Alcohol surrogate poisoning: signs, diagnosis

Ethyl alcohol is a hydrophilic organic fermentation product found everywhere: in the water of natural reservoirs and precipitation, other natural liquids, in soil layers, in the tissues of plants, animals and humans. In human blood, 0.03-0.04‰ of endogenous ethanol is constantly determined (the unit of measurement of ethyl alcohol concentration is ppm (‰), ten times less than a percent). Naturally, such a liquid, related to the tissues of the body, entering through the digestive tract, is very quickly absorbed and enters the systemic bloodstream. A fifth of the dose taken is absorbed in the stomach, the rest - in the upper parts of the small intestine. Brain tissue has the greatest ability to accumulate alcohol, after consumption, its content there is 1.75 times greater than in the blood. Therefore, alcohol poisoning, first of all, manifests itself as a disorder of the central nervous system.

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Epidemiology

Alcohol poisoning occupies one of the leading positions in the structure of mortality from external causes, competing with suicides and fatal road accidents. We mean deaths directly from poisoning, because asphyxia from vomit, mostly caused by an excess of alcohol in the blood, hypothermia in a state of alcoholic intoxication are already considered as separate causes.

In the structure of morbidity among all poisonings that have come to the attention of doctors, more than half are alcohol-related.

Periodically, the press covers cases of counterfeit alcohol sales, most often vodka. Mass alcohol poisoning is periodically recorded in different regions, and about half of the victims usually do not survive.

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Causes alcohol poisoning

Poisoning with quality food alcohol is possible only with immoderate consumption of alcoholic beverages. But moderation in this matter is very individual.

Alcohol poisoning doses depend on many factors - weight, health condition of the patient, age, presence of food in the stomach, degree of fatigue, habit of drinking alcohol. Conditionally toxic dose of absolute alcohol is considered to be 2-3 ml per kilogram of body weight, when consuming such amount symptoms of acute intoxication can already be observed.

Situations where a large dose of alcohol is taken once or over a short period of time are fatal for a person. On average, such a dose is considered to be the intake of five to eight milliliters of pure alcohol per kilogram of body weight, i.e. a half-liter bottle of even high-quality 40% vodka, drunk over a period of less than six hours, can be fatal for a non-drinker weighing 40-45 kg. However, these are average figures. Sensitivity to alcohol varies from person to person. People with alcohol addiction are more resistant to the lethal effects of alcohol, young and healthy people tolerate alcohol loads more easily than elderly people. Women and children are usually the least tolerant to the effects of ethanol.

In order to be poisoned by non-food alcohols, a very small dose is needed, for example, when consuming methyl alcohol, a fatal outcome can be caused by doses of 20 ml, although there are known cases of consuming 200 ml or more, however, the quality of life after this cannot be called high, already 15 ml causes irreversible loss of vision.

The lethal oral dose of isopropyl alcohol for adults is 240 ml, but for butyl alcohol it varies widely in different sources, from 30 to 200-250 ml.

Risk factors for alcohol poisoning include various cerebrovascular diseases (stroke, dysfunction of the GABA and glutamatergic systems, chronic cerebral pathologies), heart and metabolic disorders. The risk of fatal alcohol poisoning is higher in people with respiratory, liver and kidney failure, and gastrointestinal diseases.

Alcohol dependence increases the possibility of poisoning, although it helps to increase the body's tolerance to ethanol, however, its systematic use and the lack of a sense of proportion in alcoholics leads to the fact that they are the majority among those who die from this cause.

The risk of alcohol poisoning increases when alcohol is consumed on an empty stomach, in a state of fatigue, nervous excitement or stress.

Alcoholic beverages have an expiration date that cannot be ignored; there is a much greater risk of poisoning from a home-made product or one bought at a dubious retail outlet, sometimes even made from industrial alcohol.

