Alcohol poisoning: signs, diagnostics

Ethyl alcohol is a hydrophilic organic product of fermentation found everywhere: in the water of natural water bodies and atmospheric precipitation, other natural liquids, in soil layers, in plant tissues, animals and humans. In human blood, 0,03-0,04 ‰ of endogenous ethanol is constantly determined (the unit of measurement of the concentration of ethyl alcohol - ppm (‰) is ten times less than one percent). Naturally, such a body-like fluid, getting through the digestive tract, is absorbed very quickly and enters the systemic bloodstream. The fifth part of the accepted dose is absorbed already in the stomach, the rest in the upper parts of the small intestine. The tissues of the brain have 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 violation of the central nervous system.

[1], [2], [3], [4]

Epidemiology

Alcohol poisoning in the structure of mortality from external causes occupy one of the leading positions, competing with suicides and fatal road accidents. There is a view of death directly from poisoning, because asphyxia vomit, mostly caused by an overabundance of alcohol in the blood, hypothermia in a state of intoxication are already considered as separate reasons.

In the structure of morbidity among all the poisonings, which hit the field of view of physicians, more than half - alcoholic.

Periodically, the press covers cases of selling counterfeit liquor, more often it is vodka. Mass alcohol poisoning is periodically recorded in different regions, with about half of the victims usually not surviving.

[5], [6], [7], [8],

Causes of the alcohol poisoning

Poison high-quality food alcohol is possible only with excessive use of alcoholic beverages. But the moderation in this issue is very individual.

Doses of alcohol poisoning depend on many factors - weight, patient's health, age, the presence of food in the stomach, the degree of fatigue, the habit of drinking. The conditionally toxic dose of absolute alcohol is 2-3 ml per kilogram of body weight, with the use of such an amount, there may already be symptoms of acute intoxication.

Deadly for a person are situations where a large dose of alcohol has been taken only once or for a short period of time. On average, such a dose is considered to be the reception of five to eight milliliters of pure alcohol per kilogram of body weight, ie a half liter bottle of even a high-quality 40% vodka, soaking for a period of less than six hours can be fatal for a non-drinking person weighing 40-45kg. However, these are average indicators. Sensitivity to alcohol in all different. People with alcohol dependence are more resistant to the lethal effects of alcohol, young and healthy are more likely to suffer an alcohol load than people of old age. The least tolerant to the action of ethanol, usually women and children.

In order to poison non-food alcohols, a very small dose is needed, for example, with the use of methyl alcohol, a dose of 20 ml can be fatal if you use 200ml or more; however, the quality of life after that is not high, 15 ml already causes irreversible loss of vision.

The lethal oral dose of isopropyl alcohol for adults is 240 ml, butyl - in different sources has a wide spread from 30 to 200-250 ml.

Risk factors for alcohol poisoning are various cerebrovascular diseases (stroke, impaired GABA and glutamatergic systems, chronic cerebral pathologies), cardiac dysfunction, and metabolic disorders. The risk of fatal alcohol poisoning is higher in people with respiratory, hepatic and renal insufficiency, diseases of the gastrointestinal tract.

Alcohol addiction increases the possibility of poisoning, although it helps to increase tolerance of the organism to ethanol, however, its systematic use and lack of sense of proportion in alcoholics leads to the fact that their majority among the deceased from this cause.

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

Alcoholic beverages have a shelf life that can not be ignored; it is much more likely to be poisoned by a home-made product or bought in a dubious outlet, sometimes produced even from technical alcohol.

[9],

Pathogenesis

Speech, basically, will go about alcohol poisoning, an acute one-time situation that arose as a result of the exogenous effect on the human body of alcohol-containing substances in amounts that upset the functioning of organs and body systems and are life-threatening. Often poisoning is called intoxication, which is not entirely true. By intoxication means a condition that develops under the influence of regular and prolonged reception of alcoholic beverages, as a result of which the course of physiological processes in the body is disrupted and multi-organ failure is developing.

Most often practicing doctors face acute poisoning with alcoholic substances taken internally for the purpose of intoxication (banal peregia). And the victims are as people regularly and many drinkers, exceeding the tolerance threshold, and non-drinkers, among them - children and adolescents.

Much less often occur poisoning with technical fluids taken by mistake, or intentionally (substance abuse).

