Second Nature Care Blog

Healthy New Year 2018 - Alcohol Poisoning - Do you know the Signs?

[fa icon="calendar'] Dec 28, 2017 9:19:56 PM / by Dr. Isadora Guggenheim

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Happy New Year from Second Nature Naturopathic Care.  Make this your best and healthiest year ever with a colonic, personalized nutrition consult, ozone treatment, prolozone therapy, vitamin push, medical massage, environmental consult or a specialized lab to confirm what you've been wondering about all year. I am grateful to each and every one of my patients who continue to guide the work ahead.  

As we close out 2016 and look forward to good things in 2017 be mindful of how much alcohol you drink at year-end celebrations.  

It is estimated that more than 8 million Americans are alcohol dependent with 15% of the population at higher risk.  I think the actual numbers are probably higher.  A recent meta-analysis of the literature pointed out some interesting findings.

Regular low-dose drinking may provide protection from ishcemic heart disease.  Low-dose alcohol increases high-density lipoproteins, inhibits platelet activation, reduces fibrinogen levels and has an anti-inflammatory effect.  Moderate drinking has been linked to a reduced risk of Type II diabetes due to enhanced insulin sensitivity, metabolite production of acetaldehyde and acetate by oxidation and increased high-density lipoproteins.  Heavy drinking is associated with cardiotoxicity because of negative effects on blood pressure, increased fibrinolytic factors (thickened blood) and cardiacventricular arrhythmias. Alcohol is a carcinogen. Cancers of the oral cavity, pharynx, larynx, esophagus, liver, colorectum and female breast are related to alcohol consumption.  Increased drinking is associated with higher risk.  It's worse when individuals have genetic defects or polymorphisms that impair enzyme pathways responsible for alcohol metabolism.  

Here is a quick quiz to see if you understand the effects of alcohol and if you can recognize alcohol poisoning. The original quiz was posted on Medscape  Michael D. Levine. Quiz: Do You Know the Signs of and Best Treatment for Alcohol Poisoning? Medscape. Dec 19, 2014.

How long after ingestion does ethanol alcohol reach its peak concentration? Circle your answer.  

  • 10-15 minutes
  • 15-20 minutes
  • 20-60 minutes
  • More than an hour

Answer:

Ethanol is rapidly absorbed across both the gastric mucosa and the small intestine, reaching a peak concentration 20-60 minutes after ingestion. Once absorbed, it is converted to acetaldehyde. This conversion involves three discrete enzymes: the microsomal cytochrome P450 isoenzyme CYP2E1, the cytosol-based enzyme alcohol dehydrogenase (ADH), and the peroxisome catalase system. Acetaldehyde is then converted to acetate, which is converted to acetyl Co A and ultimately carbon dioxide and water.

At which of the following levels of ethanol alcohol consumption does cerebellar dysfunction typically begin?

  • 25-50 mg/dL
  • 50-100 mg/dL
  • 100-250 mg/dL
  • More than 250 mg/dL
Answer:
 
As a general rule, levels less than 25 mg/dL are associated with a sense of warmth and well-being. Euphoria and decreased judgment occur at levels between 25 and 50 mg/dL. Incoordination, decreased reaction time/reflexes, and ataxia occur at levels of 50-100 mg/dL. Cerebellar dysfunction (eg, ataxia, nystagmus, slurred speech at levels of 100-250 mg/dL. Coma can occur at levels greater than 250 mg/dL, whereas respiratory depression, loss of protective reflexes, and death occur at levels greater than 400 mg/dL.

Which of the following is the most important laboratory test in a patient who appears to be intoxicated with ethanol alcohol?

  • Serum creatinine
  • Salicylate concentration
  • Osmolar gap
  • Serum glucose
Answer:
 
The single most important laboratory test in a patient who appears intoxicated with ethanol is a serum glucose level. Hypoxia, head injury, seizures, and other metabolic disturbances must be excluded by either history or physical examination or sought with the appropriate tests. The routine use of a serum blood alcohol level is controversial, largely because it is unlikely to affect management in a patient who is awake and alert. Many clinicians consider the patient safe for discharge once that person is clinically (not numerically) no longer intoxicated.

Which of the following treatment modalities could potentially be used for severe, life-threatening ethanol toxicity?

  • Fomepizole
  • Magnesium
  • Sodium bicarbonate
  • Hemodialysis

Answer:

Treatment of ethanol and isopropanol intoxication is largely supportive. Because of the hemorrhagic gastritis that can follow isopropanol ingestion, H2 blockade or proton pump inhibitors may be helpful. Hemodialysis, while effective, is rarely indicated and should only be used in the setting of profound hemodynamic compromise. The primary antidotal treatment of methanol or ethylene glycol poisoning involves blocking alcohol dehydrogenase. This enzyme can be inhibited by either ethanol or fomepizole.

Which of the following is a recognized complication of ethanol alcohol poisoning?

  • Renal failure
  • Acidosis
  • Hemorrhagic gastritis
  • "Holiday heart"
Answer:
 
Patients with acute intoxication may exhibit "holiday heart," in which dysrhythmias, especially atrial fibrillation, occur following a heavy drinking episode. Ethanol lowers the threshold for developing atrial fibrillation.

How did you do?  Did you pass the test?  

My happy and healthy tips to ring in a safer 2017 New Year

  1. Make your decision whether you will be drinking or not for the night early in the day. If you decide to drink capitate the number of drinks you'll have and determine a designated driver or a safe way to get home.
  2. Either way stay well-hydrated all day and eat a full meal before the party.
  3. Before you go to the party take an extra B-vitamin with MTHFR in it, 1500 mg. of Vitamin C and 1.2 grams of NAC.  Two capsules of liver support herbs (milk thistle, chelidonium, artichoke, dandelion, ox bile and L-methionine) are great holiday herbs and amino acids that protect your liver from alcohol's negative effects.  
  4. Before, during or after drinking take some high quality Xymogen enzymes like: XymoZyme or HistDao.  
  5. Have fun, keep your behavior in check and go home at a reasonable hour.  Wake up refreshed in a New Year
 Order Xymogen
 

Topics: Addiction

Isadora Guggenheim, ND, RN, MS, CNS LMT, owner of Second Nature Naturopathic Care, LLC
For all appointments: Tel: 845 358-8385 Fax: 845 358-2963 drguggenheim@msn.com