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Pathogenesis

The discussion will mainly focus on alcohol poisoning, an acute one-time situation that arose as a result of the exogenous influence of alcohol-containing substances on the human body in quantities that disrupt the functioning of the body's organs and systems and are dangerous to life. Poisoning is often called intoxication, which is not entirely correct. Intoxication refers to a condition that develops under the influence of regular and prolonged consumption of alcoholic beverages, as a result of which the physiological processes in the body are disrupted and multiple organ failure develops.

Most often, practicing doctors encounter acute poisoning with alcoholic substances taken orally for the purpose of intoxication (banal binge drinking). Moreover, the victims are both people who drink regularly and heavily, having exceeded the permissible threshold of tolerance, and non-drinkers, including children and teenagers.

Much less common are cases of poisoning by technical liquids taken by mistake or intentionally (toxicomania).

All alcohols have the ability to be quickly absorbed through the walls of the stomach (one fifth of the dose taken) and the upper sections of the small intestine (the rest). Distribution is fairly uniform, the absorption and elimination phases of ethanol are clearly delineated. Alcohol can be detected in the blood five minutes after its intake, and an hour or two is enough to reach the highest level of its content, equal to the entire dose taken. Absolute alcohol and its breakdown products interact with various structures in living systems - intra- and extracellular receptors, enzymes, transmitters, etc.

Elimination begins when almost the entire (more than 90%) dose of pure alcohol taken is absorbed. Metabolic products and unchanged alcohol leave the body through the air coming out through the lungs and with urine. Approximately 9/10 of everything drunk is broken down by the liver into carbon dioxide and water, the tenth part is excreted unchanged. This process takes from seven hours to half a day, and ethanol is detected in the urine for a much longer time than in the bloodstream.

In the tissues of organs that are intensively supplied with blood - cerebral, heart, liver, kidneys, alcohol is distributed literally in a few minutes. Saturation occurs until the moment when a balance is established between the content of absolute alcohol in the blood and in the tissues.

In a stomach filled with food, ethanol absorption slows down, in an empty stomach and with repeated use, absorption occurs much faster. Stomach diseases contribute to an increase in the rate of ethanol absorption.

Hepatocytes break down alcohol in three stages: first, an oxidative reaction occurs with the formation of acetaldehyde; then it is oxidized to acetic (ethane, carboxylic) acid, which is metabolized with the formation of water and carbon dioxide. The metabolic process occurs at a rate of 90 to 120 mg of ethanol consumed per hour per kilogram of the drinker's weight.

Acute alcohol intoxication occurs when drinking alcohol with a strength of over 12%. Poisoning can usually be caused by taking one large dose at a time or over a short period of time. The severity of the toxic effect increases with the growth of the concentration of alcohol molecules in the blood at a high rate, that is, when the dose consumed is constantly increasing. Despite equal levels of absolute alcohol in the blood, its toxic effect in the absorption phase is more intense than in the elimination phase.

An alcohol concentration of more than three grams per liter of blood can already cause a coma, and five to six grams and above is considered a lethal dose. Much depends on the habit of drinking alcoholic beverages.

The pathogenesis of ethanol damage to the central nervous system is diverse. The alcohol molecule is completely embedded in the fatty biolayer of the neuron cell membrane and changes its fluidity, modifying the structure of phospholipids. The membrane toxic effect changes the intensity of neurotransmitter synthesis processes and the transmission of nerve impulses.

The neurotoxic effect of ethanol manifests itself in disturbances in the brain systems responsible for excitation (glutamatergic) and inhibition (GABAergic). The balance of presynaptic release of neurotransmitters and their postsynaptic action is disturbed, since ethanol is tropic to GABA receptors and potentiates the action of γ-aminobutyric acid. As the degree of intoxication increases, the GABAergic system develops resistance to its own neurotransmitter.

Ethyl alcohol interacts with the serotonergic system, leading to episodic amnesia when consumed in significant doses, and with the cholinergic system, stimulating dose-dependent inhibition of the release of acetylcholine into the synapse and inhibiting the entry of Na+ ions through the neuron membrane, which contributes to the development of a series of neurological disorders in the symptoms of acute alcohol poisoning.

