Alcohol abuse is one of the most acute social problems of our time. According to research, alcohol consumption is about 6 liters of pure ethanol per capita in the world, and in the Russian Federation, despite a certain positive trend, it reaches 10.5 liters (Fig. Below). At the same time, about 37% of alcoholic beverages are home-made or produced illegally.
In 2018, according to the Federal State Statistics Service, among Russians over 15 years old, alcoholic beverages are consumed by 60.5%. Of these, 46% drank alcohol only on holidays, 31% of respondents - 1-2 times a month, almost 17% - once a week, about 5% - several times a week and 1% - daily (systemic drinking). According to world statistics, mortality from alcohol abuse is second only to injuries, diseases of the cardiovascular system and cancer. In Russia, in the structure of total mortality for various groups of toxicants, death from acute poisoning by ethyl and other alcohols (alcohol substitutes) varies widely, reaching an average of 50-60% in the country (Fig. Below).
It should be noted that alcohol intoxication to a mild / moderate degree in itself does not pose a threat to health and life. A person who controls his social actions and does not have acute concomitant diseases does not need emergency medical care. At the same time, with severe intoxication, accompanied by a complete violation of coordination / orientation with a sharp drowsiness, inhibition, lack of verbal contact with others in some cases, medical attention may be required.
The most common medical problem caused by alcohol abuse is alcohol intoxication (ethanol intoxication). Historically, the term "alcohol intoxication" is used by specialists in various fields (psychiatrists, narcologists, toxicologists, forensic doctors). This term refers to the transient state of the body, characterized by a complex of behavioral, psychological, autonomic, somatoneurological and physiological disorders caused by the psychotropic-euphoric effect of ethanol and its toxic dose-dependent effects.
The code of alcohol intoxication according to MKB-10: F.10 - Mental and behavioral disorders caused by the use of alcohol, including: F.10.0 "Acute intoxication" - as alcohol intoxication / acute intoxication with alcoholism. Acute alcohol intoxication is most often found in the form of simple alcoholic intoxication and is one of the main causes of emergency hospitalization of patients for poisoning. So, the proportion of patients with alcohol poisoning on average is 40% of all hospitalized in toxicological departments.
Acute alcohol poisoning usually occurs when taking ethyl alcohol or alcoholic beverages, in which the ethyl alcohol content exceeds 12%. Poisoning in most cases occurs as a result of domestic, accidental use of alcohol for the purpose of intoxication. The lethal dose of 96% ethanol varies between 4-12 g / kg body weight (in the absence of tolerance, it is approximately 700-1000 ml of vodka), and an alcoholic coma occurs when the concentration of ethanol in the blood is approximately 3 g / l, death - from 5-6 g / l and higher. The gradation of the degree of intoxication with alcohol (stages of intoxication) is based on the concentration of alcohol in the blood (g / liter), in accordance with which the stages are shown in the table below.
The effect of alcohol on the human body (the narcotic effect when taking ethyl alcohol) depends on a number of factors: the volume and speed of alcohol intake, the quality of alcoholic beverages, the degree of tolerance, the psychophysical state of the body, body weight, resorption rate, intoxication phase, fasting or intake food, individual sensitivity to alcohol, concomitant smoking.
At the same time, there is a direct correlation of the development of narcotic action with the rate of increase in the concentration of ethanol in the blood, that is, a person quickly gets drunk with heavy alcohol consumption in a short period of time. The narcotic effect is higher in the phase of resorption (absorption of alcohol) than in the phase of elimination (elimination of alcohol).
Among women, alcoholism and alcohol abuse are 3-5 times less common than among males. At the same time, in women alcoholism largely proceeds differently than in men — the time for the development of alcohol dependence in a woman is longer than that for a man, but it progresses much faster. The basis of alcohol abuse in women and the development of alcohol dependence are significantly more likely to be significant psychological problems:
- postpartum / premenstrual, menopause depression;
- problems with appearance (real / far-fetched);
- perfectionism - the desire to fulfill their home and professional duties perfectly;
- prolonged disorder of personal life;
- drinking alcohol with her husband.
Moreover, borderline premorbid mental disorders in women who drink are almost 2 times more likely (70%) than in men (30%). The adverse effect on the female body of alcohol particularly quickly affects the woman's appearance, which is due to a change in the hormonal background - due to hormonal imbalance in the body, the aging process accelerates (hair turns gray, the face swells, the skin loses elasticity, wrinkles appear, the face skin acquires a crimson hue) decreases libidofrigidity develops.
Alcohol abuse in women is usually accompanied by abnormalities of the emotional sphere, manifested by depression, asthenic syndrome, hypochondriacal disorders, and hysteria. In addition, the concentration of ethanol in the blood of a woman when using equivalent doses compared to a man reaches a higher level, which is due to the significantly lower water content in the female body (ethanol is distributed in the aquatic environment).
