrome is characterized by:

Tremor

Depressed mood, irritability

- increased drowsiness

Nausea, vomiting

Nightmares, insomnia

- aggravation of symptoms of autonomic disorders after taking a small dose of alcohol

Improvement after taking a small dose of alcohol

8. What signs are characteristic of a state of severe intoxication with narcotic substances with sedative and hypnotic effects (benzodiazepines, barbiturates):

- Blood pressure is normal or slightly increased

Arterial hypotension

- decrease in heart rate

Heart rate increase

Ataxia, slurred speech

Vertical and horizontal nystagmus

Narrowed pupils

9. What signs are characteristic of a state of intoxication with narcotic substances with a psychostimulating effect (cocaine, amphetamines):

Arterial hypertension, hyperthermia

- arterial hypotension, hypothermia

- decrease in heart rate

Heart rate and respiration rate

- ataxia, slurred speech

Excited state, fussiness, injustice

- a tendency to stereotypical movements

Dilated pupils

10. What signs are characteristic of a state of intoxication with drugs of the opium group:

BP is normal or slightly elevated

Arterial hypotension

Reducing the frequency and volume of respiratory movements

- rapid breathing

Ataxia, slurred speech

- excited state, fussiness

+ "Bead pupils"

Pain reduction

11. The early manifestations (8-10 hours since the last dose) of opium withdrawal syndrome include:

Sweating

- fever

Feeling of anxiety, impatience

- drowsiness

- narrowing of the pupils

Pupil dilatation

Lacrimation, rhinorrhea

Stomach cramps

12. The late manifestations (1-2 days after the last dose) of opium withdrawal syndrome include:

Finger tremor

Sawmill (goosebumps), fever

Vomiting, diarrhea

- bradycardia

Tachycardia

Cramping and muscle pain

- decrease in muscle tone

Irritability, impulsive behavior

13. The formation of a pathological craving for alcohol is supposedly associated with the action of the following mechanisms:

A change in the lipid composition of the membrane of neurons, leading to a decrease in its viscous-elastic properties

The effect of the condensation products of acetaldehyde and biogenic amines on the centers of regulation of "motivational behavior"

- a decrease in the activity of aldehyde dehydrogenase in the liver cells

Acceleration of the dopamine neurotransmitter circuit in the structures of the hippocampus, leading to its relative excess

- restructuring of metabolic processes in brain neurons in such a way that ethanol becomes an important energy substrate

- with abstinence from alcohol

14. With chronic alcohol abuse in the blood, the following pathological changes are detected:

The increase in the average diameter of red blood cells

- hypermagnesemia

- increased androgen content

Increased activity of aminotransferases (AST and ALT)

The appearance of acetaldehyde-modified albumin and Hb

- increase in the content of vitamins E and A

Increased acetate

CT scan

15. In the pathogenesis of alcoholic hepatitis, the following processes are important:

The formation of a covalent bond between the ethanol oxidation product acetaldehyde and the cytoskeleton protein tubulin

- inhibition of collagen synthesis

AT production against acetaldehyde-modified proteins

Impaired liver ability to secrete VLDL

- activation of microsomal ethanol-oxidizing system

Activation of macrophages (von Kupffer cells) in the liver tissue and their release of inflammatory mediators

16. Indicate the most frequent somatic consequences of prolonged alcohol abuse:

Chronic hepatitis, cirrhosis

Cardiomyodystrophy

- cerebral arteriosclerosis

Chronic pancreatitis

Polyneuritis

- arthritis

Chronic gastritis

- anemia

17. The following factors contribute to the development of somatic pathology with prolonged alcohol abuse:

Drunken nature of alcohol consumption (alternating periods of drunkenness and abstinence from alcohol)

- continuous use of alcohol

A phenotype characterized by the presence of a highly active form of alcohol dehydrogenase

- a phenotype characterized by the presence of an inactive form of alcohol dehydrogenase

- phenotype characterized by the presence of a highly active form of aldehyde dehydrogenase

Phenotype characterized by the presence of an inactive form of aldehyde dehydrogenase

Thiamine Deficiency (Vitamin B1) in Food

- deficiency of ascorbic acid in food

18. Alcoholism:

- a kind of addiction

Type of substance abuse

- bad habit

- psychosomatic illness

- congenital mental illness

19. Macrocytosis of red blood cells and leukopenia in patients with alcoholism are caused by:

The toxic effects of ethanol on bone marrow stem cells

Folic acid deficiency

- iron deficiency

- enhanced destruction of red blood cells and white blood cells in severe alcohol intoxication

- thiamine deficiency (vitamin B1)