The effects of whole unchanged ethanol molecules are accompanied by intoxication with acetaldehyde, a product of its metabolism that is approximately 30 times more toxic than its predecessor. The accumulation of this metabolite occurs precisely in the tissues of the meninges, and under the influence of alcoholization, the protective function of the blood-brain barrier against aldehydes is temporarily weakened. Additionally, under the influence of intoxication, the synthesis of endogenous aldehydes is activated again in the cerebral tissues. An increased concentration of acetaldehyde and its derivatives contributes to the development of euphoria, the appearance of hallucinations and other stimulating effects, as well as the suppression of cellular respiration and nutrition, since gluconeogenesis is inhibited.

One of the leading places in the mechanism of development of acute ethyl alcohol poisoning, along with disorders of brain function, is occupied by disorders of respiratory function of the aspiration-obturator type (blockage of the respiratory tract by bronchial secretions, saliva, vomit, retraction of the tongue), and in severe cases - through the effect on the respiratory center of the brain.

Oxygen starvation develops, which aggravates cerebral disorders caused by the absence of normal oxidation-reduction reactions, water-salt balance, and other metabolic processes. In people who regularly consume alcoholic beverages, hypoglycemia often develops against the background of acute alcohol intoxication, leading to coma.

Vascular tone is disturbed, leading to a decrease in the volume of circulating blood and hemodynamic disorders. Cardiotoxic effects develop, associated with a disorder in the regulation of vascular tone against the background of changes in metabolic processes, structure and functioning of the heart muscle. In its pathogenesis, the main role belongs to metabolic disorders with inhibition of the enzymatic activity of mitochondrial enzymes and an increase in the activity of enzymes involved in ethanol metabolism, activation of free-radical oxidation, and water-electrolyte imbalance. The influence of metabolic shifts caused by thiamine deficiency is also taken into account. The result of metabolic disorders in the heart muscle is the development of heart failure with a disorder in the frequency and strength of heart contractions.

The liver's reaction to alcohol intoxication is most often expressed by the development of fatty hepatosis - severe metabolic disorders in liver cells cause fat deposits in their cytoplasm. The primary cause of dysfunction, and later - changes in the morphology of liver cells under the influence of ethanol are metabolic shifts that occur during the oxidation of alcohol. Its breakdown in cells occurs much faster than the energy released in this process is spent.

The reaction of the pancreas to acute alcohol poisoning is expressed in the development of acute pancreatitis - a very dangerous condition that requires emergency measures.

The reaction of the kidneys as an excretory organ to alcohol intoxication primarily consists of a decrease in their ability to eliminate uric acid from the body.

The most common and dangerous poisoning is counterfeit alcohol products using methyl alcohol, which breaks down into formaldehyde and formic acid, which have a broad toxic effect. The retina and optic nerve are particularly affected by methanol poisoning; drinking 15 ml of methyl alcohol is enough to permanently lose your vision. Severe acidosis develops as a result of methanol poisoning.

Higher alcohols and fusel oils are much more toxic (1.5 - 3 times) than ethyl alcohol, they are classified as chemical compounds of medium toxicity. The toxic effect caused by higher alcohols is similar to that caused by regular alcohol. The same enzymes participate in their metabolization.

For example, as a result of oxidation of isopropyl alcohol in hepatocytes, two acids are formed - propionic and lactic, in addition - the product of its metabolism is acetone, which is broken down into water and carbon dioxide over a long period of time. Acetonemia develops with oral use of isopropyl alcohol for a quarter of an hour, after which the elimination of acetone and unchanged alcohol begins through the lungs with the air leaving them. The elimination of these two components also occurs through the urinary tract.

Butyl alcohol is quickly absorbed and excreted. Its highest content is determined in the liver parenchyma and blood. It is metabolized to butanol, butanoic and acetic acids. It has a narcotic effect, affecting, in particular, the subcortical structures of the brain.

Other types of non-food alcohols cause rapid and severe poisoning with irreversible and very serious consequences.