Against the background of increasing alcohol consumption, one of the modern problems is the tendency to rejuvenate alcoholism, including the increase in cases of acute alcohol poisoning among young people. A feature is the early primary acquaintance of a teenager (boys 10-12 and girls 11-14 years old) with alcohol; an increase in mixed systematic consumption of alcoholic drinks / alcoholic substitutes (alcoholic cocktails, low alcohol drinks, moonshine) in the 14–16-year-old age period; an increase in cases of multi-day alcoholization, as well as rapidly increasing tolerance to alcohol.
As a rule, the motivation for drinking alcohol / smoking among adolescents is the desire for self-affirmation, problems with school / parents, the influence of a bad company / drinking relatives, inability to organize leisure activities, an unsuccessful experience of first falling in love, desire / fear of sexual contact.
Alcohol and its effects on human health
In almost all persons who have experienced moderate to severe alcohol poisoning over the next few days, post-toxic symptoms are manifested asthenic syndrome, decreased mood, expressed irritability, hypo/adynamiavegetative disorders insomnia (patients cannot fall asleep), anorexia (lack of appetite), dehydration (which explains why you want to drink water after alcohol).
Some people feel very sick after drinking, there is frequent vomiting, intestinal disorders. With severe intoxication, alcoholic tremor can develop (hands shake). Why are my hands shaking? Tremor is due to the toxic effects of ethanol and its decomposition products (acetaldehyde), causing a violation of the relationship between motor nerves and inhibitory function, which contributes to a persistent decrease in muscle tone and the development of tremor.
It is also known that alcohol increases appetite and, as a rule, you are hungry while taking alcohol. The appetite for salty / fatty foods and dishes is especially growing when taking strong drinks and sweets when taking dry wines, champagne, cocktails. One of the mechanisms of the influence of ethanol on the brain is the inhibition of saturation centers. Accordingly, at a certain point, control over the amount of food eaten is lost and overeating occurs. In addition, alcohol in itself is a high-calorie product and with frequent consumption of alcoholic beverages negatively affects the body weight of a person and leads to the accumulation of fat. In fig. the approximate calorific value of various alcoholic beverages (100 g / product) is given below.
Another negative effect is a decrease in the level of male sex hormone after alcohol. Content reduction testosterone slows down the metabolism and complicates the task of burning fat, and also with frequent / prolonged use of alcohol negatively affects the potency of a man and the quality of sperm.
The detrimental effect on the human body with a one-time massive consumption of alcoholic drinks or systematically abusing alcohol can be manifested by a wider and more serious complex of somatic disorders and mental disorders, which are summarized below. The main somatic disorders include:
Alcoholic damage to the heart / blood vessels
They occur against the background of chronic alcohol intoxication and accompanied by functional / organic changes in the myocardium. Manifested in the form of:
- Alcohol cardiomyopathy. Accompanied by the development of the phenomena of circulatory failure occurring on the background of alcohol excess or after it (aching / stitching pain in the heart, palpitations).
- Violation of rhythm and conduction. The most common is sinus tachycardia, less commonly, various ventricular / atrial arrhythmias. Among conduction disorders - incomplete / complete blockade of the legs of the bundle of His, less often - atrioventricular block.
- Alcohol hypertension. Alcohol abuse causes an increase in systolic and diastolic blood pressure. The minimum threshold dose of pure ethanol, causing an increase in blood pressure, is about 25 g.
Manifested in the development of severe pneumoniacaused by H. influenzae, S. pneumoniae with severe respiratory failure, as well as with a tendency to abscess and the formation of pleural empyema. An acute complication arising from HAI is acute respiratory distress syndrome.
Pathology of the digestive system
- Alcoholic liver diseaseincluding fatty liver, alcoholic hepatitis, fibrosis, steatosis, cirrhosis, hepatocellular carcinoma. As a rule, in such cases, on the morning after alcohol, the left side under the ribs hurts, bitterness in the mouth is felt and often bile is sick.
- Alcoholic acute and chronic pancreatitis. A frequent complication of chronic alcohol intoxication. Its manifestation is abdominal girdle pain, nausea (often sick in the morning) and vomiting that does not bring relief. Often with pancreatic lesions, diarrhea is noted after alcohol. In this case, diarrhea can occur outside of alcohol intake.
- Gastritis (acute / exacerbation of chronic). A frequent complication of alcohol abuse, especially of poor quality and on an empty stomach. Manifests symptoms such as heartburnsevere nausea, vomiting.
Manifested in alcohol hematuric nephritisless often - uratic nephropathy. In this case, there is pain in the kidneys, hematuria (blood in urine) proteinuria.