Vitamin B12 malabsorption

20. In the pathogenesis of alcoholic cardiomyopathy an important role is played by:

Induction of the synthesis of the peroxide-producing enzyme acyl-CoA oxidase in cardiomyocytes

Activation of SPOL processes in myocardial cells

Direct toxic effect of acetaldehyde on cardiomyocytes

- accumulation of excess glycogen in cardiomyocytes

- excessive CT formation in the liver and their increased uptake by cardiomyocytes

Increased secretion of catecholamines in the sympathetic nerve endings of the myocardium

- mutations in the genome of cardiomyocytes under the action of acetaldehyde

The toxic effect of the products of catecholamine oxidation on myocardial cells

In what ways and why does alcohol negatively affect human health?

The considered features of the action of small doses of alcohol indicate that their use is incompatible with labor activity in the conditions of modern production. What is required here is the immediate adoption of well-thought-out decisions, high concentration and stability of attention, the speed of the human operator’s response to various types of signals, quick orientation in changing working conditions.

The most important pharmacological property of ethyl alcohol consists primarily in the fact that it has the ability to be rapidly absorbed in the gastrointestinal tract, and absorption actually begins already in the oral cavity. This period (phase of resorption - absorption) after taking alcohol lasts for 1.5–2 hours, including the time it spreads in the organs and tissues of the human body. Then comes the period of elimination of alcohol and its metabolic products from the body - the elimination phase. When taken on an empty stomach, the highest concentration of alcohol in the blood appears after 15–20 minutes, and gradually 90–92% of the dose is completely oxidized in the body, turning into the final product - water and carbon dioxide.

The oxidation of alcohol begins immediately after its intake and reaches its greatest intensity in the first 5–6 hours, and then decreases in the next 6–16 hours, and the entire process of final oxidation can last up to 2 weeks (at a dose of 50–100 g). Approximately 90% of the alcohol taken in is oxidized in the liver under the influence of a special enzyme, alcohol dehydrogenases, the remaining 10% of the dose is oxidized with the participation of other enzyme systems, excreted from the body with expired air, sweat and urine. If in the first hours after administration, the concentration of alcohol in the blood exceeds its concentration in the urine, then after 2.5–3 hours the inverse ratio is observed. Moreover, in the later stages of oxidation, alcohol may already be absent in the blood, but still in the urine.

The ability of alcohol to be rapidly absorbed into the blood determines its effect on almost all organs, because they are penetrated and surrounded by a whole network of blood vessels, and the penetration of alcohol into certain organs or tissues is the greater, the more abundant the blood network that nourishes them and thereby ensures metabolic processes . As you know, the blood supply to the brain is 16 times higher than that of the muscles of the limbs, which means that the brain is saturated with alcohol much faster than the muscles. At the same time, the rate of excretion from the brain and cerebrospinal fluid washing the brain and spinal cord lags behind the excretion of alcohol by other organs and tissues - its concentration in the brain tissue is higher and lasts longer than in the blood.

Not surprisingly, the nervous system responds primarily to alcohol intake. Such targeted selectivity of action on the cells of the nervous system is due to the fact that the so-called lipids (fat formations) contained in them in a large volume are easily dissolved by alcohol. So, alcohol, penetrating into the nerve cells, reduces their reactivity, while the activity of the cortex cells of the cerebral hemispheres is disrupted, and then its effect spreads to the cells of the subcortical centers and the spinal cord. With a single and rare use of alcoholic beverages, these disorders are still reversible, while systematic ones lead to a persistent and diverse violation of the functions of nerve cells, to their structural degeneration and death.

It is known that the activity of a nerve cell is expressed in successive processes of excitation and inhibition. Alcohol primarily inhibits the process of inhibition in the cortex of the cerebral hemispheres. Due to the inhibition of inhibition processes in the nerve cells of the cortex, the subcortical centers of the brain are disinhibited. This explains the state of arousal, so typical of the picture of intoxication.

Alcohol intake, acting on the nervous system and disrupting its functions, causes a real chain reaction of changes in the activity of other body systems, which, on the basis of the feedback principle, in turn, indirectly exacerbate the initially occurring adverse effects, both transient and persistently expressed.

Let us explain this with a number of examples. So, alcohol intake, acting through the central nervous system, indirectly stimulates increased secretion of gastric juice. However, despite the increased amount of juice secreted by the wall of the stomach, it contains significantly less than normal digestive enzymes, its digestive ability is reduced.