All representatives of alcohols have the ability to quickly absorb through the walls of the stomach (the fifth part of the dose) and the upper parts of the small intestine (the rest). Distribution occurs fairly evenly, the phases of absorption and excretion of ethanol are delineated fairly clearly. Alcohol can be detected in the blood just five minutes after its administration, to reach the highest level of its content, equal to the entire accepted dose, one or two hours is enough. Absolute alcohol and its cleavage products interact with diverse structures in living systems - intra- and extracellular receptors, enzymes, transmitters and others.

Elimination begins when almost all (more than 90%) of the accepted dose of pure alcohol is absorbed. Metabolism products and unchanged alcohol leave the body through the air 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 taken out unchanged. This process takes from seven hours to half a day, and in the urine, ethanol is detected for a much longer time than in the bloodstream.

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

In a stomach full of food, the absorption of ethanol slows down, in an empty stomach and with repeated use, absorption is much faster. Diseases of the stomach contribute to an increase in the rate of absorption of ethanol.

Hepatocytes split 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 to form water and carbon dioxide. There is a process of metabolism with a rate of 90 to 120 mg of ethanol taken per hour per kilogram of weight of the drinker.

Acute alcohol intoxication occurs when drinking alcoholic strength above 12%. You can get poisoned, as a rule, by taking one large dose at a time or for a short period of time. The severity of the toxic effect increases with the concentration of alcohol molecules in the blood at a high rate, that is, when the dose of the drink is constantly increasing. Despite the equal levels of absolute alcohol in the blood, its poisoning effect in the absorption phase is more intense than in the phase of excretion.

The concentration of alcohol more than three grams per liter of blood can already cause someone, and five to six grams or more - is considered a lethal dose. Much depends on the habit of drinking.

The pathogenesis of ethanol damage to the central nervous system is manifold. The molecule of alcohol is completely implanted in the fatty biomayer of the cell membrane of the neuron and changes its fluidity by modifying the structure of phospholipids. Membranotoxic action changes the intensity of the processes of synthesis of neurotransmitters and the transmission of nerve impulses.

The neurotoxic effect of ethanol is manifested by disorders in the brain systems responsible for excitation (glutamatergic) and inhibition (GABA-ergic). The balance of presynaptic isolation of neurotransmitters and their postsynaptic action is disrupted, since ethanol tropen to GABA receptors and potentiates the action of γ-aminobutyric acid. With the increase in the degree of intoxication, the stability of the GABA-ergic system develops to its own neurotransmitter.

Ethyl alcohol interacts with the serotoninergic system, resulting in the use of significant doses to episodic amnesia, with cholinergic - stimulating a dose-dependent inhibition of acetylcholine release into the synapse and inhibiting the entry of Na + ions through the neuronal envelope, which contributes to the development of a series of neurological disorders in the symptoms of acute alcohol poisoning.

To the effects of whole unchanged ethanol molecules is added intoxication with acetaldehyde, the product of its metabolism, which is toxic to the precursor by about 30 times. 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 from aldehydes is temporarily weakened. In addition, under the influence of intoxication, the synthesis of endogenous aldehydes is activated again in the cerebral tissues. The increased concentration of acetic aldehyde and its derivatives promotes 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 the development of acute poisoning with ethyl alcohol, along with impairments in the functions of the brain, are disorders of respiratory function according to the aspiration-obturation type (obstruction of the respiratory tract by bronchial secretion, saliva, vomit, tongue Westernization), and in severe cases impact on the respiratory center of the brain.

Oxygen starvation develops, which aggravates the cerebral disorders caused by the lack of normal oxidation-reduction reactions, water-salt balance, and other metabolic processes. People who regularly drink hot drinks, in the face of acute alcohol intoxication, often develop hypoglycemia, leading to coma.

Violated vascular tone, leading to a decrease in the volume of circulating blood and hemodynamic disorders. Cardiotoxic action is associated with the disorder of the regulation of the vascular tone against the background of changes in metabolic processes, the structure and functioning of the cardiac muscle. In its pathogenesis, the main role belongs to metabolic disturbances with inhibition of the enzymatic activity of mitochondrial enzymes and an increase in the activity of enzymes involved in the metabolism of ethanol, 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 a metabolic disorder in the heart muscle is the development of heart failure with a disorder of heart rate and frequency.