Symptoms of alcohol intoxication are often manifested by exacerbation of existing chronic diseases (cystitis, hemorrhoids with the appearance of blood from the anus), colitis/enterocolitis and etc.).
Alcohol and the nervous system
The action of ethanol on the human body, as in cases of rare massive or systematic abuse of alcohol, causes damage to the central nervous system (acute alcohol disorders / alcoholic cerebral atrophy) and damage to the peripheral nervous system (alcoholic polyneuropathy).
Clinical diversity is characteristic of alcoholic damage to the central nervous system, including numerous typical / atypical neurological and psychopathological symptoms. They are based on the pronounced variability of individual reactions to ethanol intoxication and the neurometabolic shifts caused by it.
Typical forms of central nervous system damage with alcohol include: hangover seizures, withdrawal syndrome alcohol, delirium tremens, alcoholic psychosis and dementia, subclinical and moderate manifestations of cognitive dysfunction. Atypical forms are represented by alcoholic paranoid, atypical variants of delirium tremens, alcoholic delirium of jealousy, acute alcoholic hallucinosis.
Ethanol is absorbed in the human body mainly in the small intestine (85%) and stomach (15%) and after 1.5 hours on average the concentration of alcohol in the blood reaches its maximum level. It easily penetrates various tissue membranes. The negative effect of ethanol is carried out throughout the entire period of its stay in the body until its complete withdrawal. The following is the period of alcohol elimination - the time the alcohol acts on the body (table), depending on the type of alcohol, its dose and body weight.
Ethanol has a pronounced psychotropic (narcotic) effect, accompanied by a suppression of the excitation processes in the central nervous system, which is due to a violation of the function of mediator systems, a change in neurometabolism, a decrease in oxygen utilization, as well as an accumulation of decay products during its biotransformation.
Ethanol is distributed fairly uniformly in all organs and tissues. In the toxicokinetics of ethanol, two main phases are distinguished: absorption (resorption) and excretion (elimination). At the same time, in the phase of alcohol absorption, the rate of saturation of tissues / organs with ethanol is faster than the processes of its biotransformation and excretion, which determines its high concentration in the blood. Ethanol after oral administration after 5-6 minutes is detected in the blood.
The most rapidly (within several minutes) organs with intense blood supply (kidneys, brain, liver) are saturated with ethanol, followed by the establishment of a dynamic balance of the level of ethanol in tissues and blood. The alcohol release phase begins after absorption of 90% alcohol or more.
The process of oxidation of ethyl alcohol to CO2 and H2O carried out mainly by the liver (up to 90%) with the participation of the enzyme alcohol dehydrogenase. The remaining 10% is excreted through the lungs and kidneys unchanged within 7-12 hours. The rate of alcohol resorption is usually indicated when it is taken on an empty stomach and with repeated doses, and the food mass in the stomach slows down the absorption of alcohol.
The removal of alcohol and its acidic metabolites from the body is carried out unchanged with exhaled air / urine. The processes of biotransformation of ethanol take place mainly in the liver with the formation of products secreted by the kidneys.The metabolic rate of ethanol in the body is on average 90-120 mg / kg body weight / hour, but may vary depending on individual characteristics. There are several stages of biotransformation of ethyl alcohol in the liver:
- The first stage is the oxidation of ethanol to acetaldehyde.
- The second stage is oxidation. acetaldehyde before acetic acid.
- Third Stage - Transformation acetyl coenzyme A acetate in the Krebs cycle to carbon dioxide and water.
The leading place in the pathogenesis of acute alcohol poisoning is occupied by cerebral disorders, hemodynamic and respiratory disorders of various origins, which leads to disorders homeostasis (water-electrolyte balance / acid-base state, intermediate metabolism, etc.), development acidosis, hypovolemia, hypercoagulation and hypothermia. In the somatogenic stage of acute poisoning, the leading role is played by the defeat of internal organs (liver, myocardium, kidneys, pancreas) and residual cerebral disorders, as well as infectious complications in the form of pneumonia.
The following clinical forms are distinguished: acute alcohol intoxication, which is more common in the form of simple alcohol intoxication and chronic alcohol intoxication. By type of alcoholic intoxication, there are:
- Simple (typical) intoxication. The severity of its manifestations distinguish between mild, moderate and severe (coma).
- Altered forms of alcohol intoxication.
Atypical intoxication. It occurs in psychopathic individuals (epileptoid, paranoid) with chronic alcoholism against the background of existing mental disorders, with traumatic brain injuries.
