Toxic dose of alcohol. Acute alcohol intoxication. What is alcohol

The history of making intoxicating drinks goes back thousands of years.

But grape wine was especially widespread in antiquity. Wine was read as a gift from the gods. The patron saint of winemaking in Greece is Dionysus, in Latin form - Bacchus.

Harmful impurities are also contained in commercial wine. Their pathophysiological influence on the body is due not only to the strength (percentage of alcohol), but also to numerous harmful impurities. One of the companions of wine is methyl alcohol. Methyl alcohol is a neurovascular poison, and its dose of 100g is lethal to humans. Even small amounts of this alcohol affect the optic nerve and retina. Sulfur dioxide is used to process wines. It destroys B vitamins. Numerous acids (tartaric, acetic, sulphurous, and others) found in wines adversely affect the digestive organs, especially the liver and pancreas.

The alcohol content ranges from 2.8% to 12% alcohol. But beer contains various substances that increase the body's sensitivity to alcohol, enhancing its absorption. Therefore, mixing beer and vodka, as a rule, leads to rapid and severe intoxication. Wormwood, hops and other additives are added to beer to give different taste and aromatic shades. These herbs have a toxic effect on the liver and kidneys, pancreas.

Pure alcohol began to be obtained in the 6th-7th centuries by the Arabs and they called it "al cogl", which means "intoxicating". The first bottle of vodka was made by the Arab Rabez in 860. What is alcohol?

This is ethyl alcohol - a highly flammable colorless liquid with a characteristic odor, related to highly effective drugs. It causes first excitation and then paralysis of the nervous system. When alcohol enters the bloodstream, it begins to interact with erythrocytes (red blood cells), which carry oxygen from the lungs, and carbon dioxide in the opposite direction. Alcohol "sticks together" erythrocytes, larger balls are formed. The size of the "balls" increases with the amount of alcohol consumed. Such a large formation is not able to move through the capillaries, a thrombus is formed (or a rupture of the walls of the capillaries - a hemorrhage), “numbness” occurs, and then the death of parts of the body and brain. This is perceived by a person as a state of intoxication. Sleep in this state is a loss of consciousness, an alcoholic coma.

There are approximately 17 billion cells in the human brain, which leaves 2% of body weight, it absorbs up to 30% of the drunk ethanol!

1 gram of ethanol penetrated into the brain kills about 200 neurons! The action of ethyl alcohol in the brain lasts 65 days!

Recovery of reversible consequences from drinking a bottle of beer (500 g), a glass of champagne (200 g), vodka (100 g) can occur with absolute sobriety within 2-3 years!

It turns out. That the hangover syndrome is a process associated with the removal from the brain of neurons that died due to lack of blood supply. The body rejects dead cells. This is associated with morning headaches. Alcohol damages the liver. Because it neutralizes 95% of alcohol. As a result, hepatitis, cirrhosis, and then liver necrosis occurs, leading to the death of the body. Alcohol is detrimental to the digestive system. A group of persons with a healthy stomach was introduced a miniature device through which it was possible to see the walls of this organ. The subjects drank 200 g of whiskey on an empty stomach. A few minutes later, redness of the mucous membrane and swelling were observed, after an hour - numerous bleeding ulcers, and after a few hours, purulent stripes appeared on the gastric mucosa. If a person drinks regularly, then there is a stomach ulcer, cancer.

Alcohol contributes to the degeneration of the gene pool. Ethanol is able to destroy genes, which leads to the birth of sick children. The death of one or three cells at the beginning of the development of the embryo can result in further underdevelopment, or even the absence of any organ. Often the children of drinking mothers and fathers are born with an alcoholic syndrome: strabismus, congenital deafness, heart defects, with a small head, reduced brain, mentally retarded, mentally ill, with severe deformities (dropsy of the brain or its absence, cleft palate, cerebral hernia, spina bifida , incomplete number of fingers, their fusion, the absence of a part of the skeleton, etc.) In adults, there is a decrease in mental abilities, weakening of memory, dementia, personality degradation.

In mental workers, after taking alcohol, their thought processes are fundamentally worse, the speed and accuracy of calculations are reduced, as they say, the work falls out of hand.

On average in the country per year per capita (including the elderly and infants) there are 15-16 liters of "pure alcohol". By the standards of the World Health Organization, every liter drunk in excess of eight liters shortens the average life expectancy of men by a year, women by 4 months. It is alarming that over 96% of people who drink drink before the age of 15, and about a third before the age of 10.

A painful addiction to alcohol can occur in any kind of animal if they are taught to drink wine or vodka.

Typical objects of observation of the effect of alcohol on a living organism are laboratory rats and mice. By adding alcohol to water, animals become alcoholics. In the absence of an alcoholic drink, animals behave like real alcoholics: they rush around the cage, bite each other viciously. Some, after a period of excitement, limply stretch on the floor of the cell - exactly the same as a drunkard in a state of hangover. Alcoholism of animals is accompanied by changes in their sexual sphere. They have reduced sperm production, which is dominated by incapacitated spermatozoa.

Small doses of alcohol cause underdevelopment of germ cells in males and females. In young "non-drinking" animals during the experiment, the seminiferous tubules increased by 70%, while in alcoholic rats - only by 6%!

With the introduction of alcohol into the stomach, a third of the fetuses are dead, and the survivors are much smaller in weight than in the control group. Similar processes can occur in the human body.

The most common reason for drinking alcohol among schoolchildren is: shyness towards the opposite sex, the desire to seem like an adult, to be like everyone else.

Coffee is obtained from the beans of the coffee tree. The active ingredient is caffeine. The lethal dose of pure caffeine is 10-20 grams orally. The toxic effect is associated with a sharp excitation of the central nervous system. When drinking strong coffee, a person's heart rate increases, pupils dilate, blood pressure rises, and a feeling of cheerfulness appears. There is an addiction to coffee consumption. caffeine is a drug. Therefore, people who have not received their daily norm of cups of coffee are irritated, they are haunted by weakness, headache, muscle pain.

From the literature review it follows that all the selected substances are very toxic to the body, as they contain a lot of poisonous, toxic substances. They have a stronger effect on a young, growing organism and are very dangerous during the prenatal development of humans and animals.

The impact of alcohol-containing substances on the cardiovascular and respiratory systems of amphibians

Average data on the impact of alcohol-containing substances on the body of an amphibian.

The result of the impact of alcohol and nicotine-containing substances on the body of an amphibian.

Alcoholic poisoning in Russia occupies a leading position among household poisonings. Alcohol accounts for more than 60% of all fatal poisonings. Most deaths (95%-98%) occur before medical care is provided. How to recognize alcohol poisoning, and what measures should be taken to avoid tragic consequences?

ethanol(ethyl or wine alcohol) - a chemical substance of moderate toxic activity, colorless, volatile, flammable. Miscible with water in any quantity, easily soluble in fats. It spreads rapidly throughout the body, easily penetrates biological membranes.

Interesting facts about alcohol

• Ethanol is a natural substance for our body. Normally, ethanol is formed during the metabolism of various substances, as well as during fermentation in the intestines. However, its concentration is minimal (0.003 g/l) and does not pose a threat to health.
• In the stomach, 20% of the ethanol taken is absorbed, the remaining 80% is absorbed in the small intestine.
• On an empty stomach, half of the dose of ethanol is absorbed into the blood in 15 minutes. On average, after 1 hour 30 minutes, the maximum concentration of ethanol is observed in the blood.
• Strong (more than 30 degrees) and carbonated alcoholic drinks are most quickly absorbed into the blood.
• The absorption rate of ethanol increases with repeated doses and with diseases of the stomach (gastritis, peptic ulcer).
• Food in the stomach reduces the rate of absorption of ethanol. In this regard, the consumption of alcoholic beverages on a full stomach is one of the preventions of alcohol poisoning. As a rule, simultaneous consumption of 0.5 liters of vodka by adults will cause alcohol poisoning. However, the same amount of vodka drunk during the day will only maintain a state of intoxication.
• Having a good ability to dissolve in fats, ethanol easily penetrates the body through the skin. Fatal cases of poisoning in children are described when alcohol extracts of plants are used for compresses and wraps.
• Ethanol easily crosses the placental barrier and is distributed throughout the fetal body. The toxic effect of alcohol on the fetus is much stronger than on the mother's body.
• The average lethal dose of alcohol is 300 ml of 96% ethanol in a single dose.
• Ethanol is excreted from the body in three main ways: 1) 2-4% of ethanol is excreted through the kidneys, 2) through the lungs 3-7%, 3) up to 90-95% of ethanol is processed in the liver, where it is eventually broken down to carbon dioxide and water.