The liver reaction to alcohol intoxication is most often expressed by the development of fatty hepatosis - severe metabolic disorders in the liver cells cause the deposition of fats in their cytoplasm. The root cause of the dysfunction, and later - changes in the morphology of liver cells under the influence of ethanol, are the metabolic shifts that occur during the oxidation of alcohol. Its splitting in cells occurs much faster than the expenditure of energy released at the same time.

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

The reaction of the kidneys as a secretory organ to alcohol intoxication is primarily to reduce their ability to eliminate uric acid from the body.

The most frequent and dangerous poisoning is counterfeit alcoholic products using methyl alcohol, which is split to formaldehyde and formic acid, which have a wide toxic effect. Especially suffering from methanol poisoning the retina of the eye and the optic nerve, to lose sight forever enough to drink 15ml of methyl alcohol. As a result of methanol poisoning, severe acidosis develops.

Higher alcohols and fusel oils are much (in 1,5 - 3 times) toxic 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 ordinary alcohol. The same enzymes participate in their metabolization.

For example, as a result of oxidation in hepatocytes of isopropyl alcohol, two acids are formed - propionic and lactic acid, in addition - the product of its metabolism is acetone, which for a long time splits into water and carbon dioxide. Acetonemia develops by oral use of isopropyl alcohol for a quarter of an hour, at the same time, the elimination of acetone and unaltered alcohol through the lungs with air emerging from them begins. Elimination of these two components occurs also through the urinary tract.

Butyl alcohol is rapidly absorbed and is also excreted. Its greatest content is determined in the parenchyma of the liver and blood. Metabolized to butanol, butane and acetic acids. 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 use of even high-quality alcohol causes chronic alcohol intoxication. The mechanism of its development is connected with its action on the main vital organs. The systematic use of alcoholic beverages, and even a small amount, primarily affects the cells of the brain, liver and heart, as well as the digestive tract, pancreas, kidneys, lungs and retina. Alcohol dependent persons develop pathological alcohol intoxication provoking the development of inflammatory and necrotic changes in the tissues of these organs. The daily use of more than 170 grams 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 any particular person (the target organ) undergoes morphological changes, and either cardiomyopathy, or encephalopathy, or cirrhosis of the alcoholic etiology, or pancreatic necrosis and other pathologies develops. Although other organs suffer too, but to a lesser extent.

Alcohol intoxication of the target organ develops in stages:

• Vascular membranes are the first to suffer - their permeability rises;
• develops edema and increases the filling of the tissues of the body with blood;
• dystrophic processes begin, depending on the structure of the organ tissue develops protein, fatty, granular and other dystrophies;
• tissue respiration is disrupted, oxygen deficiency develops;
• Atrophic processes and sclerotic changes occur.

[10], [11], [12], [13], [14], [15], [16]

Symptoms of the alcohol poisoning

The first signs of toxic effects of alcohol are manifested even with moderate (and sometimes - light) degrees of intoxication. They are:

• migraine-like headache due to decreased vascular tone and widening of their lumen;
• dizziness and impaired coordination as a result of ethanol damage to the vestibular apparatus of the brain;
• the defeat of the autonomic nervous system is manifested by nausea and dizziness;
• vomiting as a protective reaction of an organism that is striving to get rid of a toxic substance, first the patient tears food if there was no food in the stomach or she has already left with vomit-the patient tears the bile;
• since this is a poisoning, it is quite possible for a very high temperature, alcohol also causes vascular disorders and central nervous system depression, which leads to hypothermia;
• Neurological disorders when taking large doses of alcohol can manifest as convulsions.

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

The stage of superficial coma begins when the patient loses consciousness. Communication with the patient at this stage is absent, the corneal reflex (the closing of the eyes as a response to the irruption of the cornea) and the change in the size of the pupil that reacts to the light stimulus are suppressed. Sensitivity to pain is markedly reduced, however, in response to a painful stimulus, the patient is weakly protected by the hands, there is an increase in the diameter of the pupils and mimic signs of soreness. In rest, pupils are more often narrowed, neurologic manifestations (changes in muscle tone, different pupil diameter, "floating" eyes) have a non-permanent character.