Regular consumption of even high-quality alcohol causes chronic alcohol intoxication. The mechanism of its development is associated with its effect on the main vital organs. From the systematic use of alcoholic beverages, even in small quantities, primarily the cells of the brain, liver and heart, as well as the digestive tract, pancreas, kidneys, lungs and retina of the eye suffer. Alcohol-dependent individuals develop pathological alcohol intoxication, provoking the development of inflammatory and necrotic changes in the tissues of the aforementioned organs. Daily consumption of more than 170 g of ethanol literally in a month leads to irreversible changes in the human body.

Moreover, a characteristic feature of the aggressive action of alcohol is selectivity - one organ in each specific person (target organ) is subject to maximum morphological changes, and either cardiomyopathy, or encephalopathy, or alcoholic liver cirrhosis, or pancreatic necrosis and other pathologies develop. Although other organs also suffer, but to a lesser extent.

Alcohol intoxication of the target organ develops in stages:

• the first to suffer are the vascular membranes – their permeability increases;
• swelling develops and the blood supply to the organ tissue increases;
• dystrophic processes begin, depending on the structure of the organ tissue, protein, fatty, granular and other dystrophies develop;
• tissue respiration is disrupted and oxygen deficiency develops;
• atrophic processes and sclerotic changes occur.

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Symptoms alcohol poisoning

The first signs of the toxic effects of alcohol appear already at moderate (and sometimes even mild) levels of intoxication. These are:

• migraine-like headache resulting from decreased vascular tone and expansion of their lumen;
• dizziness and loss of coordination as a result of damage to the vestibular apparatus of the brain by ethanol;
• damage to the autonomic nervous system manifests itself as nausea and dizziness;
• vomiting as a protective reaction of the body, trying to get rid of a toxic substance, first the patient vomits food, if there was no food in the stomach or it has already come out with vomit, the patient vomits bile;
• since this is poisoning, a very high temperature is quite possible, alcohol also causes vascular disorders and depression of the central nervous system, which leads to hypothermia;
• Neurological disorders caused by large doses of alcohol may manifest as seizures.

Such symptoms indicate the development of the toxicogenic stage of acute poisoning, when ethanol reaches a toxic concentration (absorption phase) and acts at the molecular and biochemical level. They are precursors to more serious disorders, in particular, alcoholic coma, which is divided into superficial and deep according to severity.

The stage of superficial coma begins when the patient loses consciousness. Communication with the patient at this stage is absent, the corneal reflex (closing of the eyes in response to irritation of the cornea) and the change in the size of the pupil reacting to a light stimulus are suppressed. Sensitivity to pain is noticeably reduced, however, in response to a painful stimulus, the patient weakly protects himself with his hands, an increase in the diameter of the pupils and facial signs of pain are observed. At rest, the pupils are often constricted, neurological manifestations (change in muscle tone, different diameters of the pupils, "floating" eyes) are inconstant.

As the central nervous system depression progresses, a deep coma stage develops, when all types of reflexes and muscle tone are absent, sensitivity to painful stimuli is completely lost, blood pressure in the arteries drops significantly (to the point of collapse) and body temperature (36℃ and below). The skin becomes covered with viscous cold beads of sweat and acquires a crimson-red or pale-bluish tint.

Quite often, both superficial and deep coma are complicated by disorders of various physiological functions. The severity of complications correlates with the concentration of absolute alcohol in the blood. Symptoms of respiratory failure are the development of acute asphyxia, cyanosis of the skin, hypotension, broncho- and laryngospasm, cough, dyspnea, noisy breathing.

Cardiac disorders are varied and non-specific – arrhythmia, tachycardia, moderate hyper- or hypotension up to collapse, acute heart failure. Vascular tone is reduced, and in deep coma – is completely absent, rheological properties of blood are disrupted, blood circulation is disrupted.

Disturbances in homeostasis are manifested by acidosis, dehydration, and imbalances in water-salt and acid-base balance.

The level of ethanol in the blood and urine at which a coma develops is very individual and has a wide range.