What are the symptoms and signs of alcohol poisoning?

The first signs of alcohol poisoning

The first symptoms of alcohol poisoning and the mechanisms of their occurrence

Severe alcohol poisoning

What determines the severity of alcohol poisoning?

Poisoning by alcohol substitutes

Alcohol surrogates

• Colognes, lotions, various medicinal tinctures (hawthorn, motherwort, etc.)
• Technical fluids (brake fluid, antifreeze, windshield wipers, etc.)
• Methyl alcohol, ethylene glycol are the most dangerous surrogates.

Methyl alcohol poisoning

Ethylene glycol poisoning

What to do in case of alcohol poisoning?

First aid for alcohol poisoning

What to do?		How?	What for?
Ensure airway patency		Take out the tongue, when it retracts Clean your mouth If possible, use a rubber bulb to remove the contents of the oral cavity (mucus, saliva, vomit residues) In case of excessive salivation, inject 1.0-0.1% atropine intravenously	Ensure an adequate supply of oxygen. Prevent upper airway blockage.
Correctly lay the patient, fix the tongue		The patient should be placed on the side Press the tongue to prevent it from sinking (you can press the tongue with a spoon or finger, it is better to wrap a napkin or handkerchief around your finger so that the tongue does not slip out)	To prevent vomit from entering the respiratory tract. Tongue drop is a common cause of death in unconsciousness.
In case of cardiac and respiratory arrest, perform chest compressions and artificial respiration		2 breaths and 30 chest compressions constitute one resuscitation cycle. Repeat until breathing and heartbeat appear or until the ambulance arrives. It is better to do it in pairs, alternately changing so that the clicks are effective.	The method is able to restart cardiac and respiratory activity or support vital organs until specialized help arrives.
Bring to consciousness if the patient is unconscious		Bring a cotton swab with ammonia up to 1 cm from the nose	Ammonia has an awakening effect, stimulates breathing.
induce vomiting (if the patient is conscious!)		Drink 1-3 cups of salt solution (1 tsp to 1 cup of warm water) Take an emetic (ipecac root) in a glass of water 2 tsp.	The procedure is effective first hours after drinking alcohol. Since the complete absorption of ethanol from the digestive tract into the blood takes 40-90 minutes (on an empty stomach). Vomiting is contraindicated in the unconscious state and in the case of a serious condition of the patient. Since there is a high risk of vomit entering the respiratory tract, which can lead to serious consequences, even death.
Perform gastric lavage		If possible, do gastric lavage through a tube Drink as much water as possible, then press on the root of the tongue to induce vomiting. Repeat until clean vomit. (Water can be salted for 1 liter 1 tsp)	The method is effective only for the first hours of poisoning. Within 1-2 hours, most of the ethanol is absorbed into the blood. After 2-3 hours from the moment of alcohol intake, gastric lavage is ineffective.
Warm the sick		Place in a warm room, wrap in a blanket, dress, etc.	Alcohol causes peripheral vasodilation, which is accompanied by a strong loss of heat.
To accept adsorbent(a substance capable of absorbing various types of toxins) activated charcoal, white charcoal, polysorb, entorosgel, etc.		White coal: 3-4 tablets, up to 3-4 times a day Enterosgel: 6 tablespoons, once. Polysorb: Adults 2-3 tablespoons, mixed with ¼-½ cup of water. Activated carbon: 1 gram per 10 kg of patient weight, 1 tab. \u003d 0.25 gr. On average, 30-40 tab. appointment. For greater efficiency, the tablets should be crushed into powder and diluted in 100-200 ml of water. The average daily dose is 20-30 gr., 80-120 tab.	Adsorbents are most effective for the first hours of poisoning. They bind and remove alcohol from the body, which did not have time to be absorbed into the blood.
Take substances that accelerate the neutralization and removal of ethanol from the body		Metadoxyl dose 300-600 mg (5-10 ml), intramuscularly; Or add 300-900 mg of metadoxil to 500 ml of saline or 5% glucose solution, inject intravenously over 90 minutes. Vitamins + Glucose Traditionally mixed in one syringe: 1) Vit. B1 (thiamine) 2ml-5%; 2) vit. B6 (pyridoxine) 3 ml-5%; 3) vit.C (ascorbic acid) 5-10ml-5%; 4)10-20 ml 40% glucose Enter intravenously. Bee honey 100-200 grams in 2-3 doses (honey contains a large amount of fructose)	Metadoxil is a drug created specifically for the treatment of alcohol intoxication. Increases the activity of enzymes responsible for the utilization of ethanol. Thus, it accelerates the processes of processing and removing ethanol. Restores liver cells. Improves the mental state of patients. Do not use in case of poisoning with surrogates (methanol, ethylene glycol), in this case their toxic effect will only increase. Vitamins, glucose, fructose, improve metabolic processes, accelerate the processes of neutralization and elimination of ethanol. Thiamine reduces the risk of alcoholic psychosis.
Restore water and mineral balance		Droppers: Sodium bicarbonate 4%-400 ml Hemodez 400 ml Quartosol, acesol 500 ml Drink: Pickle (cucumber, cabbage) Mineral water (0.5-1.5 l)	Solutions improve circulation through the vessels, restore the necessary water and mineral balance. Neutralize and remove toxins from the blood.
To accept Hepatoprotectors		Ademetionine (Heptral) 2-4 tablets a day for 2 weeks, 1 tablet = 400mg Essentiale 1-2 capsules 3 times a day, course from 3 to 6 months. 1 caps = 300 mg	Restore damaged liver cells, improve their function, accelerate the processes of ethanol neutralization.
In case of poisoning methyl alcohol or ethylene glycol drink ethyl alcohol		For the first time hours of poisoning to drink high-quality strong alcohol: 200 ml cognac, whiskey, vodka 40-50 ml of vodka 40 deg. every 3 hours 4-methylpyrazole, 10 mg per 1 kg of body weight, together with an aqueous solution of ethanol 200 ml orally, every 3-4 hours	Ethyl alcohol acts as an antidote, it stops the breakdown of methyl alcohol into toxic substances (formic acid and formaldehyde). 4-methylpyrazole (pyrozole, fomepisol) is the newest antidote for poisoning with methyl alcohol and ethylene glycol. The drug reduces the activity of the liver enzyme (alcohol dehydrogenase), thereby interrupting the formation of toxic substances from the above alcohols.

What can not be done with alcohol poisoning?

• Lay the patient on his back, there is a high risk that he will choke on vomit
• Give alcohol again, unless it's methanol or ethylene glycol poisoning
• Take a cold shower. With alcohol poisoning, the processes of thermoregulation are disturbed, the body already suffers from heat loss. Cold showers can only make matters worse.
• Force the victim to get up and walk. At the time of poisoning, all organs and systems work in extreme mode, and any additional stress can damage them.
• Do not leave the patient alone. For example: the victim can lose consciousness at any time, and suffocate if the tongue sinks.
• Do not induce vomiting, do not do gastric lavage if the patient is unconscious (at home). There is a high risk of gastric juice entering the respiratory tract and developing acute respiratory failure.