Acting on the subcortical centers of the deep structures of the brain, alcohol affects the functioning of the vasomotor center of the medulla oblongata, which regulates, in particular, the surface vessels of the skin. And after drinking alcohol, the expansion of these vessels is subjectively perceived by the drunk person as a sensation of warmth. Hence the widespread misconception that alcohol has a warming effect. In fact, the opposite effect is observed - the expansion of the skin vessels leads only to increased heat transfer of the body.

The stronger the intoxication, and therefore the stronger the toxic effect of alcohol in relation to the medulla oblongata, the higher the heat transfer and, consequently, the body temperature begins to decrease faster. This discrepancy between the subjective perception of the sensation of warmth in a drunk person and the objectively occurring increased heat transfer of the body can lead to tragic consequences: in conditions of cold and frost, intoxicated can easily and quickly freeze.

Entering the body, unaltered alcohol is excreted by respiration, with saliva and mainly through the kidneys. So, being filtered from the blood through the renal tubules, alcohol not only irritates them, but also enhances the release along with it of many valuable and necessary substances for normal functioning of the body.

As a result, the electrolyte composition of the blood is disturbed, the content of elements such as potassium, sodium, calcium, magnesium in it. Each of these elements performs one or another important function for the body. So, with a lack of magnesium in the body, irritability, trembling of hands, body, cramps are noted, blood pressure rises. Excess sodium leads to a delay and accumulation of fluid in the body.

Normally, the electrolyte composition of the blood is balanced, but a change in the blood content of only one of the elements causes an increase or decrease in the content of its other elements. In a person who has taken alcohol, the content of magnesium in the urine increases several times. Alcohol intake shifts the acid-base balance of blood towards acidity. This helps to increase the consumption of ascorbic acid, reduce the supply of vitamin B1 both in the blood and in the brain.

Alcohol inhibits the activity of enzymes that provide muscle contractions, as a result of which the energy balance changes, the oxidation of fatty acids, protein synthesis are reduced, and calcium metabolism in muscle fibers is disturbed. All this changes the power of muscle contraction and energy costs and contributes to muscle fatigue. Under the influence of alcoholic beverages, the metabolism of lactic acid is disrupted and its release is inhibited. Therefore, with a varying degree of renal failure, the content of toxins in the blood increases sharply, which increases the risk of uremia.

The use, and especially the abuse of alcohol, affecting the functions of the central nervous system, indirectly lead to violations of all the main types of metabolism - protein, carbohydrate, fat. It is characteristic that in this case, specific disorders occur in the functioning of body systems, such as cardiovascular, nervous, excretory, immune, endocrine and individual organs.

With regular intake of alcoholic beverages, the intermediate product of alcohol oxidation (acetaldehyde) can also lead to the formation of specific substances such as morphine, thus contributing to the formation of dependence - a painful craving for alcohol, which underlies chronic alcoholism.

Patients with chronic alcoholism often complain of periodically occurring pain (compressive) in the heart. This is due to specific changes in the heart muscle in most patients. The fact is that under the influence of alcohol, their heart muscle degenerates, the altered walls of the heart lose their elasticity, become flabby and cannot resist blood pressure: the heart grows in size, its cavities expand. And gradually the working capacity of the heart muscle decreases, blood circulation is disturbed. This is expressed in palpitations, shortness of breath, coughing, general weakness, and swelling.

Circulatory disorders in alcoholics and drunkards contribute to the occurrence of chronic coronary heart disease in them. Small vessels dilate, the skin becomes cyanotic-crimson in the face (everyone knows the "nose of an alcoholic"). In chronic alcohol intoxication, the walls of the vessels change, which leads to sclerosis of the vessels of the heart and brain. Cardiac and circulatory disorders are caused by the increase in blood pressure and hypertensive crises that are so frequent in patients with alcoholism, which threaten hemorrhage in the brain and subsequent paralysis, complete or partial.

Alcohol abuse leads to inflammatory changes in the kidneys, due to a violation of mineral metabolism, stones form in them. Especially often the liver is affected, which increases in volume, fat is deposited in its cells. It ceases to fulfill its main function - to neutralize toxic substances, including alcohol, its metabolic products, due to the replacement of liver tissue with fat. The amount of bile produced is reduced.

The liver damage in a patient with alcoholism is evidenced by pain, heaviness in the right hypochondrium, nausea. Developing hepatitis (inflammation of the liver) can later turn into an even more serious disease, most often ending in the death of a patient from liver cirrhosis. Chronic alcoholism is often its cause.