With the progression of central nervous system depression, the stage of deep coma develops, when all kinds of reflexes and muscle tone are already absent, the sensitivity to pain stimuli disappears completely, the blood pressure in the arteries drops to a state of collapse and the body temperature drops to 36 ℃ and lower. The skin is covered with viscous cold drops of sweat and acquires a purple-red or pale-cyanotic hue.

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

Disturbances of cardiac activity are diverse and nonspecific - arrhythmia, tachycardia, moderate hyper- or hypotension right up to collapse, acute heart failure. The tone of the vessels is lowered, and at a deep coma - and completely absent, rheological properties of blood are violated, the circulatory process is disrupted.

Disturbances of homeostasis is manifested by acidosis, dehydration, nonequilibrium water-salt and acid-alkaline states.

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

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

The rash after alcohol poisoning suggests that the liver and organs of the gastrointestinal tract no longer withstand the load and it's time to take care of them. With alcohol in this case, better to say goodbye forever.

If the rash appears after each, not even profuse, libation, then it can be an allergy to alcohol. Drinking alcohol can also provoke and intensify an allergic reaction to any allergen, respiratory, food or medicinal.

The poisoning of alcohol by surrogates unites a wide range of concepts. Symptoms of such poisonings are different and depend on what substance the individual has poisoned. Alcohol surrogates are a collective term that can mean wine and home-made vodka, then the symptomatology of poisoning with fusel oils (a mixture of higher alcohols and ethers) will prevail; counterfeit (illegal) products, perfume (cologne) and technical products (varnish, stain, stain removers, solvents), pharmaceutical tinctures for alcohol and others.

Poisoning with substandard alcohol (a truly surrogate product that is made on the basis of technical poorly purified ethyl alcohol and also containing fusel oil) causes symptoms similar to that of high-quality alcoholic drinks, except that symptoms may appear and grow more quickly, and a dose sufficient for acute poisoning, it will take less.

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

Methanol poisoning occurs quite often, mainly, it is used by people with alcohol dependence 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 which manifest themselves in not earlier than 12 hours after its administration, and sometimes even later, when the necessary amount of its cleavage products (formaldehyde and formic acid) accumulates in the body. There are symptoms of severe acidosis, clouding or complete absence of vision (pupils dilate and their reflexes absent), vegetative-vascular disorders.

Poisoning a child with alcohol is not that rare. A lethal dose for a young child can be 30ml strong alcohol. Children often try alcoholic beverages out of curiosity, sometimes they are treated by older comrades or the adults themselves give what they think are scanty doses of alcohol for medicinal purposes. The child can be poisoned by alcohol, penetrated through the skin during such home procedures as compresses and rubbing. Sometimes a child is poisoned with alcohol through breast milk, which he fed his drunk mother.

Because of the low weight and rapid metabolic processes, the severe stage of alcohol poisoning (coma) in childhood can occur very quickly. In childhood, intoxication of moderate severity is recorded with absolute blood alcohol content of 0.9-1.9 ‰, however, there have been cases when the superficial coma developed already at 0.8 ‰. In most cases, up to 2.0 ‰, a clear consciousness remains. Concentration threshold for the development of heavy intoxication has a wide range from 1.64 to 5.4 ‰ (deep coma).

In a clinical picture in a child with superficial coma, neurologic disorders predominate. In the overwhelming majority of cases, muscle tone decreases, pupils narrow, the pulse usually corresponds to the age norm or increases somewhat, blood pressure and hemodynamic data are within the norm. An electrocardiogram shows insignificant changes in metabolic disturbances. The reaction of the digestive system is expressed in nausea and vomiting.

With a deep coma, there is a lack of all reflexes, a violation of respiratory function, an increase in 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 system.

In general, the symptomatology of the increase in intoxication in childhood occurs according to the same scenario as in adults: euphoria → excitation → stupefying → coma, but more rapidly and the outcome is unpredictable. Even if the child remains alive, then, except for brain lesions, the condition can be complicated by aspiration pneumonia and mental disorders. Subsequently, the child will periodically experience convulsive seizures or hallucinations, delusions, abnormal excitation or inhibition.

Acute alcohol poisoning as a one-time situation can occur with anyone, even, in principle, a non-drinker, relaxed and lost control of the dose of alcohol consumed. Just a person who is not accustomed to the action of ethanol, for poisoning, a much smaller concentration of it in the blood.