Complications of alcohol poisoning

• Acute toxic hepatitis
• Acute liver failure
• Alcoholic delirium ("delirious tremens"), delirium, hallucinations
• Syndrome Mendelssohn(Mendelssohn's syndrome is a serious condition in which acute respiratory failure develops due to the ingress of gastric juice into the respiratory tract). With alcohol poisoning, the syndrome often develops if vomit enters the respiratory tract.

Prevention of alcohol poisoning

• Don't drink alcohol on an empty stomach
• Do not drink alcohol in large doses
• Do not drink alcohol in case of diseases of the gastrointestinal tract, overwork, malnutrition
• Do not drink alcohol while taking medications (antidepressants, sleeping pills, painkillers, etc.)
• Eat a heavy meal before drinking
• Eating after drinking alcohol
• Try not to combine different alcoholic drinks
• Try to take alcoholic beverages in ascending degrees
• Do not drink low-quality alcoholic beverages
• The best prevention is NOT to drink at all!

Catad_tema Alcohol addiction - articles

The toxic effect of alcohol

The toxic effect of alcohol

ICD 10: T51

Year of approval (revision frequency): 2016 (review every 3 years)

ID: KR499

Professional associations:

• Association of Clinical Toxicologists

Approved

Interregional charitable public organization "Association of Clinical Toxicologists"

Agreed

Scientific Council of the Ministry of Health of the Russian Federation __ __________ 201_

alcohol

ethanol

propyl alcohol

isopropyl alcohol

amyl alcohol

butyl alcohol

alcohol, unspecified

chemical-toxicological diagnostics

pathological syndromes

accelerated detoxification

List of abbreviations

BP - blood pressure

ADH - alcohol dehydrogenase

ALAT - alanine transferase

ASAT - aspartate transferase

GGTP - gamma-glutamyl transpeptidase

GGTP - gamma-glutamyl transferase

HD - hemodialysis

HDF - hemodiafiltration

GLC - gas liquid chromatography

GIT - gastrointestinal tract

IVL - artificial lung ventilation

KOS - acid-base state

CT - computed tomography

CPK - creatine phosphokinase

LDH - lactate dehydrogenase

ICD10 - International Statistical Classification Classification of Diseases and Related Health Problems, Tenth Revision

MRI - magnetic resonance imaging

ARDS - acute respiratory distress syndrome

ICU - intensive care unit

PZh - gastric lavage

Ultrasound - ultrasonography

FBS - fibrobronchoscopy

FD - forced diuresis

CVP - central venous pressure

AP - alkaline phosphatase

EC - ethyl alcohol

EGDS - esophagogastroduodenoscopy

ECG - electrocardiography (cardiogram)

EEG - electroencephalography

EAPCCT – European Association of Poison Centers and Clinical Toxicologists

LD - lethal (lethal) dose

Rg - radiograph

Terms and Definitions

Alcohol- Chemically, alcohols include any monohydric alcohol in the series - methyl, ethyl, propyl, butyl, etc. In ICD 10, in the broad sense of the word, under the term "alcohol", appearing in the heading T.51 "Toxic effect of alcohol", various monohydric alcohols are meant - ethyl (ethanol), methyl (methanol), propyl (propanol), etc. In everyday life in Russia, official, specialized scientific literature, the media, the concept and, accordingly, the name "alcohol" is associated with ethyl alcohol (ES), which has a code in ICD 10 - T51.0 Thus, the term alcohol is essentially used as a synonym for alcoholic beverages.

Alcohol intoxication- a phrase that characterizes a health disorder caused by excessive consumption of alcoholic beverages. Historically, the term "alcohol intoxication" is used by medical specialists of various profiles, including toxicologists, psychiatrists-narcologists (mainly), forensic doctors. Currently, the concept of "alcohol intoxication" is present in the ICD10 under the code F10 - Mental and behavioral disorders caused by alcohol, including: F.10.0 "Acute intoxication" - as acute intoxication with alcoholism and alcohol intoxication. At the same time, it is customary to distinguish the following clinical forms: acute alcohol intoxication: simple alcohol intoxication; altered forms of alcohol intoxication; pathological intoxication; chronic alcoholism 1, 2, 3 stages; alcoholic psychoses (alcoholic delirium, acute alcoholic hallucinosis, acute alcoholic paranoid, etc.). "Chronic alcohol intoxication" characterizes a disease that has developed as a result of prolonged abuse of ES and is not accompanied by coma (with the exception of the terminal stage of multiple organ failure). For this disease, various behavioral and mental disorders are more characteristic. The substitution of the concepts of "alcohol intoxication", "acute alcohol intoxication" and "alcohol poisoning" often leads to incorrect diagnosis, hospitalization and therapy of the victim.

Alcoholic coma– a coma that has developed as a result of the use of ES mainly in the form of alcoholic beverages in a toxic / lethal dose with the appearance of a toxic / lethal concentration of ethanol in the blood.

Detoxification- the process of neutralization and removal of a toxic substance from the body that has come from outside. Detoxification, as a natural process of protecting the body from a toxicant, includes various mechanisms aimed at converting the poison into non-toxic compounds (metabolites), carried out mainly in the liver, removing the poison or its metabolites in various ways - through the kidneys, intestines, liver, lungs, skin. In the process of natural detoxification, metabolites can be formed that are more toxic than the toxicant that has entered the body (lethal synthesis), in addition, going through the process of metabolism in the liver, excreted through the kidneys, the toxicant and its toxic metabolites can lead to damage to these organs and the development of acute renal or liver failure.

Detox accelerated In order to more intensively remove the toxicant from the body, various methods of accelerated detoxification are used, such as forced diuresis (medicated increase in urination), cleansing of the gastrointestinal tract (gastric lavage, administration of laxatives, enterosorbents, intestinal lavage), extracorporeal methods of extrarenal cleansing of the body (hemodialysis and its modifications, hemosorption, peritoneal dialysis, plasmapheresis, etc.).

Disease- arising in connection with the influence of pathogenic factors, a violation of the body's activity, working capacity, ability to adapt to changing conditions of the external and internal environment with a simultaneous change in protective-compensatory and protective-adaptive reactions and mechanisms of the body.

Instrumental diagnostics- diagnostics using various devices, devices and tools for examining the patient.

Intoxication- Violation of vital functions caused by toxic substances penetrating the body from the outside or formed in it in violation of various biochemical processes and functions of the excretory organs and leading to the development of endotoxicosis Small Medical Encyclopedia. Intoxication is a broader pathological process, including not only and not so much exogenous, but perhaps more endogenous toxicosis.

Laboratory diagnostics- a set of methods aimed at analyzing the material under study using various specialized equipment.

Poisoning- a disease that develops as a result of external (exogenous) effects on the human or animal body of chemical compounds in quantities that cause violations of physiological functions and endanger life

Alcohol poisoning(or ethanol) - a coma, acutely developed as a result of the use of a toxic dose of ES. A state that is not accompanied by loss of consciousness after the use of ES is regarded as alcohol intoxication, which does not require emergency medical care, since a person comes out of the state of intoxication on his own.

Syndrome- a set of symptoms with common etiology and pathogenesis.

Somatogenic stage of poisoning- the period of the course of an acute chemical disease, which begins after the removal from the body or destruction of a toxic substance in the form of a trace lesion of the structure and functions of various organs and systems of the body, manifested, as a rule, by various somatic, neuropsychiatric complications, such as pneumonia, acute renal, liver failure, toxic polyneuropathy, anemia, psychoorganic syndrome, etc. At this stage of poisoning, specific (antidotal) therapy is not required, and detoxification can only be directed to the treatment of endotoxicosis.

State- changes in the body that occur due to the impact of pathogenic and (or) physiological factors and require medical care;

Alcohol surrogates- substitutes for alcoholic beverages used for the purpose of intoxication, which are substances from the group of monohydric, polyhydric alcohols, organic solvents, which have a narcotic effect on the central nervous system, similar to the effect of ethanol, but, as a rule, have a higher toxicity. They are used in everyday life and production for technical purposes and are not intended for ingestion. ICD10 does not contain the subheading "toxic effect of alcohol surrogates".