The irritating effect of alcoholic beverages on the mucous membranes and the consequences of intensive smoking of many drunkards and alcoholics cause inflammatory processes that they often encounter in the throat, often with damage to the vocal cords. In patients with alcoholism, as a rule, a hoarse and coarse voice, laryngeal cancer is often observed. Due to circulatory disorders in the lungs, they develop congestion, and the elasticity of the lung tissue is significantly reduced. Therefore, they are much more likely than non-drinkers to suffer from chronic bronchitis, pneumonia, emphysema. Weakening of the lungs is accompanied by a painful cough, profuse sputum production.

Systematic abuse of alcohol not only greatly facilitates infection with tuberculosis and sexually transmitted diseases, but also significantly complicates their course. First of all, due to a sharp weakening due to drunkenness of the body's defenses. These are diseases of people who do not observe the rules of personal hygiene, who abuse alcohol. Infection with sexually transmitted diseases in 9 cases out of 10 occurs in a state of intoxication.

With systematic drunkenness and alcoholism, pronounced changes occur not only in the central, but also in the peripheral nervous system. Many patients experience discomfort at the tips of the fingers and toes, a feeling of numbness and tingling in them. With prolonged alcohol abuse, paralysis of the limbs may develop. Inflammatory changes in the intercostal, sciatic and other nerves lead to serious consequences - neuralgia, neuritis, accompanied by constant pain, restriction of movement. The drinker becomes practically disabled.

All this leads to increased sensitivity to colds and infectious diseases that occur in patients, moreover, much harder than for non-drinkers, with severe and protracted complications. The severity and severity of diseases of the internal organs and nervous system are directly dependent on the duration of alcoholization, stage and rate of the course of alcoholism. The development of disorders begins already at the earliest stages of alcohol abuse, and their frequency, severity increases with increasing intensity, duration of alcohol abuse and the severity of chronic alcoholism.

It is known that in patients with stage III alcoholism 1.9 times more often than in stage II, diseases of the internal organs are found, and certain symptoms of damage to the brain, spinal cord and peripheral nerves are noted in almost all patients with alcoholism. The frequency of diseases caused by alcohol increases by 4 times already with a twofold increase in alcohol consumption. According to foreign researchers, in people who abuse alcohol, in 60% of cases there is inflammation of the pancreas, in 26–83 - cardiomyopathy, in 15–20 - tuberculosis, in 10–20% - gastritis and peptic ulcers of the stomach.

At the same time, for some people suffering from chronic alcoholism, for some time, signs of alcoholic damage to internal organs may be absent.

Alcoholism is a common cause of death for patients. The mortality rate of patients with alcoholism is almost 2 times higher than that of people who do not drink alcohol. Among the causes of mortality, alcoholism and related diseases occupy third place, second only to diseases of the cardiovascular system and malignant tumors. Thus, alcoholism itself is the direct cause of death or accelerates its onset: drunkards and alcoholics, as a rule, do not survive to old age, dying at working age, reduce their life expectancy by 10-12 years. So, domestic forensic experts believe that the fact of alcohol intoxication occurs in 2/3 of cases of violent and sudden death. At the same time, the relationship between the frequency of such types of death and the severity of intoxication is clearly traced. The mildest manifestations of alcohol intoxication were noted in 6.4% of accidents, moderate and severe intoxication - in 20.2%, and severe alcohol poisoning - in 45.9% of cases.

One of the direct causes of death in patients with alcoholism is suicide committed while intoxicated or hangover. According to the World Health Organization (WHO), 12-21% of patients with alcoholism attempt suicide, and 2.8-8% commit suicide. But is it not suicidal systematic drunkenness leading to death as a result of illnesses and injuries, because the sad contribution of alcohol to various types of injuries is very indicative.

95% of patients with alcoholism suffer from alcoholic gastritis. Gastritis is a lesion of the gastric mucosa. It is characterized by disturbances in the function of the stomach with manifestations such as pain, heaviness in the epigastric region, poor appetite, bad breath, nausea, vomiting, upset stool, and weight loss. The secretion of the stomach can vary in a variety of ways: from a significant increase to a sharp deterioration. Often, alcoholic gastritis precedes the development of an even more serious and dangerous disease, such as peptic ulcer of the stomach and duodenum.

Alcoholic polyneuropathy, or, as they used to call it, polyneuritis is a kind of disease that develops in people who abuse alcohol for a long time. The name "poly" means plural, "neuritis" - inflammation of the nerves. Under the influence of the chronic effects of alcohol on peripheral nerves, their degeneration occurs. All organs, including muscles, act, as is known, by the "order" of the nervous system and under the influence of impulses that pass through the nerve fibers, and with polyneuritis these fibers undergo profound changes right up to complete death. Accordingly, that part of the muscles and organs that was innervated by the affected nerves loses or sharply weakens its function. This disease is observed in about 1/3 of patients with alcoholism, mainly in its later stages.