After the removal or destruction of ethanol, the somatogenic stage of acute poisoning occurs, the complications that arise at this stage are the consequences of chemical trauma and the body's reactions to them. The patient's death may also occur at this stage.

A rash after alcohol poisoning indicates that the liver and gastrointestinal tract can no longer withstand the load and it is time to take care of them. In this case, it is better to say goodbye to alcohol forever.

If the rash appears after every, even moderate, drinking, it may be an allergy to alcohol. Drinking alcohol can also provoke and intensify an allergic reaction to any allergen, respiratory, food or medicinal.

Poisoning with alcohol substitutes covers a wide range of concepts. Symptoms of such poisonings vary and depend on the substance with which the individual was poisoned. Alcohol substitutes are a collective term that can mean homemade wine and vodka, in which case symptoms of poisoning with fusel oils (a mixture of higher alcohols and ethers) will prevail; counterfeit (illegal) products, perfumes (cologne) and technical products (polish, stain removers, solvents), pharmaceutical tinctures on alcohol, etc.

Poisoning with low-quality alcohol (a truly surrogate product, which is made on the basis of technical, poorly purified ethyl alcohol, and also containing fusel oils) causes symptoms similar to poisoning with high-quality alcoholic beverages, except that the symptoms may appear and increase faster, and also - the dose sufficient for acute poisoning will be needed less.

The so-called false surrogates are liquids not intended for internal use, containing other alcohols or their mixture with ethyl, various chemical compounds that cause effects similar to intoxication. They are characterized by significant toxicity and the symptoms of their toxic effect can differ significantly from ethanol poisoning.

Methyl alcohol poisoning occurs quite often, mainly by people with alcohol addiction as a substitute for ethanol or consumers of illegal vodka. Methanol or wood alcohol is a very toxic and insidious product, the symptoms of intoxication of which manifest themselves no earlier than 12 hours after its consumption, and sometimes later, when the body has accumulated the necessary amount of its breakdown products (formaldehyde and formic acid). Symptoms of severe acidosis, clouding or complete loss of vision (pupils dilate and their reflexes are absent), vegetative-vascular disorders appear.

Alcohol poisoning of a child is not such a rare occurrence. A lethal dose for a small child can be 30 ml of strong alcohol. Children often try alcoholic drinks out of curiosity, sometimes they are treated by older friends or adults themselves give, as it seems to them, tiny doses of alcohol for medicinal purposes. A child can be poisoned by alcohol that penetrates through the skin during such home procedures as compresses and rubbing. Sometimes a child can be poisoned by alcohol through breast milk, which was fed to him by a drunk mother.

Due to the small weight and fast metabolic processes, severe alcohol poisoning (coma) in childhood can occur very quickly. In childhood, moderate intoxication is registered at an absolute alcohol content in the blood of 0.9-1.9‰, however, there have been cases when a superficial coma developed already at 0.8‰. In most cases, clear consciousness is preserved up to 2.0‰. The concentration threshold for the development of severe intoxication has a wide range from 1.64 to 5.4‰ (deep coma).

In the clinical picture of a child with a superficial coma, neurological disorders predominate. In the vast majority of cases, muscle tone decreases, pupils constrict, the pulse usually corresponds to the age norm or increases slightly, arterial pressure and hemodynamic data are within normal limits. The electrocardiogram shows insignificant changes in metabolic disorders. The reaction of the digestive system is expressed in nausea and vomiting.

In deep coma, there is a lack of all reflexes, respiratory function impairment, increased heart rate and a strong decrease in blood pressure. In accordance with the severity of the lesion, complications develop from the central nervous and cardiovascular systems.

In general, the symptoms of increasing intoxication in childhood follow the same scenario as in adults: euphoria → excitement → dullness → coma, but more rapidly and the outcome is unpredictable. Even if the child survives, in addition to brain damage, the condition may be complicated by aspiration pneumonia and mental disorders. Subsequently, the child will periodically experience seizures or hallucinations, delirium, abnormal excitement or inhibition.