Toxigenic stage of poisoning- the period of the course of an acute chemical disease, starting from the moment a toxic substance enters the body in a concentration capable of causing a specific effect and continuing until the moment it is removed. It is characterized by the specificity of clinical manifestations, reflecting the chemical and toxicological properties of a toxic substance, its effects on target organs. The severity of this period of the disease is directly dependent on the dose of the poison taken, its concentration in the blood. The main therapeutic task in this period is to reduce its duration as early as possible by using various methods of accelerated detoxification, antidote, symptomatic therapy.

1. Brief information

1.1 Definition

Alcohols are an extensive and very diverse class of organic compounds: they are widely distributed in nature, are of great industrial importance and have exceptional chemical properties.

Aliphatic saturated alcohols with a long chain of up to 5 carbon atoms (methyl, ethyl, propyl, butyl and amyl) have the greatest toxicological significance.

The toxic effect of alcohol(according to the ICD10 wording) implies a health disorder caused by the ingestion of one or more representatives of this group and is interpreted as acute poisoning. At the same time, from the standpoint of clinical characteristics, the leading value, both in terms of the frequency of occurrence of this pathology and medical consequences, is poisoning with ES (ethanol) or a commonly used concept - alcohol poisoning, which, from the standpoint of toxicologists, is a disorder of consciousness (coma) caused by excessive simultaneous intake of ethanol. Poisoning with other alcohols of this group can manifest itself with various symptoms with preserved consciousness.

Given the higher toxicity and the specificity of clinical manifestations and complications, these recommendations do not consider the toxic effect (poisoning) of methanol (methyl alcohol), which is separated into separate clinical recommendations.

1.2 Etiology and pathogenesis

Alcohols included in the T51 group are characterized by limited volatility and, with relatively low toxicity, acute inhalation alcohol poisoning in clinical practice practically does not occur, with the exception of cases of inhalation use of some alcohols (isopropyl) and some technical formulations containing alcohols for the purpose of drug intoxication. The most common in clinical practice are acute oral poisoning with alcohols used for the purpose of intoxication.

Acute alcohol poisoning usually occurs when taking ethyl alcohol or various alcoholic beverages with an ethyl alcohol content of more than 12%. The lethal dose of 96% ethanol ranges from 4 to 12 g per 1 kg of body weight (approximately 700-1000 ml of vodka in the absence of tolerance). Alcoholic coma occurs when the concentration of ethanol in the blood is 3 g / l and above, death - at a concentration of 5-6 g / l and above. Poisoning, as a rule, is of the nature of household - accidental, with the aim of intoxication.

Poisoning with pure higher alcohols - propyl, butyl, amyl alcohols are much less common in toxicological practice than with ethyl alcohol, poisoning with their mixture with ethyl alcohol is more common. Lethal doses and concentrations: cases of fatal poisoning by ingestion are described - 0.1-0.4 liters of propyl alcohol or more. Death occurred in the period from 4-6 hours to 15 days, coma - when the content of propanol in the blood was about 150 mg%. However, fatal poisoning is also described when 40 ml of alcohol is ingested. The lethal dose (LD100) of isopropyl alcohol by mouth for adults is considered to be 240 ml, lethal concentration levels vary from 0.04 mg/l in children and 4.4 mg/l in adults. Routes of entry into the body - inhalation, oral, percutaneous, however, in clinical practice, poisoning as a result of oral intake of these alcohols predominates.

Fusel oil is a mixture of higher (C3 - C10) monohydric aliphatic alcohols, ethers and other compounds. Higher alcohols with up to 10 carbon atoms are soluble in water. From a toxicological point of view, the oral route is important. Despite the fact that fusel oils are present in a number of alcoholic legal drinks, individual representatives of monohydric alcohols, as independent chemicals, have the main clinical and toxicological significance.

Butyl alcohols (С4Н9ОН) - colorless liquids with a characteristic alcohol odor are used as solvents in the perfumery and pharmaceutical industries, in the production of synthetic rubber, for the manufacture of BSK brake fluid (containing up to 50% butanol), etc.

Amyl alcohols (С5Н11ОН) exist in the form of 8 isomers of amyl alcohol (primary, secondary, tertiary amyl and isoamyl alcohols, diethyl carbinol, sec-butyl carbinol, etc.), which are obtained during oil refining. The main practical value is normal amyl alcohol, the main component of fusel oil - an oily product of alcoholic fermentation. Butyl, amyl alcohols can cause damage by inhalation, skin contact, however, they pose the greatest danger when ingested when used for the purpose of intoxication, or mistakenly in "pure form" or as part of solvents or other technical fluids.

The generality of the physicochemical properties of alcohols ultimately determines the similarity of the toxicokinetics of these compounds. All representatives of this group, entering inside, are quickly absorbed into the blood from the stomach and upper sections of the small intestine, and are fairly evenly distributed in the body. The exception is alcohols containing 6 or more carbon atoms, which can accumulate in adipose tissue due to high lipophilicity.

ES is quickly absorbed into the blood from the gastrointestinal tract (up to 80% in the small intestine) and is fairly evenly distributed in organs and tissues, while two distinct phases are distinguished in the toxicokinetics of ethanol: resorption (absorption) and elimination (excretion).

In the resorption phase, the rate of saturation of organs and tissues with ethanol is much faster than its biotransformation and excretion, as a result of which an increase in its concentration in the blood is observed. After oral administration, the maximum concentration of ethanol in the blood is reached after 1-2 hours.

The elimination phase occurs after the absorption of more than 90% of alcohol. To determine the above phases of the distribution of ethanol, the ratio of the levels of its concentration in urine and blood is calculated. In the resorption phase, this is the average ratio<1, а в фазе элиминации - всегда >1.

Phase determination is of great diagnostic and forensic importance.

About 90% of ES is oxidized by the liver with the participation of the enzyme alcohol dehydrogenase to CO2 and H2O, the remaining 10% is excreted unchanged through the lungs and kidneys within 7–12 hours. The rate of ethanol metabolism in the human body is on average 90–120 mg/kg of body weight per hour, but this figure can vary significantly depending on individual characteristics.

Organs with intensive blood supply (brain, liver, kidneys) are saturated with ethanol for several minutes with the establishment of a dynamic equilibrium of the level of ethanol in the blood and tissues. Food masses in the stomach slow down the absorption of alcohol, and when taken on an empty stomach or with repeated doses, as well as in people with stomach diseases, the resorption rate is higher.

The excretion of alcohol from the body is carried out unchanged with urine and exhaled air, and in the urine it is determined much longer than in the blood. The excretion of ethanol does not depend on the pH value, while its acidic metabolites are better excreted by urine, which has an alkaline reaction.

The biotransformation of ethanol is carried out mainly in the liver with the formation of products that are excreted mainly by the kidneys.

Ethanol has a psychotropic effect due to narcotic effects on the central nervous system (CNS). In severe poisoning, a weakening of the excitation processes occurs, which is due to a change in the metabolism of the brain cell, a violation of the function of mediator systems, and a decrease in oxygen utilization. The severity of the narcotic effect of ethanol depends on its concentration in the blood, including the rate of its increase in the blood in the resorption phase, in which the narcotic effect of ethanol is higher than in the elimination phase at the same concentrations in the blood; the degree of development of the patient's tolerance to alcohol.

The leading place in the pathogenesis of acute alcohol poisoning, along with cerebral disorders, is occupied by respiratory disorders of various origins. The hypoxia formed as a result of these processes exacerbates cerebral disorders and homeostasis disorders (acid-base state, water-electrolyte balance, interstitial metabolism, etc.). This is facilitated by hypoglycemia, which often develops in chronic alcoholics against the background of acute alcohol intoxication.

At the heart of hemodynamic disorders in acute alcohol poisoning is a violation of vascular tone, relative, less often - absolute hypovolemia, impaired microcirculation as a result of acidosis, hypercoagulation and hypothermia.