A dysphoric variant of intoxication is distinguished (when instead of the characteristic euphoria that develops with simple alcoholic intoxication, a gloomy mood arises with conflict, anger, irritability, a tendency to aggression); the paranoid version (with the appearance of resentment, pickiness, suspicion, a tendency to interpret the words and deeds / words of others as a desire to scoff, humiliate, deceive and related aggression); intoxication with hebephrenic features (in the presence of a latent schizophrenic process), manifested by antics, foolishness, senseless rampage; intoxication with hysterical features (in persons with pronounced egocentrism), manifested by violent scenes of despair, demonstrative suicidal attempts, theatrical actions.
Pathological intoxication (epileptoid / paranoid forms). Refers to acute short-term occurring mental disorders with a peculiar symptomatology. Pathological intoxication can develop even when taking small doses of alcohol on the background of psychogenic, prolonged insomnia, overwork, organic cerebral insufficiency. It is characterized by a sudden onset of a change in consciousness in the form of twilight stupor and delusional-hallucinatory experiences, which leads to a distorted perception of the world and its delusional interpretation.
Marked affective tension is noted - anxiety, confusion, unaccountable fear, anger. Actions are divorced from the real situation and are determined solely by the plot of experiences. At the same time, the patient does not have a state of stupor, which manifests itself with simple intoxication and a violation of statics and coordination of movements. The defining sign is the nature of impaired consciousness.
Pathological intoxication can occur suddenly and also stop, often ending in a deep sleep of the patient. Its duration can vary from several minutes to several hours, after which the patient may feel weakness, headache, partial with fragmentary memories / total amnesia.
Chronic alcohol intoxication develops as a result of prolonged abuse of alcohol (chronic alcoholism) and, as a rule, is not accompanied by a coma. It is characterized by various mental disorders - alcoholic psychoses (acute alcoholic hallucinosis, alcoholic delirium) and behavior (alcoholic paranoid with delusions of persecution / jealousy).
The development of alcohol abuse is influenced by hereditary, social and psychological factors.
Heredity. Craving for alcohol (addiction) is due to:
- The individual genetic characteristics of the body are the breakdown of ethanol in the human body and the formation of acetaldehyde occurs under the influence of an enzyme alcohol dehydrogenaseand neutralization of toxic acetaldehyde by acetaldehydrogenase. However, the rate of action of enzymes (the rate of chemical reactions) is a hereditary factor and can vary significantly. It has been proven that the vast majority of people with alcohol dependence are people with metabolic processes with accelerated alcohol breakdown and better tolerance of large amounts of alcohol.
- Features of intrauterine development (the use of alcohol by a woman during pregnancy).
This group most often includes people prone to addiction and certain reactions when they get into difficult life situations. The motivation for drinking alcohol is most often the desire to relax and relieve fatigue / stress; stop attacks of anxiety, fear, depression; low self-esteem and the desire to prove their worth; loneliness; loss of loved ones and another grief; inability to organize leisure / boredom; guilt; lack of purpose and monotony of life; uncriticality in alcohol intake.
Dependence on alcohol is formed as a result of alcoholic traditions and lifestyle of parents (with early involvement of children), family, circle of friends; material shortage (housing problems, lack of work, poor nutrition, inability to support a family financially, etc.); availability of alcohol / alcohol substitutes; alcohol advertising.
The clinical manifestations of acute alcohol intoxication can vary significantly among different subjects, and one depending on many different factors: the dynamics (time / speed) of alcohol intake, individual characteristics of the subject (gender, age, body weight, physical / mental state), quantity / quality of food and non-alcoholic drinks taken previously / while drinking, qualitative characteristics of alcohol (strength, quality, combination of alcoholic drinks), alcohol tolerance Golu, ambient temperature.
Common symptoms of acute alcohol intoxication are: the smell of alcohol from the mouth, lability of mood (from feelings of euphoria to depression), decreased ability to critically evaluate one's / others' actions, impaired attention, altered behavior (disinhibition, aggressiveness, lack of distance), discoordination of movements (shakiness) gait, difficulty maintaining balance, difficulty in performing precise movements).
Speech blurred, reduced criticism (risky behavior and neglect of danger), nystagmus are characteristic. Paleness / redness of the skin, injection of the sclera may be observed. However, the listed symptoms of alcohol intoxication are not always clearly pronounced with a mild degree of alcohol intoxication, since the subject can control his behavior to some extent or try to hide intoxication.
In general, the clinical manifestations of acute alcohol intoxication are divided depending on the severity, which correlate with the alcohol content in the blood of the subject. At an alcohol concentration of 0.1-0.5%, the disturbances are insignificant or even absent.
Easy degree. It is characterized by euphoria, increased mood, a feeling of physical / mental comfort, increased gestures, physical activity, an illusory-positive perception of the world appears, and verbal contact with surrounding people improves.
There is a slight increase in parasympathetic activity (decreased blood pressure, slight tachycardia), hyperemia of the skin (red spots on the face or red face, and some have red spots on the body). As a rule, external signs of intoxication are controlled by willpower and are completely controlled.
