1. Ansam Jalal Aram M.Sc. Pharmacology and Toxicology Hawler medical Univercity /college of pharmacy

2. Alcohol

3. Outline of the lecture:
What are Alcohols
Famous examples
What is Ethanol
Pathophysiology
Mechanism of toxicity
Sources
Health problems related to ethanol toxicity
Stages of ethanol toxicity
Treatment

4. Alcohol
Are organic compounds that composed of the hydroxyl functional group (–OH) which bounds to a carbon atom
 e.g., methyl alcohol, ethyl alcohol.
 Propyl alcohol may be n-propyl alcohol or isopropyl alcohol.

5. Ethanol toxicity Ethanol is 2 carbon –chain alcohol
The leading cause of morbidity across cultures
Is the most common psychoactive drug used by children , adolescents and adults

6. Pathophysiology
Ethanol is readily and rapidly absorbed and distributed through the body
the primary route of absorption is oral, inhalation and even percutaneously
PPC occur after min after ingestion
Co-ingestion with food will affect the absorption
It metabolized in liver by ADH to acetaldehyde then it further break down to acetate by aldehyde dehydrogenase

7. Mechanism of toxicity
It binds directly to Gamma –aminobutyric acid (GABA)receptor in the CNS and cause sedative effects similar to those of benzodiazipines
It also block the N- methyl-D- aspartate (NMDA) and glutamate receptors
It has direct effect on cardiac muscle , thyroid and liver.

8. Sources
Alcohol drink .
Over the counter medication (cough medication or mouth washes).
Alcohol containing substances eg: perfume , cleaning fluids.

11. Acute ethanol toxicity can cause :
CNS depression
Mild vasodilation can cause decrease in blood pressure
Flushed skin
Urticaria
Inhibition of spermatogenesis
Hypothermia
Tachycardia
Myocardial depression

14. Variable papillary response
Respiratory depression
Decrease sensitivity to airway foreign body
Diuresis
Hypoglycemia > 50 mg/dl

16. High dose of ethanol can cause
Ataxia, slurred speech
Acute pancreatitis
Liver cirrosis
Sever myocardial depression
Hypotension
Atrial fibrillation
Lactic acidosis
CHF
Sudden death

20. Treatment
Hypoglycemia and respiratory depression are the most 2 immediate life threatening conditions
Access the airways and secure it with endotracheal tube if the patient is not maintaining good ventilation
Mechanical ventilation
Replace fluid by IV
Ensure normal body temperature

21. Correct hypoglycemia
2-3ml /kg of 25% dextrose solution
And electrolyte replacement
If acute after 1 hr
Nasogastric tube and evacuating the stomach contents
If chronic give thiamine 100mg IV or IM

22. GABA antagonist eg: naloxone
Diuretic is not helpful
Charcoal is not recommended
Fructose infusion but with monitoring
Dialysis but with monitoring

23. Summary
Ethanol Is the most common psychoactive drug used by children , adolescents and adults
It binds to (GABA)receptor and cause sedation
It also block (NMDA)glutamate receptor
It has direct effect on cardiac muscle , thyroid and liver.
There are six stages of Ethanol intoxication.
Hypoglycemia and respiratory depression are the most 2 life threatening conditions

24. References
Poisoning and Drug Overdose, Seventh Edition (Poisoning & Drug Overdose) 7th Edition
Goldfrank's Toxicologic Emergencies, Tenth Edition 10th Edition

25. Seitz, Mikko Salaspuro, Markku Savolainen, Paul Haber, Hiromasa Ishii, Rolf Teschke, Hans Moshage, and Charles S. Lieber, From Alcohol Toxicity to Treatment Helmut K. (2005). Alcohol Clin Exp Res, 29, 7: 1341–1350.
Wilson E, Waring WS. (2007). Severe hypotension and hypothermia caused by acute ethanol toxicity. Emerg Med J. Feb;24(2):e7
A.W. Jones.( 2008 ).Biochemical and physiological research on the disposition and fate of ethanol in the body. In Medicolegal Aspects of Alcohol, J. Garriott, Ed. Lawyers & Judges Publishing, Tucson, AZ,, pp 47–
C.S. Lieber. (2005).Metabolism of alcohol. Clin. Liver Dis. 9: 1–35
Alan Wayne Jones.(2011). Fatality from Drinking Denatured Alcohol and Hypothermia. Journal of Analytical Toxicology, 35.

26. Questions?