In addition, it is possible to develop a non-specific cardiotoxic effect most often against the background of a previous pathology of the cardiovascular system (alcoholic cardiomyopathy, etc.)

In the somatogenic stage of poisoning, the main place is occupied by residual cerebral disorders, damage to internal organs, primarily the liver, kidneys, myocardium and pancreas, as well as infectious complications (mainly pneumonia), which leads to disruption of all vital functions. Cardiac arrhythmias are possible, including fatal ones, associated with developed alcoholic cardiomyopathy against the background of chronic alcohol intoxication.

Higher alcohols cause intoxication similar to alcohol. They are oxidized in the body with the participation of alcohol dehydrogenase, microsomal ethanol-oxidizing system and aldehyde dehydrogenase to the corresponding aldehydes and acids.

The acute toxicity of higher alcohols is 1.5 - 3 times higher than the toxicity of ethanol. In accordance with this, higher alcohols and fusel oils are classified as moderately toxic compounds.

Isopropyl (propyl) alcohol can enter the body orally, inhalation and precutaneous. The metabolite of isopropyl alcohol is acetone, which slowly oxidizes to CO2 and H2O. In total, 30-50% of the dose is metabolized. 82% of isopropyl alcohol is absorbed from the gastrointestinal tract in the first 20 minutes and almost ends after 2 hours.

In adults, the elimination half-life of isopropanol and its metabolite acetone is 2.9–16.2 ​​hours (with an average time of 7 hours) and 7.6–26.2 hours, respectively. Due to the good solubility in fats, propyl alcohols can linger in the body for quite a long time. The release of isopropyl alcohol and acetone with exhaled air begins 15 minutes after ingestion of alcohol. Excretion of isopropyl alcohol and acetone also occurs in the urine; the release of acetone, depending on the dose of isopropyl alcohol, can continue for a number of days.

Butyl alcohol can enter the body by inhalation and oral route.

During inhalation of 1-butanol, about 55% is absorbed, but it is rapidly excreted: 1 hour after the inhalation is stopped, it is absent in the exhaled air. Upon entering the stomach, butyl alcohols are rapidly absorbed: after 2-3 hours they disappear from the blood (tert-butyl alcohol was also detected after 24 hours). The maximum accumulation is in the liver and blood. Oxidation to butanol, butanoic and acetic acids occurs.

About 83% of 2-butanol is excreted in exhaled air, 4-5% in urine and less than 1% in feces.

Vapors are irritating to the mucous membranes of the upper respiratory tract and eyes. When exposed to the skin, dermatitis and eczema may occur the sooner, the higher the content of unsaturated compounds in butyl alcohol (butyl alcohol and crotonaldehyde, etc.) formed during its industrial production. Butyl alcohol causes a narcotic effect; in this case, the central nervous system is affected, especially the subcortical formations of the brain.

The lethal dose of butyl alcohol when taken orally - according to various sources, from 30 to 200-250 ml. Smaller doses can cause severe poisoning with intracranial hemorrhage and visual disturbances (changes in the fundus, narrowing of the visual fields, atrophy of the optic nerve and blindness).

Amyl alcohol after oral administration, it circulates in the blood for several hours (various isomers - from 4 to 50 hours); its decomposition products are aldehydes and ketones; Excretion from the body occurs through the lungs and in the urine.

By the nature of the action on the body, amyl alcohols are drugs with a strong local irritant effect. First of all, the nervous system is affected and paralysis of the vital centers of the brain stem occurs.

Alcohol poisoning caused by moonshine or other surrogates with a high content of monohydric aliphatic alcohols is characterized by rapid development, longer duration, deeper impairment of consciousness, epileptiform CNS disorders and severe post-toxication syndrome. Frequent use of such surrogates contributes to the rapid development of the psycho-organic syndrome.

1.3 Epidemiology

Acute ES poisoning is one of the leading causes of emergency hospitalization for poisoning. According to the reports of the toxicological centers of Russia (Form No. 64), patients with this pathology accounted for 37.4%, 42.9%, 36.9%, 30.7%. of all hospitalized in these units in 2008 - 2011, respectively. In 2015, this figure averaged 32.7%. In federal districts, the proportion of patients hospitalized with ethanol poisoning in 2015 ranged from 7.1% in the Northwestern Federal District to 69% in the Urals and Siberian Federal Districts. The average hospital mortality rate for ethanol poisoning was 3.0% in 2005-2012, and 4.7% in 2015. Mortality as a result of ethanol poisoning in relation to other causes of death from poisoning in the Russian Federation is the leading factor for the same period, ranging from 55.8% in 2005 to 42.1% in 2012, 2015 - 43, 7%, other alcohols - 3.3% - 4.0%.

1.4 Coding according to ICD10

Toxic effect of alcohol (T51):

T51.0 - Toxic effect of ethanol (ethyl alcohol);

T51.2 - Toxic effect of 2-propanol (propyl alcohol);

T51.3 - Toxic effect of fusel oils (alcohol: amyl; butyl; propyl;

T51.8 - Toxic effect of other alcohols;

T51.9 - Toxic effect of alcohol, unspecified;

1.5 Classification

Classification of coma due to the toxic effect (acute poisoning) of ethanol, which is subdivided by depth, respectively

coma superficial uncomplicated,

coma superficial complicated,

deep coma uncomplicated

coma deep complicated.

Toxic effect of alcohols:

2-propanol (propyl alcohol),

fusel oils (alcohol: amyl;

butyl; propyl

classified according to severity:

mild - not accompanied by loss of consciousness,

moderate severity - with a disorder of consciousness according to the type of stupor condition, toxic encephalopathy, but without complications,

severe - characterized by complete loss of consciousness (coma), which may be accompanied by various complications.

2. Diagnostics

2.1 Complaints and medical history

With ethanol poisoning, there are practically no complaints, since the patient is unconscious. In case of poisoning with higher alcohols with preserved consciousness, complaints are characteristic of exposure to narcotic and irritating substances: weakness, dizziness, headache, pain in the epigastric region, nausea, vomiting. In case of poisoning with butanol, amyl alcohols, there may be complaints of diarrhea.

The anamnesis should be aimed at clarifying the following data: type of toxic substance (vodka, wine, beer, technical alcohol, solvent - its name, trade mark, etc.), dose, time of taking the toxicant.

In addition, it is advisable to find out some data from the anamnesis of life: previous diseases, injuries, bad habits.

Most often, an anamnesis can be collected only after the patient’s consciousness is restored, since ethanol (alcohol) poisoning is a coma, and the victims are usually delivered by ambulance teams from public places, the streets on the call of random passers-by, however, even in this case, the person who came into consciousness, the patient is far from always able to remember and report the necessary anamnestic information.

2.2 Physical examination

In case of poisoning with ethanol, higher alcohols, it is recommended to evaluate the following:

The appearance of the skin - there is no specific color, in case of respiratory failure, shock, cyanosis of the lips, face, acrocyanosis, coldness is noted, with a deep coma there may be moisture. It is necessary to identify the presence / absence of a rash, local changes, the so-called. "Decubitus ulcers" due to positional injury due to pressure from one's own body weight, the so-called positional pressure on certain areas of soft tissues, leading to the appearance of areas of skin hyperemia, which are often regarded as bruises, hematomas, burns, phlebitis, allergic edema, etc. and are usually detected in the early stages (1-3 days).

Assess the psychoneurological status: state of consciousness (clear, lethargy, stupor, coma, psychomotor agitation, hallucinations). In the presence of coma - assess its depth, the presence or absence of reflexes, the width of the pupils, their reaction to light, the presence (absence) of anisocoria, the state of muscle tone. When anisocoria, pathological reflexes are detected, pay attention to their constancy (“pupil game”), since with a superficial alcoholic coma, anisocoria and pathological reflexes can appear and quickly disappear.

Assess the state of breathing: adequacy, frequency, depth, uniformity of participation in the act of breathing of all parts of the chest, auscultatory picture.

