Complications of alcoholism

An comprehensive overview of complications of alcohol use disorder is described here.

1. Dr.S.K.Kar Department of psychiatry, C.S.M.M.U Complications of alcoholism

2. Preparation of alcohol Absolute alcohol (gms / 100ml) Standard drink Beer (standard) Beer (strong) Wines Fortified Wines Spirits (Whiskey, Rum, Gin, Vodka, Brandy etc) Arrack 2.3 – 3.1 6.2 – 8.6 3.9 – 10.1 10.9 – 15.9 31.2 25.7 300 – 400 ml 100 – 150 ml 100 – 250 ml 60 – 90 ml 30 ml 40 ml

3. Preparations of alcohol

4. 500 mg% BAC 0 mg% BAC

5. BAC mg/dl Effects <80 Euphoria, feeling of relaxation and talking freely, clumsy movements of hands and legs, reduced alertness but believes himself to be alert >80 Noisy, moody, impaired judgement, impaired driving ability 100-200 Electroencephalographic changes begin to appear, Blurred vision, unsteady gait, gross motor in-coordination, slurred speech, aggressive, quarrelsome, talking loudly. 200-300 Amnesia for the experience – blackout 300-350 Coma 350-600 May cause or contribute to death

6. Mental & Behavioural Effects Drowsiness Impaired attention Impaired memory Impaired judgement Impulsive behaviour Inappropriate sexual behaviour Aggressive behaviour Inappropriate social conduct Impaired occupational performance Mood lability(rapid changes) Stupor/Coma

7. Physical Effects Flushed face Rapid pulse Headache Stomach ache Diarrhoea Sweating Slurred speech Motor in coordination Unsteady gait Nystagmus Respiratory depression

8. t/t- Supportive care High dose BZDs Antipsychotics Thiamine Hydration

9. Alcoholic Liver Disease: Increase in fat accumulation in liver cells ( fatty liver ) Cirrhosis may occur in upto 15% chronic alcoholics Hepatic encephalopathy

10. Fatty Liver Clinical Features Symptoms Often asymptomatic Signs Hepatomegaly Investigations Elevated AST, ALT, Bilirubin Treatment Abstinence Prognosis Completely reversible with abstinence

11. Symptoms Anorexia, nausea, vomiting, pain abdomen, fever Signs Icterus , tender hepatomegaly Investigations Elevated AST, ALT & bilirubin, prolonged prothombin time Complication Fulminant hepatic failure, ascites, encephalopathy, gastrointestinal bleed, coagulopathy Prognosis In the absence of complications reversible with abstinence

12. Symptoms Anorexia, weight loss, abdominal discomfort, distension of abdomen Signs Jaundice, spider naevi , clubbing, parotid enlargement, palmar erythema , gynaecomastia , testicular atrophy, Dupuytren’s contracture, distended veins over abdomen, hepatomegaly or shrunken liver, splenomegaly , ascites Complications Ascites , variceal bleed, hepatic encephalopathy, spontaneous bacterial peritionitis , hepatic failure, renal failure

13. Symptoms Agitation, mood swings, confusion, disorientation, disturbed sleep, altered sensorium , coma Signs Flapping tremor, Hyper-reflexia, coma Precipitating factors G.I. bleed, infection, increased protein intake, use of sedatives, Electrolyte imbalance Investigations Elevated levels of serum ammonia, abnormal liver function tests, prolonged PT, abnormal EEG

14. Nutritional deficiency Signs and symptoms Protein calorie malnutrition Weight loss, lethargy, fatigue Vitamin B1 deficiency Beriberi, Wernicke – Korsakoff syndrome Vitamin B2 deficiency pellagra Vitamin B6 deficiency Peripheral neuropathy Vitamin A deficiency Night blindness, keratomalacia Vitamin C deficiency Scurvy

15. Section 185 (chapter XIII) of Motor vehicle act (India) , 1988- driving by a drunken person or by a person under the influence of drugs.-Whoever, while driving, or attempting to drive, a motor vehicle,- Has, in his blood, alcohol exceeding 30 mg per 100 ml of blood detected in a test by a breath analyser , or Is under the influence of a drug to such an extent as to be incapable of exercising proper control over the vehicle, shall be punishable for the first offence with imprisonment for a term which may extend to six months, or with fine which may extend to two thousand rupees, or with both.

16. Alcohol produces physical as well as psychological complications. No organ in the body is resistant from the adverse effect of alcohol. All complications are preventable. Life is a precious gift……..preserve it “ AVOID ALCOHOL….AVOID COMPLICATIONS”