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Файл:Ординатура / Хирургия / Библиотека им академика М.И. Перельмана / Книга_5536_Библиотеки_им_академика_М_И_Перельмана.pdf
Alcohol
headaches. A good indicator of alcohol intoxication in oneself is the sensation
of vertigo, or feeling as though the room is spinning. This may lead to a loss of
equilibrium, and the sufferer will feel the need to sit or lie down.
In more severe cases of intoxication, alcohol in the body can cause vomiting.
This is the body’s way of rejecting the alcohol and preventing it from entering the
bloodstream. If vomiting persists, medical attention should be sought immediately,
as alcohol poisoning may have occurred. In severe cases of intoxication, the sufferer
is likely to black out, suffer temporary memory loss, or pass out completely. Once
the ingestion of alcohol has ceased, the sufferer may experience a hangover, which
is essentially caused by dehydration. Headaches and stomachaches are the most
common complaints when experiencing a hangover, but lethargy is also common,
as is the loss of appetite or the persistent feeling of vertigo.
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Acute Alcohol Intoxication
Acute alcohol poisoning is a related medical term used to indicate a dangerously
high concentration of alcohol in the blood, high enough to induce coma, respiratory
depression, or even death. It is considered a medical emergency. The term is mostly
used by healthcare providers. Toxicologists use the term “alcohol intoxication” to
discriminate between alcohol and other toxins.
Intoxication may be recognised by:
■ ataxia and slurred speech
■ emotional lability and disinhibition
■ smell of alcohol on the breath
■ mood variations
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Illustrated Handbook of Drugs & Alcohol Related Health Issues
The signs and symptoms of acute alcohol poisoning include:
■ severe confusion, unpredictable behavior and stupor
■ sudden lapses into and out of unconsciousness or semi-consciousness (with
later alcoholic amnesia)
■ vomiting while unconscious or semi-conscious
■ seizures
■ respiratory depression (fewer than eight breaths a minute)
■ pale, bluish, cold and clammy skin due to insufficient oxygen
[
Assessment of Alcohol Intoxication
The potential for alcohol withdrawal syndrome (AWS) can be gauged only imprecisely
by asking the patient the pattern, type, and quantity of recent and past alcohol use.
Recent intake of alcohol can be assessed from the history, physical examination
(e.g., alcohol on the breath), or toxicological analysis of urine or blood. The
specific clinical picture of alcohol intoxication depends on quantity and frequency
of consumption, the duration of drinking at that level, tolerance, time since last
drink, expectations of effects, and the environment or setting of drinking.
According to the DSM-IV (APA, 1994) substance intoxication is:
■ The development of a reversible, substance-specific syndrome due to recent
ingestion of (or exposure to) a substance. Note: Different substances may
produce similar or identical syndromes.
■ Clinically significant maladaptive behavioral or psychological changes that
are due to the effect of the substance on the central nervous system (e.g.,
belligerence, mood lability, cognitive impairment, impaired judgment, and
impaired social or occupational functioning) and develop during or shortly
after use of the substance.
■ Note: The symptoms are not due to a general medical condition and are
not better accounted for by another mental disorder.
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Alcohol
Other substance intoxication considerations:
■ The most common signs and symptoms involve disturbances of perception,
wakefulness, attention, thinking, judgment, psychomotor behavior, and
interpersonal behavior.
■ Patients should be medically observed at least until the blood alcohol level
(BAL) is decreasing and clinical presentation is improving.
■ Highly tolerant individuals may not show signs of intoxication. For example,
patients may appear “sober” (or even exhibit significant withdrawal symptoms)
at BALs well above the legal limit (e.g., 80 or 100 mg percent), but will
still need detoxification.
Obtain alcohol and other drug use history (especially recency of use)
■ observe vital signs
■ physical examination
■ mental health examination to establish:
o level of consciousness
o Orientation
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o memory
o judgment
o comprehension
o mood
o speech
o perception (hallucinations)
Complications of acute alcohol intoxication or overdose
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JPG
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Possibly:
■ respiratory paralysis, particularly if vomit is inhaled
■ obstructive sleep apnoea
■ fatal cardiac arrhythmia when blood alcohol is greater than 0.4 mg / ml
Alcohol intoxication will only resolve with time. Management of intoxication depends
on the location of the affected person, type of service available, and skills of the
worker to monitor and observe for complications. Management includes:
■ managing behaviours of affected person (e.g. don’t engage in discussion
of emotive topics, diffuse aggressive behaviour)
■ provide a non-threatening and non-stimulating environment
■ encourage sleep
■ observe for signs of other medical conditions that mimic intoxication (e.g.
head injury, diabetes, infection, epilepsy, drug toxicity).
Clinical signs of alcohol-related overdose may include:
■ decreased consciousness, coma or stupor
■ changing mental status
■ cold and clammy skin, lowered body temperature
■ lowered blood pressure, tachycardia/ bradycardia
■ breathing difficulties, slow and noisy respirations
Managing overdose:
Illustrated Handbook of Drugs & Alcohol Related Health Issues
■ maintain airway, breathing and circulation
■ refer to hospital for further assessment
As polydrug use complicates any clinical picture, obtain drug use history where
possible, in particular use of other central nervous system depressants such as
methadone and heroin.