Examine visible mucous membranes - some higher alcohols are irritating and can cause a burning sensation, pain when swallowing.

Pay attention to the presence / absence of injuries, especially in the face, head, abdomen, lower back.

Pay attention to the presence / absence from the exhaled air of a smell characteristic of ES, higher alcohols, but it is not an absolute fact confirming ES poisoning, since the state of alcoholic intoxication can accompany various somatic, infectious diseases, injuries.

2.3 Laboratory diagnostics

2.3.1 Chemical-toxicological laboratory diagnostics

The basis is chemical-toxicological laboratory diagnostics. Of the modern express methods for the qualitative and quantitative determination of ethanol, gas-liquid chromatography (GLC) with the use of a flame ionization detector or a thermal conductivity detector has an indisputable advantage, providing high accuracy (sensitivity 0.005 g/l of ethanol) and specificity of the study and allowing along with the main study to identify in biological fluids, a number of substances characterized by a narcotic effect (aliphatic alcohols (C1-C5), ketones, industrial chlorine and organofluorine derivatives, aliphatic and aromatic hydrocarbons, glycols and esters). It is not recommended to use for the purpose of diagnosis the determination of the presence and level of ES in the blood using the analysis of exhaled air (alcometer), since this method does not allow determining the presence of other alcohols, is inferior in accuracy to GLC, and also does not allow obtaining the required amount of exhaled air (maximum complete active expiration) in a patient in a coma).

Persuasiveness level - D(level of evidence - 4)

The determination of ethyl alcohol in blood and urine is recommended to be carried out 2 times with an interval of 1 hour in order to confirm the result of the first study and determine the phase of poisoning by the ratio of ethanol concentration in these biological media (resorption or elimination).

Persuasiveness level - D(level of evidence - 4)

Comments:The average concentration of alcohol in the blood upon admission of patients in a coma is 3.0-5.5 g / l, in children the toxic effect of alcohol without the onset of coma is observed at an ethanol concentration in the blood of 0.9-1.9 g / l, coma develops at an ethanol level of 1.6 g/l. However, there is no complete correlation between the depth of coma and the concentration of ethanol in the blood, although there is a tendency to deepen the coma as the amount of alcohol in the blood increases. Moreover, the same concentrations are sometimes found in persons in a state of alcoholic intoxication and alcoholic coma. Therefore, a single indicator of the concentration of ethanol in the blood cannot serve as a criterion for the severity of alcohol poisoning. In this regard, it is necessary to determine the ratio of alcohol concentrations in biological media after a second study, which, in addition to clinical, this ratio also has forensic medical significance.

The GLC method is provided with domestic analytical equipment available in our country and is not dangerous for the patient.

For patients in a superficial coma, a single determination of the presence and level of ethanol is recommended.

Persuasiveness level - D(level of evidence - 4)

Patients in a deep coma with an initially high level of ethanol in the blood are recommended to be re-examined (after detoxification), especially in the case of insufficiently fast positive clinical dynamics of recovery of consciousness.

Persuasiveness level - D(level of evidence - 4)

Persuasiveness level - D(level of evidence - 4)

Persuasiveness level - D(level of evidence - 4)

With a deep coma, a repeated 2 or 3-fold study (qualitative and quantitative) is recommended, depending on the clinical situation. Given that the metabolite of isopropanol is acetone, the detection of the latter in an amount exceeding the allowable level of metabolic acetone (for example, in diabetes mellitus) can be regarded as an indirect confirmation of the use of isopropanol.

Persuasiveness level - D(level of evidence - 4)

Comments: Blood sampling rules . Blood in the amount of 15 ml is taken by gravity into the syringe, placed in 2 bottles of 10 and 5 ml, containing 3-5 drops of heparin solution for every 10 ml of blood, and tightly closed with lids or in the same volumes using vacuum test tubes. Urine in an amount of at least 5 ml is also taken into the vial and tightly closed with a stopper.

Important: when taking blood for ethanol, other alcohols and volatile compounds, the skin at the insertion site of the blood sampling needle must not be treated with ethyl alcohol, because. this will lead to false results.

Additional chemical-toxicological diagnostics is recommended for suspected combination of poisoning with alcohol and psychoactive substances (drugs, psychotropic drugs), other alcohols, chlorinated and aromatic hydrocarbons. Research methods will depend on the toxicant being determined.

Persuasiveness level - D(level of evidence - 4)

2.3.2 Clinical and biochemical laboratory diagnostics

It is strongly recommended that all patients perform a general (clinical) blood test, urine, biochemical blood test (determination of total bilirubin, direct bilirubin, total protein, glucose, urea, creatinine). The frequency of these studies will depend on the severity of the poisoning and the length of the patient's stay in the hospital.

Persuasiveness level - D(level of evidence - 4)

Persuasiveness level - D(level of evidence - 4)

For the differential diagnosis of poisoning with alcohol and other toxicants that cause impairment of consciousness, it is recommended to determine the level of glucose in the blood, the determination of CBS, in order to assess the state of homeostasis and indirectly detect methanol and ethylene glycol poisoning, which are characterized by the development of decompensated metabolic acidosis.

Persuasiveness level - D(level of evidence - 4)

Persuasiveness level - D(level of evidence - 4)

With the development of hepatopathy, liver failure, the determination of aldolase, alkaline phosphatase, GGTP, GGTP, prothrombin time, coagulogram, bilirubin fraction, protein fractions is recommended.

Persuasiveness level - D(level of evidence - 4)

2.4 Instrumental diagnostics

Instrumental diagnostics has no specifics and is carried out for the purpose of differential diagnosis and monitoring of the patient's condition.

electrocardiography (ECG) - the probability of the presence of cardiomyopathy, chronic cardiac pathology (especially since the history of the life of such patients upon admission to the hospital is practically unknown),

chest radiography,

x-ray of the skull in two projections - for patients brought from the street, public places, in the presence of traces of injuries.

esophagogastroduodenoscopy (EGDS) - higher alcohols have a local irritating effect on the mucous membrane of the digestive tract (up to 2 times).

Persuasiveness level - D(level of evidence - 4)

Additional instrumental diagnostic methods are recommended to be performed once in order to detect trauma, comorbidity or possible complications (ultrasound examination (ultrasound) (ECHO-scopy) of the brain, computed tomography (CT) and magnetic resonance imaging (MRI) of the brain, ultrasound of the abdominal organs, kidneys, pancreas, fibrobronchoscopy FBS.

Persuasiveness level - D(level of evidence - 4)

2.5 Differential diagnosis

At the stage of primary health care, it is recommended to exclude the disease or condition that caused the coma on the background of alcohol intoxication, in particular:

traumatic brain injury, acute cerebrovascular accident;

hypoglycemic coma;

infectious disease (meningitis, encephalitis, etc.)

hepatic and uremic coma, coma with endocrinological diseases, severe encephalopathy with water-electrolyte and metabolic disorders.

Persuasiveness level - D(level of evidence - 4)

In the hospital, upon admission of the patient, it is also recommended to exclude the diseases or conditions listed above, and in the absence of positive dynamics after 2.0-4.0 hours after the start of infusion therapy, a more in-depth study is recommended, including chemical-toxicological, in order to exclude the presence of a combined intake of any - or psychotropic drugs or other somatic or infectious disease.

Persuasiveness level - D(level of evidence - 4)

3. Treatment

At the stage of primary health care, it is recommended to normalize impaired breathing and restore or maintain adequate hemodynamics (see 3.1 "Treatment of hemodynamic disorders".