Acute alcohol poisoning as a one-time situation can happen to anyone, even a person who is basically a non-drinker, who has relaxed and lost control over the dose of alcohol consumed. In a person who is not accustomed to the effects of ethanol, a much lower concentration of it in the blood is enough for poisoning.

However, chronic alcohol poisoning, although it increases the body's tolerance to its toxic effects (there are known cases of one person drinking three bottles of vodka at a time), causes irreparable damage to the body, all its organs and systems suffer, and is not a panacea for acute intoxication. Moreover, people suffering from alcoholism often become victims of counterfeit products and poisoning with industrial alcohols. The main symptom of chronic alcoholism is dependence, in the initial stage - weak, when a person can be distracted from the desire to drink. This stage of alcoholism is reversible, without access to alcohol, the dependence goes away.

The next stage comes when the desire to drink becomes obsessive, and the person lives in anticipation of this event.

The third, severe and irreversible stage, when psychological dependence develops into physiological: chronic alcohol poisoning leads to hormonal status disruption, the patient reaches a "plateau of tolerance" to ethanol - the dose of absolute alcohol without a gag reflex increases several times. Elimination of a hangover syndrome with new portions of alcohol leads to the patient practically "not drying out". Forced elimination of alcohol leads to delirium.

The fourth stage is characterized by complete dysfunction of vital organs and social degradation. The patient indiscriminately consumes everything - any alcoholic beverages, colognes, solvents, etc. In the absence of alcohol, a fatal outcome may occur, and its presence also leads to death.

Mild alcohol poisoning is characterized by unnatural animation, sociability, and slightly incoherent speech. The patient's behavior is not aggressive. Externally, as a rule, the skin turns red (blush on the cheeks, sometimes on the neck and décolleté), the pupils dilate, the patient experiences frequent urges to urinate and increased sweating - the body is intensively eliminating alcohol. If you stop at this stage, the symptoms do not cause significant inconvenience and quickly pass without consequences.

The average degree of poisoning is characterized by excitement, hostility, lethargy, disorientation in space (dizziness, swaying gait) and slurred speech, pale skin, nausea and even vomiting. The next morning the patient usually has no appetite, nausea, intense thirst, weakness, trembling hands, and may vomit (hangover syndrome). If this is an isolated case, it also passes without consequences. In patients with chronic diseases, their exacerbation may occur.

Next comes a pre-comatose state, which develops into the coma described above.

Many people ask: How long does alcohol poisoning last? It is impossible to answer this question, since it is absolutely individual, as is the amount of alcohol consumed, necessary for poisoning. A one-time toxic effect of alcohol on the body can last from several hours to several days. In case of chronic intoxication, the effect of alcohol becomes irreversible, since pathological changes occur in the vessels and organs. Even a small amount of alcohol is a poison and no one can reliably predict the consequences of its use, even a single one.

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Stages

The stages of intoxication and the corresponding symptoms depending on the alcohol content in the blood are roughly assessed as follows:

• up to 0.3‰ a person does not yet feel intoxicated and there are no deviations in his behavior;
• 0.3 – 0.5‰ – subclinical stage of intoxication, deviations in well-being and behavior are recorded only through special testing;
• on average 1.5‰ – mild (euphoric with a predominance of positivism) degree of intoxication, the person is sociable, talkative, evaluates himself and his actions only positively, at the same time concentration decreases, there are many mistakes in test tasks;
• on average 2.5‰ – average severity of intoxication (excitement with a predominance of negativity and hostility), emotions are unstable, their inhibition function is disrupted, self-critical assessment and concentration of attention are greatly reduced, perception is distorted, movements are imprecise, reactions are slow;
• 4‰-5‰ – high level of intoxication with the risk of death (soporous state with transition to a superficial coma), noticeable decrease in reactions, uncoordinated movements, a person cannot stand, then sit, vomiting, uncontrolled natural functions, convulsions, a decrease in temperature below normal and blood sugar levels;
• More than 5‰ – severe intoxication (deep coma), death is highly likely;
• 7‰ and higher – fatal poisoning, death occurs from cerebral edema, acute respiratory or cardiovascular failure.