Medium degree. Behavior is gradually becoming more provocative, disinhibited, the subject loses the ability to control volitional effort. Speech is becoming increasingly inadequate, inarticulate and poorly controlled.
Intoxicated can talk to themselves, conduct dialogue with a non-existent interlocutor. Shout out single words, often swear words. Rudeness, irritability, pickiness, aggressiveness, pronounced importunity, viciousness, rudeness and impulsivity are often noted.
Past grievances and failures are updated. Movements become sweeping and uncoordinated. Gait - uncertain / shaky. Control over the motivational sphere is lost and the subject may commit inappropriate actions in various situations.
The manifestation of negative individual character traits hidden in a sober state is characteristic. Some people may have tearfulness, a tendency to "pour out their souls", ask for forgiveness from everyone, engage in self-flagellation. Others, on the contrary, have unbridled aggression, a tendency to swear and start fights. And in a small contingent of individuals - moderate intoxication is associated with severe drowsinesscaused by inhibition of the processes in the central nervous system, which explains why you want to sleep, followed by immersion in sleep. The sense of caution is reduced, the subject often neglects situations that are dangerous to health and life. Activation of the sympathetic nervous system (strong heartbeat, rapid breathing, increased heart rate, high blood pressure) is characteristic.
Tendon reflexes are often reduced, hiccups and diarrhea, nystagmoid movements of the eyeballs may appear. Instability in Romberg posepossibly involuntary urination and diplopia. The pronounced smell of alcohol is clearly defined from the mouth. Difficulty in activating the memory is noted.
The subject's appearance is typical: clothing unbuttoned stained, untidy. The face is puffy, often hyperemic, which is caused by a rush of blood to the superficial vessels (which explains why the face turns red), but in rare cases it can be pale. It may be noted: hiccups, sneezing, intense thirst (dried up), nausea, vomiting. As a rule, after sobering up (the next day), the subject recalls all the events of the intoxication period in full and can give them an estimate.
Severe degree. The motor activity of the subject is usually limited, he hardly stands on his feet, often falls and can not rise. An increasing physical weakness appears. Speech becomes illegible: monotonous muttering / scraps of words and phrases, facial expressions are absent or extremely poor, hiccups appear after alcohol. Orientation in time / place is lost.
Contact with the subject is extremely difficult. The subject can fall asleep anywhere, regardless of the time of day in postures that are not physiological for sleep. In a dream, urination, defecation, less often, convulsions can be observed. As a rule, one succeeds in waking up a drunk, but he again immediately falls asleep. After waking up the next day, some people have difficulty recovering fragmentary events and feel memory lapses, while others have complete amnesia (remember nothing) and only a few can recover events completely.
In case of impaired consciousness to a coma, vomiting, involuntary urination, and bowel movements may occur. In the toxicogenic stage of alcohol poisoning, the severity of the condition is determined by the depth of the coma. In the phase of superficial coma, loss of consciousness, a complete lack of contact with the subject, a decrease in pupillary / corneal reflexes and a sharp decrease in pain sensitivity are observed. Neurological symptoms appear, but they are intermittent: an increase / decrease in tendon reflexes and muscle tone, the appearance of pathological eye symptoms (anisocoria, floating eyeballs, myosis), trismus of the masticatory muscles, myofibrillation.
Blood pressure decreases, rapid breathing, shallow. The heart beats violently, heart sounds are deaf, the pulse is frequent, weak tension and filling. The skin is cold, pale, moist.
The deep coma phase is characterized by further depression of the central nervous system, complete loss of pain sensitivity, lack of pupillary and tendon reflexes, and muscle atony. The skin is covered with sticky sweat, cold, pale, body temperature is reduced to 36 ° C and below.
Aspiration-obstructive respiratory disorders of central / mixed origin may appear, a sharp decrease in blood pressure, tachycardia, deafness of heart sounds. With the development of complicated forms of alcohol intoxication, convulsions, psychopathological disorders (delirium) can occur.
Tests and diagnostics
Diagnosis of acute alcohol poisoning is carried out on the basis of a medical history (establishing the fact of drinking alcohol / dose / time), data from an objective examination of the patient and the results of laboratory analysis:
- Determination of ethyl alcohol in blood and urine.
- General (clinical) urine / blood test.
- Biochemical blood test (direct / total bilirubin, total protein, creatinine, glucose, urea).
- To assess the severity of poisoning - determination of the acid-base state, sodium, calcium, potassium, chloride in the blood serum, ALAT level, ASAT activity.
If necessary, instrumental examinations (ECG, ultrasound, MRI of the brain) are performed.