Persuasiveness level - D(level of evidence - 4)

Persuasiveness level - D(level of evidence - 4)

Persuasiveness level - D(level of evidence - 4)

1. in cases of aspiration-obstructive respiratory disorders, it is recommended to perform an oral toilet; to reduce hypersalivation and bronchorrhea, atropine ** (1–2 ml of a 0.1% solution) is injected subcutaneously;
2. with a superficial coma - aspiration of the contents of the upper respiratory tract is carried out using an air duct;
3. with a deep coma - tracheal intubation is performed.
4. in case of respiratory failure according to the central type, it is necessary to carry out artificial ventilation of the lungs after preliminary intubation of the trachea.
5. with a mixed form of disorders, aspiration-obstructive respiratory disorders are first eliminated, and then artificial ventilation is connected.
6. inhalation of oxygen is shown.
7. to resolve atelectasis - a sanitation FBS.

Persuasiveness level - D(level of evidence - 4)

Persuasiveness level - D(level of evidence - 4)

3.1 Treatment of hemodynamic disorders

In severe hemodynamic disorders, anti-shock therapy is recommended: intravenous plasma-substituting solutions, saline solutions and glucose solutions.

Persuasiveness level - D(level of evidence - 4)

After relief of respiratory failure and associated hypoxia, the use of succinic acid preparations (solution of meglumine sodium succinate ** - 1.5% - 400.0) and cardiovascular agents in therapeutic doses (cordiamin, caffeine) is recommended.

Persuasiveness level - D(level of evidence - 4)

Persuasiveness level - D(level of evidence - 4)

Persuasiveness level - D(level of evidence - 4)

3.2 Correction of homeostasis disorders

Correction of water and electrolyte balance is recommended to be carried out with crystalloid, colloid solutions and glucose under the control of pulse, blood pressure (BP) and central venous pressure (CVP), cardiac index, total peripheral resistance, hematocrit, hemoglobin and electrolyte concentrations, as well as diuresis.

Persuasiveness level - D(level of evidence - 4)

Comments:The volume of liquid introduced for this purpose averages 2.0-3.0 liters or more at a ratio of colloidal to crystalloid solutions of 1:3.

Persuasiveness level - D(level of evidence - 4)

Comments: During intoxication, the early elimination of COS disorders is important, since a long-term state of metabolic acidosis, which naturally develops with alcohol poisoning, can in itself have a pronounced adverse effect on various body systems.

To accelerate the metabolism of ethanol, normalize metabolic processes, a combination of intravenous administration of dextrose ** (10-20% solution of 500-1000 ml) with insulin (16-20 units) and a complex of vitamins (thiamine ** 5% solution of 3-5 ml, pyridoxine) is recommended. ** 5% solution 3-5 ml, cyanocobalamin** 300-500 mcg, ascorbic acid** 5% solution 5-10 ml, thioctic acid** 0.5% solution 2-3 ml).

Persuasiveness level - D(level of evidence - 4)

In order to normalize energy metabolism, it is recommended to inject succinic acid preparations - ethylmethylhydroxypyridine succinate**, sodium meglumine succin**t, etc.

Persuasiveness level - D(level of evidence - 4)

For the prevention of Wernicke's toxic post-alcohol encephalopathy, the administration of thiamine** (100 mg intravenously) is recommended.

Persuasiveness level - D(level of evidence - 4)

Persuasiveness level - D(level of evidence - 4)

3.3 Detoxification

gastric lavage (PG) probe,

the introduction of a saline laxative (preferably sodium sulfate),

1. purgation.

Persuasiveness level - D(level of evidence - 4)

3.4 Accelerated detox

For a more intensive release of ethanol, the use of forced diuresis (FD) is recommended, which is carried out with urine alkalinization.

Persuasiveness level - D(level of evidence - 4)

With a deep coma with areflexia, no positive dynamics after the PD cycle, an extremely high level of ethanol (10 or more g / l) or higher alcohols in the blood, HD or HDF is recommended.

Persuasiveness level - D(level of evidence - 4)

• In patients under 18 years of age for the treatment of alcohol poisoning, complex therapy is recommended, which includes detoxification (cleansing the gastrointestinal tract - washing the stomach with water at room temperature, strictly controlling the total amount of water used for this (no more than 1 liter in the first year of life, 1-3 liters from 1 years up to 6-7 years, 4-5 liters at the age of 8-15 years. The amount of fluid administered intravenously for the implementation of FD is used at the rate of 7.0-8.0 ml / kg per hour), Symptomatic treatment is also carried out, administration vitamins that enhance the metabolism of ethanol.

Persuasiveness level - D(level of evidence - 4)

In what ways and why does alcohol adversely 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. Here, first of all, the immediate adoption of well-thought-out decisions, high concentration and stability of attention, the speed of response of the human operator to various types of signals, and quick orientation in changing working conditions are required.

The most important pharmacological property of ethyl alcohol lies primarily in the fact that it has the ability to be rapidly absorbed in the gastrointestinal tract, absorption actually begins in the oral cavity. This period (phase of resorption - absorption) after taking alcohol lasts for 1.5-2 hours, including the time of its distribution in the organs and tissues of the human body. Then comes the period of removing alcohol and its metabolic products from the body - the phase of elimination. 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 highest 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 is oxidized in the liver under the influence of a special enzyme - alcohol dehydrogenase, the remaining 10% of the dose is oxidized with the participation of other enzyme systems, excreted from the body with exhaled air, sweat and urine. If in the first hours after ingestion the concentration of alcohol in the blood exceeds its concentration in the urine, then after 2.5-3 hours the reverse ratio is observed. Moreover, in the late stages of oxidation, alcohol may no longer be in the blood, but still be in the urine.

The ability of alcohol to be quickly absorbed into the blood determines its effect on almost all organs, because they are permeated 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 circulatory network that feeds them and thereby ensures metabolic processes. . As you know, the blood supply to the brain is 16 times greater than that of the muscles of the limbs, which means that the saturation of the brain with alcohol occurs much faster than the muscles. At the same time, the rate of excretion from the brain and the cerebrospinal fluid that bathes 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.

It is not surprising that in the first place the nervous system reacts to the intake of alcoholic beverages. Such targeted selectivity of the effect on the cells of the nervous system is due to the fact that the so-called lipids (fatty formations) contained in them in a large volume are easily dissolved by alcohol. So, alcohol, penetrating into nerve cells, reduces their reactivity, while the activity of the cells of the cerebral cortex is disrupted, and then its effect extends 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 leads to a persistent and diverse dysfunction 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 cerebral cortex. As a result of inhibition of the processes of inhibition in the nerve cells of the cortex, the subcortical centers of the brain are disinhibited. This is what explains the state of excitement so typical of the picture of alcoholic intoxication.

Alcohol intake, affecting the nervous system and disrupting its functions, causes a real chain reaction of changes in the activity of other body systems, which, according to the feedback principle, in turn, indirectly aggravate the initially occurring adverse effects, both transient and persistent.

Let's explain this with a few 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 much less digestive enzymes than normal, its digestive capacity is reduced.

Influencing 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 superficial vessels of the skin. And after taking alcohol, the expansion of these vessels is subjectively perceived by the drunk person as a feeling of warmth. Hence the common misconception that alcohol has a warming effect. In fact, the opposite effect is observed - the expansion of skin vessels leads only to increased heat transfer from the body.

The stronger the intoxication and, therefore, the stronger the toxic effect of alcohol on the medulla oblongata, the higher the heat transfer and, therefore, the faster the body temperature begins to drop. Such a discrepancy between the subjective perception of the feeling 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, an intoxicated person can easily and quickly freeze.

Entering the body, alcohol is excreted unchanged by breathing, 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 of many valuable substances necessary for the normal functioning of the body.

As a result, the electrolyte composition of the blood, the content of such elements as potassium, sodium, calcium, and magnesium in it, is disturbed. 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 the hands, body, convulsions are noted, and blood pressure rises. Excess sodium leads to fluid retention and accumulation in the body.

Normally, the electrolyte composition of the blood is balanced, while a change in the content of only one of the elements in the blood 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 the blood towards acidity. This contributes to an increase in the consumption of ascorbic acid, a decrease in 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, fatty acid oxidation and protein synthesis decrease, and calcium metabolism in muscle fibers is disrupted. All this changes the strength of muscle contraction and energy costs and contributes to the onset of muscle fatigue. Under the influence of alcoholic beverages, the metabolism of lactic acid is disrupted and its release is inhibited. Therefore, with varying degrees of renal failure, the content of toxins in the blood increases sharply, which increases the risk of uremia.