Persons suffering from alcoholic polyneuritis, there are all kinds of unpleasant phenomena: "goosebumps", numbness, tightening of the muscles (especially the lower extremities), all kinds of pains - pulling, burning, stitching; sharp weakness in the limbs is noted - the legs become like cotton. Convulsions often occur due to spasm of a certain muscle group.

Everyone saw a special hammer in the hands of a neuropathologist. Everyone knows the picture of how neuropathologists check tendon reflexes by tapping the hammer at certain points where the nerves come closer. Normally, under the influence of such strokes, nerve irritation occurs, which leads to a reduction in the muscle group innervated by him, and the leg trembles accordingly. In alcoholics, when hammering the same areas with a hammer, such muscle contractions do not occur, because the nerves that feed these muscle groups seem to be out of order, atrophy and do not conduct impulses.

A special place is occupied by sexual disorders in alcoholism, which are extremely complex. They are mainly due to the fact that under the influence of chronic alcohol intoxication, gross changes in the pituitary gland, adrenal glands and gonads occur. A sharp decrease in the activity of male hormones occurs and their production drops sharply. On the other hand, in the appearance of sexual dysfunction, general biological and microsocial conditions are of great importance: violation of marital relations, change in social and marital status, etc.

RCHR (Republican Center for Health Development of the Ministry of Health of the Republic of Kazakhstan)
   Version: Clinical Protocols of the Ministry of Health of the Republic of Kazakhstan - 2015

Toxic effect of alcohol (T51)

Toxicology

general information

Short description

Recommended by
Expert advice
   RSE at RVP "Republican Center
   health development "
   Ministry of Health
   and social development
   dated October 30, 2015
   Protocol No. 14

The toxic effects of ethyl alcohol- This is a pathological condition caused by the toxic effect of ethanol on organs, systems and the body as a whole, as a result of a single dose of potentially toxic doses or as a result of prolonged use of ethanol.

Protocol Name:Toxic effect of alcohol (adults and children)

Protocol code:

ICD Code 10:
  T 51 Toxic effects of alcohol

Abbreviations used in the protocol:

HELL - arterial pressure
ALT - alanine transferase
AST - aspartate transferase
BP - abdominal cavity
HBO - hyperbaric oxygenation
ZHMT - closed head injury
CT - cT scan
MRI - magnetic resonance imaging
ONMK - acute cerebrovascular accident
OPN - acute renal failure.
Fri - protothrombin time
PTI - prothrombin index
SOP operating procedure standards
UD - level of evidence
Ultrasound - ultrasonography
FGDS - fibrogastroduodenoscopy
CNS - central nervous system
ECG - electrocardiography

Development Date:2015 year.

Protocol Users:general practitioners, emergency doctors, paramedics, therapists, pediatricians, toxicologists, resuscitators.

Assessment of evidence of recommendations
  Evidence Scale

BUT	High-quality meta-analysis, systematic review of RCTs or large-scale RCTs with a very low probability (++) of systematic error, the results of which can be spread to the corresponding population.
AT	High-quality (++) systematic cohort or case-control studies or High-quality (++) cohort or case-control studies with a very low risk of systematic error or RCTs with a low (+) risk of systematic error, the results of which can be disseminated to the corresponding population .
FROM	A cohort or case-control study or a controlled study without randomization with a low risk of bias (+). Results that can be distributed to the corresponding population or RCTs with a very low or low risk of bias (++ or +), the results of which cannot be directly distributed to the corresponding population.
D	A description of a series of cases or an uncontrolled study or expert opinion.
GPP	Best Pharmaceutical Practice.

Classification

Clinical classification:
with the flow:
  Acute
  Chronic (drunken state)
by severity of condition:
  Mild
  Moderate
  Severe

Diagnostics

The list of basic and additional diagnostic measures:
Diagnostic measures carried out at the stage of emergency ambulance(see algorithm app 2 ) :
  · Collection of anamnestic data, complaints, assessment of objective data (a mandatory questionnaire in case of poisoning of a patient / relative / witnesses see Appendix 1);
  · Express determination of the level of glycemia (with depression of consciousness);
  ECG for cardiovascular failure
  Pulse oximetry.
The main (mandatory) diagnostic examinations carried out at the stationary level during emergency hospitalization and after a period of more than 10 days from the date of delivery of tests in accordance with the order of the Ministry of Defense:
  · Test for the alcohol content in biological media;
  · General blood test (4 parameters);
  · general urine analysis;
  · Biochemical analysis of blood (determination of urea, creatinine, total protein, ALT, AST, bilirubin, amylase, potassium, sodium, calcium, glucose).
Additional diagnostic examinations carried out at the stationary level during emergency hospitalization and after a period of more than 10 days from the date of delivery of tests in accordance with the order of the Ministry of Defense:
  · Ultrasound of the organs of the BP, kidneys and pelvis;
  · FGDS;
  ECG
  · Study of the acid-base state of the blood;
  Coagulogram (PTI, PV, fibrinogen, INR);
  · Chest x-ray;
  · CT / MRI of the brain, lungs, abdominal organs, kidneys (with the development of complications of acute poisoning);
  · EEG - with a complication of the central nervous system.