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

The next stage comes when the desire to drink becomes obtrusive, a person lives expecting this event.

The third, severe and irreversible stage, when psychological dependence develops into a physiological one: chronic alcohol poisoning leads to a violation of the hormonal status, the patient reaches the "tolerance plateau" to ethanol - the dose of absolute alcohol without a vomiting reflex grows at times. Elimination of hangover syndrome with new portions of alcohol leads to the fact that the patient practically "does not dry out". Forced elimination of alcohol leads to delirium.

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

The mild poisoning with alcohol is characterized by unnatural animation, sociability, slightly incoherent speech. The behavior of the patient is not aggressive. Externally, as a rule, the skin reddens (blush on the cheeks, sometimes on the neck and in the décolleté zone), the pupils dilate, the patient often has urge to urinate and sweating - the body intensively takes out alcohol. If you stop at this stage, the symptoms do not bring significant discomfort and quickly pass without consequences.

The average degree of poisoning is characterized by excitation, hostility, inhibition, disorientation in space (dizziness, swinging gait) and inarticulate speech, pallor of the skin, nausea and even vomiting. The next morning the patient usually has no appetite, nausea, severe thirst, weakness, trembling of the hands, may be vomiting (hangover syndrome). If this is an isolated case, then it also passes without consequences. In patients with chronic diseases, there may be an exacerbation.

Next comes the predkomatoznoe state, growing into a coma, described above.

Many people ask: How long does alcohol poisoning last? Reply to it is impossible, because it is absolutely individual, as well as the amount of drunk, necessary for poisoning. One-time toxic effect of alcohol on the body can last from several hours to several days. With chronic intoxication, the effect of alcohol becomes irreversible, since pathological changes occur in the vessels and organs. Alcohol, even in small amounts, is a poison and the consequences of its use, even one-time, can not be predicted by anyone.

[17]

Stages

The stages of intoxication and the corresponding symptomatology, depending on the alcohol content in the blood, are roughly estimated as follows:

• up to 0.3 ‰ a person still does not feel intoxicated and deviations in his behavior are absent;
• 0,3 - 0,5 ‰ - subclinical stage of intoxication, abnormalities in well-being and behavior are recorded only through special testing;
• on the average 1.5 ‰ - easy (euphoric with prevalence of positivism) degree of intoxication, the person is sociable, talkative, evaluates himself and his actions only positively, at the same time concentration of attention decreases, in test tasks there are many mistakes;
• on average, 2.5 ‰ is the average severity of intoxication (excitation with predominance of negativism and hostility), emotions are unstable, their inhibition function is upset, self-critical evaluation and concentration of attention are greatly understated, perception is distorted, movements are inaccurate, reactions are slow;
• 4 ‰ -5 ‰ - a high degree of intoxication with the threat of death (a co-morbid state with the transition to superficial coma), a marked decrease in reactions, uncoordinated movements, a person can not stand, and then sit, vomiting, uncontrollable natural departures, convulsions, lower temperature norms and blood sugar levels;
• More than 5 ‰ - severe intoxication (deep coma), very likely a lethal outcome;
• 7 ‰ and higher - lethal poisoning, death comes from cerebral edema, acute respiratory or cardiovascular insufficiency.

On average, patients with alcohol poisoning in comatose state on admission to the hospital in the blood are usually found from 3.5 to 5.5 ‰.

[18]

Complications and consequences

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

Even if the patient has experienced a toxicogenic stage of alcohol poisoning, accompanied by a severe coma, it is not a fact that he will 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 toxicohypoxic encephalopathy, the consequence of which can be a vegetative existence. A rare complication of alcohol coma is myorienal syndrome, which arises from the violation of 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 serious complications. Coming out of a coma, patients notice myalgia, restriction of movements, progressive swelling of the affected extremities, sometimes separate parts of the trunk. The consistency of the edema is very dense, it covers the affected area from all sides.

The late complications of acute ethanol intoxication are a protective reaction of the body to its damaging effect and are manifested, first of all, as a violation of the neuropsychological status. The patient comes out of the unconscious state gradually - reflexes are restored, muscle tone, muscle fibrillation twitches appear. Often when you leave the coma, patients have hallucinations, stages of psychomotor agitation, followed by periods of deep sleep.