The use, and even more so the abuse of alcoholic beverages, affecting the functions of the central nervous system, indirectly lead to violations of all major types of metabolism - protein, carbohydrate, fat. Characteristically, in this case, specific disorders occur in the functioning of body systems, such as the cardiovascular, nervous, excretory, immune, endocrine, and individual organs.

With regular intake of alcoholic beverages, an 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 that underlies chronic alcoholism.

Patients suffering from chronic alcoholism often complain of intermittent pain (constriction) in the region of 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 is reborn, the altered walls of the heart lose their elasticity, become flabby and cannot withstand blood pressure: the heart increases in size, its cavities expand. And the efficiency of the heart muscle gradually decreases, blood circulation is disturbed. This is expressed in palpitations, shortness of breath, coughing, general weakness, and edema.

Circulatory disorders in alcoholics and drunkards contribute to the occurrence of chronic coronary heart disease. Small vessels expand, the skin becomes bluish-purple in color on the face (everyone knows the “nose of an alcoholic”). With chronic alcohol intoxication, the walls of blood vessels change, which leads to sclerosis of the vessels of the heart and brain. Violations of cardiac activity and blood circulation are also responsible for such a frequent increase in blood pressure in patients with alcoholism, hypertensive crises, threatening 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 perform its main function - to neutralize toxic substances, including alcohol, its metabolic products, due to the replacement of liver tissue with adipose tissue. The amount of bile produced decreases.

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

The irritating effect of alcoholic beverages on the mucous membranes and the consequences of heavy smoking of many drunkards and alcoholics cause inflammation in the pharynx that often occurs in them, often with damage to the vocal cords. In patients with alcoholism, as a rule, a hoarse and rough voice, cancer of the larynx is often observed. Due to impaired blood circulation in the lungs, they develop congestion, and the elasticity of the lung tissue is significantly reduced. Therefore, they are much more likely than people who do not drink to suffer from chronic bronchitis, pneumonia, and emphysema. The weakening of the lungs is accompanied by a painful cough, copious sputum.

The systematic abuse of alcohol not only greatly facilitates the infection with tuberculosis and venereal diseases, but also significantly aggravates their course. First of all, due to a sharp weakening of the body's defenses due to drunkenness. These are diseases of people who do not follow the rules of personal hygiene, 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 in the tips of the fingers and toes, a feeling of numbness and tingling in them. With prolonged alcohol abuse, paralysis of the limbs can develop. Inflammatory changes in the intercostal, sciatic and other nerves lead to severe consequences - neuralgia, neuritis, accompanied by constant pain, restriction of movement. The drinker becomes practically disabled.

All this causes an increased sensitivity to colds and infectious diseases, which are much more severe in patients than in non-drinking people, with pronounced and protracted complications. The severity and severity of diseases of the internal organs and the nervous system are directly dependent on the duration of alcoholization, the stage and rate of alcoholism. The development of disorders begins already at the earliest stages of alcohol abuse, and their frequency and severity increase with an increase in the 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, there are diseases of the internal organs, and certain symptoms of damage to the brain, spinal cord and peripheral nerves were noted in almost all patients with alcoholism. The frequency of diseases caused by alcohol increases by 4 times even with a twofold increase in the consumption of alcoholic beverages. According to foreign researchers, in persons 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, in a number of people suffering from chronic alcoholism, up to a certain time, signs of alcoholic damage to internal organs may be absent.

Alcoholism is a common cause of death in 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 death among the population, alcoholism and related diseases occupy the third place, second only to diseases of the cardiovascular system and malignant tumors. Thus, alcoholism in itself serves as a direct cause of death or accelerates its onset: drunkards and alcoholics, as a rule, do not live to old age, dying at working age, reduce their life expectancy by 10-12 years. Thus, domestic experts in forensic medicine 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 quite 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 immediate causes of death of patients with alcoholism are suicides committed in a state of intoxication or a hangover. According to the World Health Organization (WHO), 12–21% of alcoholics attempt suicide, and 2.8–8% commit suicide. But isn't it suicidal systematic drunkenness, leading to death as a result of diseases and injuries, because the sad contribution of alcohol to various types of injuries is very revealing.

95% of patients with alcoholism suffer from alcoholic gastritis. Gastritis is a lesion of the gastric mucosa. It is characterized by dysfunction of the stomach with such manifestations as pain, heaviness in the epigastric region, poor appetite, bad breath, nausea, vomiting, upset stool, weight loss. The secretion of the stomach can change 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 it used to be called, 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 chronic alcohol effects on peripheral nerves, their degeneration occurs. All organs, including muscles, act, as you know, on the “order” of the nervous system and under the influence of impulses that pass through the nerve fibers, and with polyneuritis, these fibers undergo the most profound changes, 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 experience all sorts of unpleasant phenomena: “goosebumps”, numbness, muscle tightening (especially of the lower extremities), all kinds of pains - pulling, burning, stabbing; there is a sharp weakness in the limbs - the legs become like cotton. Often there are convulsions due to spasm of a certain muscle group.

Everyone saw a special hammer in the hands of a neuropathologist. Everyone is familiar with the picture of how neuropathologists check tendon reflexes by tapping with a hammer on certain points where the nerves come closer. Normally, under the influence of such blows, irritation of the nerve occurs, which leads to a contraction of the muscle group innervated by it, and the leg shudders accordingly. In alcoholics, when tapping 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, atrophied and do not conduct impulses.

A special place is occupied by sexual disorders in alcoholism, which are extremely complex. Basically, they are associated with the fact that under the influence of chronic alcohol intoxication, gross changes in the pituitary gland, adrenal glands and sex glands occur. There is a sharp decrease in the activity of male hormones and their production drops sharply. On the other hand, general biological and microsocial conditions are of great importance in the appearance of a sexual disorder: violation of marital relationships, changes in social and marital status, etc.

In short: Toxicologist S. Radchenko: 750 ml of vodka for non-drinkers and three bottles of vodka for non-alcoholic non-alcoholics is a lethal dose of alcohol for the human body. In addition to an overdose, dangerous diseases that have become aggravated or first appeared under the influence of alcohol can lead to death.

Alcohol can kill a person in two ways:

1. Alcohol and a 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.

Lethal dose of alcohol

For a non-drinking white male weighing 70 kg:

• 300 ml pure alcohol
• How much alcohol is in 750 ml vodka drunk within five hours or less.

For regular non-alcoholic drinkers:

• approximately 600 ml of pure alcohol or 3 bottles of vodka drunk within five hours or less.

Lethal dose of alcohol.

In fatal alcohol poisoning, death occurs in an unconscious state from cardiac arrest or respiratory arrest. A fatal overdose of alcohol can be suspected if unconsciousness lasts more than six hours after drinking alcohol. As a rule, nothing can be done at such times.

Please note that it is almost impossible to drink a lethal dose of alcohol without a hearty snack. Most often, too heavy and plentiful snack at the table leads to an alcohol overdose. If a person eats moderately and competently, and at the same time drinks a lot, then before a lethal dose is taken, he simply loses consciousness, and this saves his life. The body has time to react in time, when nothing prevents the timely absorption and processing of alcohol.

A plentiful snack accumulates in the intestines along with drunk alcohol, 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 the strength to drink more. And when the drunk alcohol is finally absorbed and enters the bloodstream, the body is unable to cope with so many toxic substances.

Death from alcohol-related diseases

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 (death of pancreatic tissue), acute urinary retention, liver failure, alcoholic hallucinosis and alcoholic delirium. The presence of alcohol in the body can aggravate existing human diseases and cause their exacerbations, and exacerbations of particularly serious diseases can have irreversible consequences, even death.

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

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