Diagnostic criteria for diagnosis:
Moderate poisoning:
Complaints:
  nausea, vomiting, palpitations, headache, dizziness, general weakness, malaise, insomnia, constriction of the hands, muscle pain.
Medical history: includes a clear relationship between deterioration and alcohol consumption / abuse.

Physical examination: objectively, consciousness is preserved, psychomotor agitation / retardation of consciousness, the smell of alcohol, hyperemia of the skin, dry skin and mucous membranes, tremor of the extremities, tachycardia, blood pressure may remain normal, or a tendency to hypertension with prolonged abuse, and hypotension with the phenomena of hypovolemia. . In the lungs, wheezing is possible with toxic pulmonary edema. Perhaps an increase in liver size during palpation and percussion. Violation of diuresis (usually oliguria).

Laboratory research:
  · The presence of alcohol in the blood, or its absence in the somatogenic phase of poisoning;
  Increased ALT, AST, amylase, urea, creatinine
  · Changes in the coagulogram.
  Increased hematocrit (with hypovolemia)
  Metabolic acidosis, decreased potassium, sodium.

Instrumental research:
Pulse Oximetry -tachycardia, bradycardia, hypoxia.

Indications for consultation of narrow specialists:In case of poisoning with the development of complications and exacerbation of concomitant pathology.

Differential diagnosis

Differential diagnosis:

Table - 1. Differential diagnosis in case of impaired consciousness or the absence of a clear toxicological history.

Pathognomonic signs	Toxic effect of ethyl alcohol    (with impaired consciousness)	ZHMT	ONMK	Psychotropic drug poisoning
Inconsistency level alcohol mismatch	-	+	+	+
Positive dynamics on detoxification therapy	+	-	-	+
History of circumstances of head injury	-	+	-	-
The presence of objective signs of head injury	-	+	-	-
Confirmation of TBI by instrumental research methods	-	+	+	-
the presence of focal neurological symptoms	-	+	+	-
Confirmation by instrumental research methods	-	+	+	-
A history of toxic doses of psychotropic drugs	-			+
High blood alcohol	+		alcohol can be found in biological media	alcohol can be found in biological media
Detection of other psychotropic substances in biological media	-	-	-	+

Treatment abroad

Get treatment in Korea, Israel, Germany, USA

Treatment abroad

Get medical advice

Treatment

The goals of treatment:
  · Elimination of the toxic effects of alcohol by removing metabolic products from the body;
  · Restoration of impaired functions of affected organs and systems.

Treatment tactics
  · Removal of non-absorbable poison;
  · Removal of absorbed poison, toxic products of alcohol metabolism;
  · Treatment of complications (correction of water-electrolyte, metabolic disorders, treatment of toxic hepatopathy, nephropathy, encephalopathy, cardiopathy).

Non-drug treatment:
  Mode - I.II.III
  Diet No. 1-15
  · Gastric lavage up to 5-10 liters of water, to clear waters, with depression of consciousness after preliminary intubation of the trachea.

Drug treatment:
Drug treatment provided at the emergency stage:
  See the algorithm of prehospital care (Appendix 2) and SOP ambulance.

Inpatient drug treatment:
  Sorbing substances:
  · Activated carbon 1 g / kg per os once for the adsorption of exotoxins.
  Correction of acid-base balance based on the principles of infusion therapy.
  Correction of water-electrolyte balance, based on the principles of infusion therapy.
  Forced diuresis.
  Symptomatic Therapy

Antidote therapy:

With the development of complications, treatment is carried out according to the clinical protocols of the developed complications and the standards for resuscitation.