Alcohol intoxication treatment
The treatment of alcohol poisoning is largely determined by the degree of poisoning. If we are talking about the usual overdose of alcohol with the development of mild intoxication and the appearance of unexpressed post-toxic symptoms, then in such cases home care can be provided. First of all, it should be aimed at how to cleanse the body of ethanol and its metabolites as soon as possible, as well as to relieve symptoms of intoxication.
If alcohol was consumed recently and is still in the stomach (resorption stage), it is necessary to rinse the stomach with 2-3 liters of clean water and induce vomiting. To wash the stomach, you can use a weak solution Potassium permanganate/Sodium bicarbonate. After washing the stomach so that the poisoned one can recover, you can give a drink a solution of ammonia (5-10 drops in 30 ml of water) or make short-term inhalation of ammonia vapor (give a sniff).
If alcohol was consumed 2-3 hours ago or more, then such a plentiful washing does not make sense, since alcohol has already entered the intestines. You can clear the intestines at home by causing profuse diarrhea. To do this, you must accept Magnesium sulfate (magnesia) in an amount of 10-15 g. or other laxatives. You can also do a cleansing enema.
The second direction is the need to dilute the concentration of alcohol in the body, which is achieved by drinking plenty of water (at least 2.5-3.0 l) of mineral water (without gas), fortified (with lemon juice) or regular drinking.
If available, you can use Rehydron. Coffee / tea, kefir, milk and other types of alcohol (for example, beer) are not suitable for these purposes. Also, to cleanse the body of a toxic agent, you can use drugs (sorbents) - Polysorb, Activated carbon, Sorbex, Lactofiltrum, Smecta, Almagel, Enterosgel and other drugs that effectively bind a toxic agent in the body.It should be borne in mind that in the case of using sorbents, other drugs can be used no earlier than 2 hours later.
Since alcohol does not have specific antidotes, drug therapy at home is reduced to vitamin therapy, which allows the poisoned person to quickly recover after alcohol. Vitamin therapy is used in the form of a restorative cocktail based on water, which includes: vitamin C, vitamins B1, B6, B12, nicotinic acid, vitamins D and E.
Since the toxic effects of alcohol can be accompanied by various symptoms, symptomatic treatment of alcohol intoxication can be carried out at home. So with a headache, you can take Aspirin (in the absence of contraindications), which binds and neutralizes acetaldehyde or Nurofen, Ibuprofen. Accept Paracetamol in such cases is not recommended due to toxic effects on the liver.
Recovery from alcohol intoxication at home will help Glycine (reduces the toxic effects of alcohol and improves central nervous system function) and succinic acid. All drugs for the removal of alcohol intoxication at home are freely available in the pharmacy network.
With insufficient effectiveness, the patient may be given a dropper for alcohol intoxication at home, which is usually done by a paramedic from a specialized care team.
What is dripping? As a rule, the composition of the dropper varies depending on the general condition of the patient and the specific symptoms. It is not recommended to carry out the treatment of alcohol poisoning on their own when symptoms like high blood pressure or kidneys are sick, if you feel sick after alcohol for 2-3 days and there is frequent severe vomiting of bile, as well as in cases of ineffectiveness of the measures taken (poisoned poorly several days) since harm the body.
So, often, with alcohol poisoning, complaints about heartache, and others can give him Corvalol or Valocardin, which is strictly unacceptable due to the combination phenobarbital and alcohol and can lead to fatal consequences. It should be understood that only the doctor of the appropriate profile can restore the central nervous system function (restore the brain) or know how to treat kidneys after alcohol, so you should contact a medical institution.
Treatment of moderate to severe alcohol intoxication in a hospital setting also begins with gastric lavage / laxatives for bowel cleansing. In coma, gastric lavage is performed after tracheal intubation and insertion of the probe. For washing, water is used in an amount of 5-8 l with the addition of a small amount of potassium permanganate. Then, 500 ml of glucose solution and 200 ml of solution are introduced through a gastric tube sodium bicarbonate. A dropper with an isotonic solution is prescribed Sodium chloride and a solution of 5% Glucose 1000-1500 ml volume). In order to force diuresis, diuretics are introduced (Lasix, Furosemide).
As "sobering" funds can be used: Corazole, Caffeine, Etimizole, Bemegrid, Phenamine, Cordiamine, A nicotinic acid, Carbon dioxide, Pyridoxine, Apomorphine, oxygen, the sobering effect of which is due to the antagonistic pharmacological action with respect to ethanol.
For the relief of moderate / severe intoxication, it is recommended that, under the control of the pulse and blood pressure, an intravenous mixture containing detoxification, analeptic and symptomatic agents (for example, analeptic mixture No. 1: solution Bemegrid, Cordiamine, Caffeine, Corazole and 40% glucose / isotonic sodium chloride solution). The effect of this pharmacological complex begins to manifest itself after 15 minutes: relaxation and sleep ensue, and patients awaken in a sober state. If necessary, quickly recover after alcohol amid instability of the effect of injection of mixture No. 1, it is advisable to re-introduce Caffeine, Cordiamine with addition Cytone.