Alcohol Dependence
Alcohol dependence, sometimes known as ‘alcoholism’, is the most serious form
of drinking problem and describes a strong, often uncontrollable, desire to drink.
Drinking plays an important part in the day to day life of alcohol dependent people,
which could lead to building up a physical tolerance or experiencing withdrawal
symptoms if they stop.
There are varying degrees of alcohol dependence and they don’t always involve
excessive levels of drinking. If you find that you ‘need’ to share a bottle of wine
with your partner most nights of the week, or always go for a few pints after work,
just to unwind, you are likely to be drinking at a level that could affect your longterm health. You could also be becoming dependent on alcohol. If you find it very
difficult to enjoy yourself or relax without having a drink, you could have become
Alcohol
psychologically dependent on alcohol. Physical dependence can follow too, that
is your body shows withdrawal symptoms, such as sweating, shaking and nausea,
when your blood alcohol level falls.
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Citation: http://www.fhshh.com/upload/0/50/05038cf2a4a8eea3.jpg
Alcohol dependence is a previous psychiatric diagnosis in which an individual is
physically or psychologically dependent upon drinking alcohol. Alcohol dependence is
a complex syndrome, with both physiological and psychological signs and symptoms.
Key features of alcohol dependence include:
■ tolerance or narrowing of drinking repertoire
■ a perceived ‘loss of control’ over one’s drinking behaviour/salience of
alcohol over other issues
■ withdrawal (physical and psychological) symptoms on cessation of use
■ relief or avoidance of withdrawal symptoms by drinking
■ rapid recommencement of pre-established, or high-risk drinking patterns
after a period of abstinence
Alcohol dependence is a powerful driving force that develops deep in the brain and
increasingly determines your drinking. The driving force of alcohol dependence is
that it increasingly controls your daily life. It causes damage to your physical and
mental health, your work capacity, your brain functioning and your relationships.
Alcohol becomes more important than other aspects of life. For some people, their
body gets so used to functioning with alcohol that they develop a compulsive need
for it.
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Illustrated Handbook of Drugs & Alcohol Related Health Issues
Some things that can contribute to alcohol dependence:
■ Life stresses, such as your situation at work or home
■ Difficult personal relationships
■ Hurtful / traumatic experiences from the past
■ An underlying medical or mental health disorder
If you, your partner, a family member or friend find it increasingly difficult to stop
drinking after two or three drinks, you may be alcohol dependent.
Citation: http://abuse-drug.com/wp-content/uploads/2016/03/Diagnosis-of-alcoholism-2.jpg
Signs of alcohol dependence can include:
■ Arguments with family members about drinking
■ Anxiety at facing a social situation without a drink
■ Having an urge or strong desire to drink
■ Inability to stop drinking once you have started
■ Feeling annoyed when other people comment on, or criticise your drinking
habits
■ Inability to control your behaviour
■ Continuing to drink even though you have health problems that are affected
or caused by your drinking
■ Feeling remorse or guilt after drinking
■ Difficulty in managing feelings
Alcohol
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■ Poor judgement
■ Risky behaviour - putting yourself or others in danger
■ Focusing recreational activities around obtaining alcohol, drinking or
recovering from alcohol use
■ Drinking alone or in secret
■ Blackouts
■ Needing more alcohol to feel satisfied or to gain the same effect
■ Feeling physically unwell
Some people experience just one of these at the start.
Alcohol abuse or alcohol dependence?
The terms alcohol abuse and alcohol dependence are often used interchangeably,
when in fact medically speaking, there is clear distinction between the two. Both
involve the serious misuse of alcohol likely to cause real damage to health and
wellbeing. But while people with alcohol abuse problems usually manage to carry
on their lives with some semblance of normality, once dependence kicks in, the
alcohol takes over.
Alcohol abuse refers to regular excessive drinking which has a more tangible
negative effect on people’s lives
family or social obligations as a result of recurrent drinking; encounters with the
law or emergency services arising from excessive alcohol use or regularly combining
alcohol with physically hazardous situations, such as driving or operating machinery.
2
. Examples of this include failing to fulfil work,
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center-florida.jpg
As outlined above, when dependence sets in, alcohol takes over the central role in
someone’s life and they usually end up giving up important activities and relationships
because of their drinking. One of the early signs of dependence is when you need
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more alcohol to achieve the desired effect. As dependence gets more established,
people end up spending most of their time thinking about alcohol or engaging in
activities necessary to obtain, use, or recover from the effects of drinking. Then,
as dependence takes over, people notice that they get the shakes if they don’t have
a drink. And so they simply have to keep drinking to avoid experiencing these
withdrawal symptoms.