Other types of treatment:
Other species provided at the stationary level:
Hemodialysis:
  Indications:
  · With the development of acute renal failure;
  Contraindications:
  Cerebral hemorrhage,


Plasmapheresis
  Indications:
  · With the development of liver failure.
  Contraindications:
  Cerebral hemorrhage,
  Gastrointestinal bleeding
  Severe cardiovascular failure.
HBO:
  Indications:
  · With the development of brain hypoxia.
  Contraindications:
  Acute viral infection;
  Increased body temperature
  Upper respiratory tract infection;
  Ear diseases and eardrum pathology;
  Blood diseases
  Optic neuritis;
  Neoplasms;
  Severe hypertension;
  Psychiatric diseases (including epilepsy);
  · Individual hypersensitivity to oxygen.

Surgical intervention:no

Further maintenance:
  · In case of frequent drunken conditions, consultation of a narcologist for registration with preventive treatment.
  · After suffering a severe degree of poisoning, with the development of persistent dysfunction of organs and systems, the patient should be taken to the dispensary registration by a specialized specialist at the PHC level.
·
  · With the development in a patient’s hospital of persistent severe disorders from organs and systems (acute surgical pathologies, autonomic conditions, acute multiple organ failure, etc.) requiring constant monitoring by a specialist, after a consultation, the patient is transferred to a specialized department.

Cure rate indicators
  · General condition improvement, patient recovery;
· Normalization or tendency to approach normal indicators of existing pathological changes in laboratory parameters.

   Drugs (active substances) used in the treatment

Hospitalization

Indications for hospitalization:

Indications for emergency hospitalization:
  · Moderate and severe poisoning;
  · Development of withdrawal symptoms.
Indications for planned hospitalization:   no

Information

Sources and literature

1. Minutes of meetings of the Expert Council of the RCHR of the MHSD of the Republic of Kazakhstan, 2015
   1. List of used literature: 1) And, V. Markova, V.V. Afanasyev, E.K. Tsybulkin "Clinical toxicology of children and adolescents" 1999. 2) E.A. Luzhnikov, L.G. Kostomarova "Clinical Toxicology" 2000 3) Gheorghe Mogosh "Acute poisoning", 1984. 4) E.A. Luzhnikov, Yu.N. Ostapenko, G.N. Sukhodulova "Emergency conditions for acute poisoning", 2001 5) G.N. Uzhegov "Acute poisoning", 2001. 6) .B.D. Kamarov, E.L. Luzhnikov, I.I.Shimanko "Surgical methods of treatment of acute poisoning", 2001 7) L.A. Tiunov, V.V. Bushes "Toxicology of carbon monoxide", 1969 8) A.A. Ludevig's Acute Poisoning, 1986 9) E.A. Luzhnikov "Emergency treatment of acute poisoning and endotoxemia", 2001 10) I.B. Soldatov, V.A. Danilin, Yu.V. Mitic "Professional pathology of the upper respiratory tract in the chemical industry" 11) A.I. Burnazyan, A.K. Guskova "Massive radiozone lesions" 12) G.G. Zhamgotsev, M.V.Predtechensky "Medical care for affected SDYAV", 1993. 13) K.Kasenov "Snake poisons and body reactivity", 1977. 14) V.V. Sokolovsky "Histochemical studies in toxicology" 15) .M.V. Ship "Derivatives of dithiocarboxylic acid", 1971 16) L.I. Medved "Hygiene and toxicology of new pesticides and a poisoning clinic" 17) M.D. Mashkovsky "Medicines", 1984. 18) A.L. Kostyuchenko "Efferent therapy", 2001 19) Bayzoldanov, Sh. T. Bayzoldanova "Guide to the toxicological chemistry of toxic substances isolated by extraction", 2003. 20) E.A. Luzhnikov "Emergency treatment of acute poisoning and endotoxemia", 2001. 21) A.I. Martynov "Intensive care", 1998. 22) J. Henry, H.Widman "Prevention and treatment of poisoning", 1998. 23) Matthew J. Ellenhorn, Donald G. Barceloux "Medical toxology. Díagnosіs and Teatment of human poіsonіng", 1988 24) Lewіs R. Goldfrank "Goldfrankіs toxіcologіal emergencіes", 1994. 25) Journal of Toxіcology, Clіnology Tocology, 38 41, 2003 26) Thompson L, Evaluation of regional and non-regional poison centers. New England Journal of Medicine 1983; 308: 191-194. 27) Litovitz T et al, Poison information providers: an assessment of proficiency. American Journal of Emergency Medicine 1984; 2: 129-135. 28). Litovitz T, Elshami JE, Poison center operations: the necessity of follow-up. Annals of Emergency Medicine 1982; 11: 348-352. 29) Sullivan JB, Proper use of the toxicology laboratory. Emergency Medicine Reports 1984; 5: 125-132. 30) Kellerman Al et al. Impact of drug screening in suspected overdose. Ann Emerg Med 1987; 16: 1206-1216.