To accelerate the metabolism of alcohol, a dropper containing a multicomponent composition is prescribed. For example: a solution of 20% glucose (500-1500 ml), Insulin (20 units), vitamin C (5-10 ml), solution Pyridoxine (5 ml) A nicotinic acid (3-5 ml), solution Thiamine (5-10 ml). To stop psychomotor agitation / lethargy, restore coordination (speech, gait, shaking hands), a drug with pronounced vitamin activity can be used - Panthenol (Panthevitol). And in cases of severe arousal and the presence of a convulsive syndrome - Relanium, Fenazepam, Seduxen or solution Sodium Oxybutyrate.
To carry out dehydration-detoxification therapy, especially when alcohol intoxication after prolonged binge is prescribed dropwise intravenous injection of a solution Haemodesis (400 ml) Saline (400 ml) with the addition of 1 ml of solution Diphenhydramine (1%) and 1 ml of solution Corglucon. As a detoxification agent, you can prescribe Reamberin, which effectively activates the enzymatic processes of the Krebs cycle, normalizes the gas composition of the blood and the acid-base balance, promotes the utilization of glucose / fatty acids, and also has a moderate diuretic effect.
Alternatively, after prolonged binge, a solution Unitiola intramuscularly or intravenously Sodium Thiosulfate, Solcoserylimproving the process of oxygen absorption. In most cases, a dropper with alcohol intoxication allows you to get a quick effect.
In case of moderate and severe poisoning, drugs for symptomatic therapy are widely used. So, with a significant decrease in blood pressure, plasma-replacing solutions are administered - Reopoliglyukin, Polyglukin, intravenously / drip (400-1000 ml / day), Hemodez with 1 ml of solution Corglucon. In case of respiratory failure, analeptics are prescribed: Cytone, Lobelin, Bemegrid. To prevent edema (lungs, brain), a solution is prescribed Furosemide, Lasix. These therapeutic agents allow you to recover quite quickly after alcohol intoxication. In cases of acute poisoning with developed alcohol withdrawal symptoms after relief of poisoning, further treatment should be carried out in a narcological clinic. The figure below shows the algorithm for stopping alcohol intoxication.
- Activated carbon.
- A nicotinic acid.
- Magnesium sulfate.
- Sodium Thiosulfate.
- Thiamine bromide.
- Pyridoxine hydrochloride.
- Vitamin C.
- Acetylsalicylic acid.
- Sodium chloride.
- Sodium Oxybutyrate.
Procedures and operations
Physiotherapy (acupuncture, electrosleep, massage).
Alcohol use during pregnancy
Despite the well-known negative effects of alcohol on the fetus and the unborn baby, nevertheless, psychological attitudes regarding the possibility of drinking alcohol during pregnancy vary significantly. So, only 69% of women believe that strong alcoholic beverages are harmful to the fetus and it is necessary to completely refrain from drinking alcohol during pregnancy, 29% allow alcohol in small doses during this period without abuse, and another 24% of respondents believe that drinking red wine / beer is not only acceptable during pregnancy, but also beneficial. At the same time, 78% of women of childbearing age do not have any knowledge about the fetal alcohol syndrome, the causes and consequences for the fetus / child.
It should be emphasized once again that the use of alcohol by women during pregnancy leads to significant negative consequences for the health of the child. The diverse spectrum of teratogenic effects of alcohol is due to the rapid penetration of ethanol through the blood-brain barrier and placenta, i.e., the fetus, in fact, is exposed to the same level of alcohol as the woman's body.
An aggravating factor is the prolonged unchanged ethanol circulation in the blood / tissues of the fetus and the newborn, since its destruction in the liver does not occur, which is due to insufficiency / absence of the enzyme alcohol dehydrogenase, since its production in the fetus begins only in the second half of pregnancy. In addition, embryonic tissues are not yet able to metabolize alcohol. Thus, a "reservoir" for alcohol is created in the tissues of the fetus and amniotic fluid, which determines the long-term adverse effect on it, causing the development of alcohol tolerance and the formation of alcohol dependence. The embryotoxic effects of ethanol are due to a negative effect on the neurochemical / neuroendocrine processes and protein biosynthesis in the brain.
The critical period for the teratogenic effect of ethanol is the period of alcohol consumption: the use of drinks containing ethanol on the 15-25th day of pregnancy causes a delay in the migration of neurons from the germ layer, impaired neuronal proliferation, general structural disorganization of the central nervous system, and a cytotoxic effect, which leads to the risk of fetal death and formation birth defects. Alcohol intake in the 2nd trimester of pregnancy adversely affects the development of brain structures, the musculoskeletal system, and in the 3rd trimester it affects the growth and development of the skeleton and muscle tissue of the fetus. At the same time, the intake of ethanol-containing drinks significantly increases the frequency of spontaneous abortions; early / late toxicosis; premature discharge of amniotic fluid; weakness of labor.