Illustrated Handbook of Drugs & Alcohol Related Health Issues
Signs and symptoms of alcohol dependence
If you are worried that you may be becoming alcohol dependent or are concerned
about someone else’s drinking, look out for these four warning signs and symptoms:
■ Worrying about where your next drink is coming from and planning social,
family and work events around alcohol.
■ Finding you have a compulsive need to drink and finding it hard to stop
once you start.
■ Waking up and drinking – or feeling the need to have a drink in the
morning.
■ Suffering from withdrawal symptoms, such as sweating, shaking and nausea,
which stop once you drink alcohol.
What causes alcohol dependence?
Usually several different factors contribute to someone becoming alcohol dependent.
Alcohol dependence can run in families. It’s partly down to your genes, but is also
influenced by your family’s attitudes to alcohol and the environment you grow up in.
Stressful events, such as bereavement or losing a job, can also trigger heavy drinking,
which can then lead to alcohol dependence.
People who are alcohol dependent have higher rates of other psychiatric disorders
than people in the general population – particularly depression, anxiety, posttraumatic stress disorder, psychosis and drug misuse. Often, people drink to try
and reduce the symptoms (sometimes known as ‘self-medicating’), but in the long
term alcohol makes these disorders worse because it interferes with the chemical
balance in our brains.
Some people believe that there’s such thing as an ‘addictive personality’ which
leads to alcohol dependence.
How to reduce your risk of becoming alcohol dependent
Taking regular breaks from alcohol is the best way to lower your risk of becoming
dependent on it. If you drink regularly, your body builds up a tolerance to alcohol.
Tolerance is a physiological response we have to any drug: the more you consume,
the more your body needs to have the same effect. Regular drinking induces certain
Alcohol
enzymes in your liver that break up (metabolise) alcohol. If you drink heavily over
weeks or months, levels of these enzymes go up, your tolerance builds and you
need more alcohol to get the same effects 3.
Brain systems get tolerant to alcohol too, and although you may be able to walk
a straight line after drinking quite a lot, this means the brain has adapted so that
next day the brain cells ‘expect’ alcohol. Withdrawal symptoms such as anxiety
and jitteriness occur, and you can find yourself drinking alcohol just to relieve that.
Breaking your drinking cycle is an important way to test for – and tackle – this kind
of dependence. It can prevent your body from becoming accustomed to alcohol
and help to lower or ‘reset’ your tolerance.
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Alcohol Withdrawal
Alcohol withdrawal syndrome is a potentially life-threatening condition that can
occur in people who have been drinking heavily for weeks, months, or years and
then either stop or significantly reduce their alcohol consumption.
Alcohol withdrawal symptoms can begin as early as two hours after the last drink,
persist for weeks, and range from mild anxiety and shakiness to severe complications,
such as seizures and delirium tremens (also called DTs). The death rate from DTs
-- which are characterized by confusion, rapid heartbeat, and fever -- is estimated
to range from 1% to 5%. Because alcohol withdrawal symptoms can rapidly
worsen, it’s important to seek medical attention even if symptoms are seemingly
mild. Appropriate alcohol withdrawal treatments can reduce the risk of developing
withdrawal seizures or DTs. It’s especially important to see a doctor if you have
experienced previous alcohol withdrawal episodes or if you have other health
conditions such as infections, heart disease, lung disease, or a history of seizures.
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Illustrated Handbook of Drugs & Alcohol Related Health Issues
Alcohol Withdrawal Syndrome
Alcohol withdrawal syndrome is a set of symptoms that can occur following a
reduction in alcohol use after a period of excessive use. Symptoms typically include
anxiety, shakiness, sweating, vomiting, fast heart rate, and a mild fever. More severe
symptoms may include seizures, seeing or hearing things that others do not, and
delirium tremens (DTs). Symptoms typically begin around six hours following the
last drink, are worst at 24 to 72 hours, and improve by seven days.
Alcohol can be an addictive substance. When a person has been drinking for
an extended period of time, her body becomes accustomed to the presence of
alcohol. If something happens, whether voluntarily or involuntarily, that inhibits
her consumption, a person is likely to experience numerous symptoms, such as
insomnia, nausea, and hallucinations. This process is known as alcohol withdrawal
syndrome.
Alcoholism is a major problem in many countries around the world. Although
alcohol is generally a socially and legally acceptable indulgence, it is one that can
result in serious consequences if it is abused. Once a person becomes addicted, it
may be very difficult for her to simply stop drinking or to drink in moderation, as
is often suggested by the associates of alcoholics.
Citation: http://images.wisegeek.com/girls-at-party.jpg
When a person develops an alcohol addiction, chemical changes occur in the
brain and it no longer functions normally. If that individual decides she would
like to overcome her addiction, she is doing more than exercising a choice. She
is essentially requesting that her body make another modification which can have
physical and psychological effects. These can include vomiting, involuntarily shaking,
and seizures. A person may also experience hallucinations, anxiety, and insomnia.
Alcohol withdrawal syndrome is not a condition that develops from having a single
alcoholic drink or even several drinks on various occasions. This condition usually
results from long-term, regular consumption. It is important to note, however, that