Information

List of protocol developers with qualification data:

1) Orazbaev Murat Bekaydarovich MD MBA JSC “National Scientific Center of Oncology and Transplantology” in Astana, the main non-staff toxicologist of the Ministry of Health and Social Development of the Republic of Kazakhstan.
  2) Toybaeva Gulmira Maratovna Kazakh Medical University of Continuing Education JSC, head of the clinical toxicology course.
  3) Shakirov Talgat Dauthanovich JSC "Kazakh Medical University of Continuing Education", an assistant in the course of clinical toxicology.
  4) Mazhitov Talgat Mansurovich - doctor of medical sciences, professor of Astana Medical University JSC, doctor of clinical pharmacology of the highest category, general practitioner of the highest category.

Indication of no conflict of interest:   no

Reviewers:Tuleutaev Tleutai Baysarinovich - professor, associate professor of the internship department of surgery at the Republican State Pedagogical University at the State Medical University Semey

Indication of the conditions for revising the protocol:   Revision of the protocol 3 years after its publication and from the date of its entry into force or in the presence of new methods with a level of evidence.

Annex 1

Mandatory questions when interviewing a patient, relatives and witnesses of poisoning:
  What kind of poison are we talking about?
  How much poison is taken? (volume of fluid drunk, how many sips made)
  When did the poisoning occur? (find out the exposure time)
  · Circumstances leading to poisoning (suicide, accidental, criminal, domestic, industrial poisoning)
  · What treatment measures have already been taken, how and how did they wash the stomach?
  · Anamnesis of life: are there any pregnancy, mental illness, concomitant diseases
It is always necessary (if possible) to bring along a package of the substance that caused the poisoning.

Attached files

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• Being self-medicated, you can cause irreparable harm to your health.
• The information available on the MedElement website cannot and should not replace a doctor’s face-to-face consultation. Be sure to contact medical facilities if you have any diseases or symptoms that bother you.
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• The MedElement website is a reference resource only. Information posted on this site should not be used to arbitrarily change a doctor’s prescription.
• The editors of MedElement are not responsible for any damage to health or material damage arising from the use of this site.

In short:   Toxicologist S. Radchenko: 750 ml of vodka for non-drinkers and three bottles of vodka for non-alcoholic non-alcoholics - a lethal dose of alcohol for the human body. In addition to an overdose, dangerous diseases that are exacerbated or first caused by alcohol can lead to death.

Alcohol can kill a person in two ways:

1. Alcohol and snack provoke an attack of an existing disease, and a person dies;
2. Alcohol kills by itself simply because a lethal dose has been drunk, in other words, an overdose has occurred.

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Lethal dose of alcohol

For a non-drinking man of a white race with a body weight of 70 kg:

• 300 ml pure alcohol
• so much alcohol is contained in 750 ml of vodkadrunk for five hours or faster.

For regular non-alcoholic drinkers:

• approximately 600 ml of pure alcohol or 3 bottles of vodkadrunk for five hours or faster.

The lethal dose of alcohol.

With fatal alcohol poisoning, death occurs in an unconscious state from a cardiac arrest or respiratory arrest. A fatal overdose of alcohol can be suspected if the unconscious state lasts more than six hours after taking alcohol. As a rule, nothing can be done on such terms.

Please note that drinking a lethal dose of alcohol is almost impossible without a hearty snack. Most often, an overdone and plentiful snack at the table leads to an overdose of alcohol. If a person bites moderately and competently, and at the same time drinks a lot, then before he reaches a lethal dose, he simply faints, and this saves his life. The body manages to react in time, when nothing prevents the timely absorption and processing of alcohol.

An abundant snack accumulates in the intestines with the drunk alcohol, the alcohol does not have time to be absorbed, and it seems to a person that he drank much less than he actually did. He feels within himself the strength to drink more. And when the drunk alcohol is finally absorbed and enters the bloodstream, the body is not able to cope with so many toxic substances.

Alcohol-related deaths

In addition to a possible overdose, alcohol can cause other serious harm to the body. Excessive alcohol consumption can cause diseases of the liver, heart and other organs: for example, a deadly attack of pancreatic necrosis (necrosis of the pancreatic tissue), acute urinary retention, liver failure, alcoholic hallucinosis and alcoholic delirium. The presence of alcohol in the body can aggravate a person’s existing diseases and cause their exacerbations, and exacerbations of especially serious diseases can have irreversible consequences, including death.

Among the diseases that may be aggravated by alcohol intake are acute pancreatitis, renal colic, cardiac arrhythmia, bronchospastic syndrome (asthma attack for various reasons:

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