On average, patients with alcohol poisoning in a comatose state usually have blood levels of 3.5 to 5.5‰ upon admission to hospital.

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Complications and consequences

In the toxicogenic stage of alcohol poisoning, the most dangerous complications are considered to be the development of respiratory failure with respiratory arrest and aspiration asphyxia.

Even if the patient has survived the toxicogenic stage of alcohol poisoning, accompanied by severe coma, it is not a fact that he will be able to avoid "trace" destructive and functional changes in the work of various organs and systems of the body. The greatest danger in the somatogenic stage is the development of pneumonia or toxic-hypoxic encephalopathy, the consequence of which may be vegetative existence. A rare complication of alcoholic coma is myorenal syndrome, which occurs due to impaired blood circulation in the vessels due to positional pressure on certain muscle groups as a result of prolonged immobility. This is one of the most severe complications. After emerging from a comatose state, patients notice myalgia, limited movement, progressive swelling of the affected limbs, sometimes individual parts of the body. The consistency of the edema is very dense, it covers the affected area from all sides.

Late complications of acute ethanol intoxication are a protective reaction of the body to its damaging effect and manifest themselves primarily as disturbances of the neuropsychic status. The patient comes out of unconsciousness gradually – reflexes and muscle tone are restored, fibrillatory muscle twitching appears. Often, when coming out of a comatose state, patients have hallucinations, stages of psychomotor agitation, alternating with periods of deep sleep.

Immediately after regaining consciousness, severely ill patients may develop a convulsive syndrome; attacks are accompanied by respiratory dysfunction due to tonic spasm of the masticatory muscles, abundant secretion of bronchial secretions, and residual overstrain of the skeletal muscles. In most cases, these disorders pass with subsequent inhibition and asthenia of patients. In the period after coma, as a rule, a transient asthenovegetative syndrome may be observed.

In chronic alcoholics, the return to consciousness is accompanied by the development of hangover and withdrawal syndromes, and delirium develops immediately without a period of abstinence from alcohol. The patient comes out of a coma immediately in "delirium tremens" or its symptoms appear after some time.

The consequences of acute alcohol intoxication may be the development of toxic hepatopathy or nephropathy of moderate severity, the signs of which appear at the end of the toxicogenic or somatogenic stage. Against the background of prolonged binge drinking preceding the poisoning, the probability of the onset of an acute inflammatory process of alcoholic genesis in the liver and fatty degeneration of its parenchyma cannot be ruled out.

In people who regularly consume alcohol, the consequence of prolonged intoxication may be liver cirrhosis. Acute alcohol poisoning for patients with cirrhosis may result in the development of acute liver failure, bleeding from dilated veins of the esophagus and stomach, thrombosis of the portal vein, which results in the development of hepatic coma after alcohol poisoning (in most cases, this is a fatal outcome).

Complications from the liver can result in chronic liver failure, ascites-peritonitis, and malignant neoplasms.

Complications of poisoning with repeated vomiting and the resulting dehydration (deficiency of sodium, chlorine and potassium, metabolic alkalosis) may include the development of a hyponatremia kidney. Symptoms are expressed as acute renal failure, which is eliminated by correction of the failure.

Acute alcohol poisoning provokes relapses of chronic diseases of the digestive organs; in particular, due to uncontrollable vomiting, patients with chronic gastritis may develop gastroesophageal rupture-hemorrhagic syndrome.

If vomit enters the respiratory system, it can cause aspiration pneumonia.

A later complication is acute or exacerbation of chronic inflammation of the pancreas ( pancreatitis ) or cholecystopancreatitis. These complications are typical for the use of counterfeit alcohol in small doses without symptoms of poisoning.

Systematic alcohol consumption leads to a decrease in the concentration of calcium and magnesium ions in the blood, an increase in the content of cortisol, and the initiation of blood acidification reactions, which contributes to the death of neurons and the development of atrophic changes in brain tissue.