It is proved that when drinking pregnant alcohol, the child may not have all the symptoms of fetal alcohol syndrome (FAS), the prevalence of which is from 2-7 per 1000 live births, but suffer from violations of the fetal alcohol spectrum, in the form of various deviations of neurodevelopment.
Fetal alcohol syndrome (FAS) includes the abnormal development of the child in several areas:
- Disorders of the brain and disorders of the central nervous system (malformations of the brain, mental retardation, delayed speech development, impaired behavior, decreased intelligence, learning disabilities, hyperactivity, attention deficit, epileptic seizures).
- Postnatal weight / height deficiency.
- The formation of specific facial anomalies (Figure below).
Therefore, all women who drank alcohol during pregnancy should be in the group at high risk of developing pathology during childbirth.
There is no special diet after acute alcohol poisoning, but there are a number of requirements for the diet in this period, compliance with which will accelerate detoxification of the body and restore the functions of organs and systems. The main principle - nutrition should be as gentle as possible and not overload the body.
- Drink plenty of fluids (at least 2.5 L / day) to speed up the elimination and processing of alcohol and its metabolites. If there is no appetite on the first day after poisoning, this day can be made completely unloading with the use of a large amount of liquid. In addition to purified water, you can use water with the addition of lemon juice / honey, mineral alkaline still water; weak slightly sweetened green tea; a decoction of rose hips, black currants; dried fruits compote; fruit-berry-vegetable fruit drinks; dairy products; cucumber / cabbage pickle (without vinegar); freshly squeezed juices from citrus fruits, tomato juice.
- Eat small meals, fractionally. Food should be at room temperature.
- Vegetable and chicken broths, boiled / baked vegetables, chicken meat are extremely useful.
- Food should contain a reduced amount of fat with the exception of sausages, canned foods, fried, salted, pickled and smoked products, flour products, hot spices, spicy seasonings, vinegar and fast food, which cause irritation of the gastrointestinal mucosa and increased stress on the liver, pancreas, kidneys.
- To restore intestinal microflora, it is recommended to include dairy products with bifidobacteria (natural yogurts, kefir, yogurt).
Prevention of acute alcohol poisoning includes the following measures:
- Know and control your individual dose of alcohol. If you feel that you have drunk more than the norm, try to induce vomiting immediately.
- Correctly choose a drink based on its quality (do not drink low-quality drinks and alcohol substitutes).
- Do not drink alcohol on an empty stomach. Have a good snack. Drink slowly.
- Do not drink alcohol with carbonated drinks.
- Do not lower the strength of drinks or mix different types of alcohol.
- Do not smoke while drinking alcohol and periodically ventilate the room.
- With frequent abuse and the appearance of craving for alcohol, you must consult a doctor psychiatrist-narcologist for treatment.
Consequences and Complications
Complications of acute alcohol poisoning can be various heart rhythm disturbances, acute coronary insufficiencyacute cerebrovascular accidents, acute hepatitis, pancreatitisrespiratory and renal failure. The cause of sudden death when taking high doses of ethanol is most often ventricular fibrillation, electrical myocardial instability.
In the vast majority of cases, with a mild / moderate degree of ethanol poisoning, the prognosis is favorable. Residual intoxication symptoms disappear within 1-2 days. With severe poisoning - with the development of alcoholic coma and acute emergency conditions (acute respiratory, cardiovascular, hepatic and renal failure), the prognosis worsens significantly.
List of sources
- Uvarov I.A., Pozdeev A.R., Lekomtsev V.T. Mental and behavioral disorders associated with alcohol use. - M., 1996.
- Dukhanina I.V., Moskvichev V.G., Vertkin A. L. Classification, terminology, examination of disability, organizational aspects of medical care in emergency conditions associated with the use of alcohol // Medical care. 2006. No. 3. S. 3-5.
- Bonitenko Yu.Yu., Livanov G.A., Bonitenko E.Yu., Kalmanson M.L., Vasiliev S.A. Acute alcohol intoxication (pathogenesis, clinic, diagnosis, treatment). - St. Petersburg: IIC "Baltika", 2003.
- Narcology: national leadership / under. ed. N.N. Ivantsa, I.P. Anokhina, M.A. Vinnikova, -M.: GEOTAR-Media, 2008 -720 S.
- Acute and chronic alcohol intoxication / Yu.I. Pigolkin et al. - M .: MIA, 2003 .-- 279 p.