The constant toxic effect of alcohol affects the work of the heart muscle in different ways - some develop hypertension, others - ischemic heart disease. Chronic alcoholics are posthumously diagnosed with sclerosis of the heart muscle, its obesity, dilation of the heart cavities, alcoholic cardiomyopathy, the obligatory symptom of which is considered to be fatty liver dystrophy.

Chronic alcoholism provokes the formation of malabsorption syndrome caused by the activation of enzymes that break down, in particular, retinol, which leads to accelerated destruction of retinol and hypovitaminosis A, in addition to a deficiency of other vitamins, minerals, proteins. The result of these processes is the development of multiple organ failure.

Fatal alcohol poisoning is often a consequence of excessive drinking, since this toxic substance affects all vital organs and systems of the human body. The pathomorphology of acute fatal intoxication is expressed in the form of increased permeability of the walls of all vessels without exception, plethora and hemorrhages are observed in all tissues and organs, blood circulation and lymph flow are completely disrupted. When autopsied, the cause of death is diagnosed as alcohol poisoning.

Also, in acute alcohol intoxication, the cause of death can be asphyxiation from vomit and hypothermia even at positive temperatures.

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Diagnostics alcohol poisoning

Patients with alcohol poisoning are almost always admitted to a medical facility unconscious. They undergo express diagnostics to determine the amount and type of alcohol-containing substance that caused the poisoning, using gas-liquid chromatography. This analysis usually takes several minutes.

Analysis of the remains of the consumed product and gastric lavage waters can be performed.

Also, tests are required to determine the level of ethyl alcohol in the blood and urine. This test is done twice with an interval of one hour. When taking blood for ethanol content, the skin is treated with an alcohol-free antiseptic to obtain the correct result. In parallel, the presence and concentration of other alcohols (methyl, butyl, isopropyl) is determined if the patient's symptoms raise suspicion of their presence.

For a comprehensive assessment of the patient's condition, standard laboratory diagnostics are mandatory. Blood is taken for general and biochemical tests, and urine. Depending on their results, specific studies may be prescribed.

The patient must undergo, first of all, an electrocardiogram. Additional instrumental diagnostics depend on the expected complications and may include ultrasound examination, computed tomography and magnetic resonance imaging, radiography, endoscopic gastroduodenal examination, and electroencephalogram.

Differential diagnostics of alcohol poisoning is carried out with craniocerebral injuries received against the background of intoxication, comas of other genesis (thyroid, diabetic, uremic), cardiogenic shock, vascular catastrophes (heart attack, stroke), poisoning with drugs and medicines. The greatest complexity is presented by cases of development of somatic comatose states against the background of alcohol poisoning or mixed intoxications.

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Treatment alcohol poisoning

Many people are confused and do not know what to do in case of alcohol poisoning. After all, it is necessary to take urgent measures, remove the intoxication, in order to prevent a fatal outcome.

Prevention

The most effective preventive measure against alcohol intoxication is a sober lifestyle, however, most citizens are unable to abstain from drinking at all.

Therefore, to avoid poisoning with alcoholic beverages, you should at least not drink on an empty stomach and not have a snack. Before the planned feast, try to eat high-calorie food (at least a sandwich with butter).

Avoid drinking large amounts of alcohol in a short period of time, and be sure to have a snack with each drink.

Do not drink during periods of acute or exacerbation of chronic diseases, during periods of taking medications, overwork, and do not “wash down” stress.

Try not to mix different alcoholic drinks and avoid drinking products of dubious quality.

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Forecast

According to statistics, deaths from alcohol poisoning are quite common, however, usually the victims of such cases are people who did not receive timely medical care.

According to resuscitation specialists who treat patients in an alcoholic coma, the most common outcome of treatment (≈90% of cases) is the patient’s recovery with full restoration of body functions; in 9.5% of cases, various complications develop and only 0.5% end in the patient’s death.

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