Immediately after returning to consciousness in severe patients, convulsive syndrome may develop, attacks accompanied by a violation of respiratory function due to tonic spasm of masticatory muscles, abundant secretion of bronchial secretion and residual overstrain of skeletal muscles. In most cases, these disorders occur with subsequent inhibition and asthenization of patients. In the period after coma, as a rule, a transient asthenovegetative syndrome can be observed.

In chronic alcoholics, the return to consciousness is accompanied by the development of hangover and abstinence syndromes, and delirium develops immediately without a period of abstinence from alcohol. The patient exits the coma immediately in a "white fever" or her symptoms appear after a while.

The consequences of acute alcohol intoxication may be the development of toxic hepato- or nephropathy of moderate severity, the signs of which appear at the end of the toxicogenic or somatogenic stage. Against the background of the preceding long drinking-bout poisoning, the possibility of initiating an acute inflammatory process of alcoholic genesis in the liver and fatty degeneration of its parenchyma is not ruled out .

People who regularly drink alcohol, the consequence of prolonged intoxication may be cirrhosis of the liver. Acute alcohol poisoning for patients with cirrhosis can result in the development of acute hepatic insufficiency, bleeding from the esophageal and gastric dilated veins, portal vein thrombosis, which results in a hepatic coma after alcohol poisoning (in most cases, it is fatal).

Complications from the liver can result in its chronic failure, ascites-peritonitis, malignant neoplasm.

Complications of poisoning with multiple vomiting and the resulting dehydration (sodium, chlorine and potassium deficiency, metabolic alkalosis) may be the development of hyponatrickemic kidney. Symptomatology is expressed as acute renal failure, eliminated by correction of insufficiency.

Acute alcohol poisoning provokes relapses of chronic diseases of the digestive organs, in particular, because of indomitable vomiting in patients with chronic gastritis, gastroesophageal esophageal hemorrhagic syndrome can develop.

The ingestion of vomit into the respiratory organs provokes the development of 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 reception of alcohol leads to the fact that the concentration of calcium and magnesium ions decreases in the blood, the content of cortisol is increased and the reactions of acidification of the blood are triggered, which contributes to the death of neurons and the development of atrophic transformations in the brain tissues.

The constantly present toxic effect of alcohol affects the operation of the heart muscle in different ways - someone develops hypertensive disease, another - ischemic heart disease. Chronic alcoholics posthumously detect sclerosis of the heart muscle, its obesity, enlargement of the heart cavity, alcoholic cardiomyopathy, the obligate symptom of which is fatty liver disease.

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 the lack of other vitamins, minerals, and proteins. The result of these processes is the development of multi-organ failure.

The consequence of excessive libations is often a lethal poisoning with alcohol, 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, all the tissues and organs are full of blood and hemorrhages, blood circulation and lymph flow are completely disturbed. When autopsied with such morphological signs and high concentrations of ethanol in blood and urine, the cause of death is diagnosed - alcohol poisoning.

Also, acute alcohol intoxication causes death asphyxia vomit and hypothermia, even at a positive temperature.

[19],

Diagnostics of the alcohol poisoning

Patients with poisoning alcohol-containing products almost always enter a medical institution in an unconscious state. He carried out rapid diagnostics to determine the amount and type of alcohol-containing substance that caused poisoning, using gas-liquid chromatography. The time of this analysis usually takes several minutes.

An analysis of the residues of the product and gastric washings can be performed.

Also, assays are required to determine the level of ethyl alcohol in the blood and urine. Such a study is done twice with an interval of one hour. When blood is taken to ethanol to get the right result, the skin is treated with an antiseptic that does not contain alcohol. In parallel, the presence and concentration of other alcohols (methyl, butyl, isopropyl) is determined if the patient's symptoms raise suspicion in their presence.

For a holistic assessment of the patient's condition, generally accepted laboratory diagnostics are mandatory. Blood is taken for analysis, general and biochemical, urine. Depending on their results, specific studies can be assigned.

Necessarily the patient is made, in the first place, electrocardiography. Additional instrumental diagnostics depends on the expected complications and may include ultrasound, computer and magnetic resonance imaging, radiography, endoscopic gastroduodenal examination, and an electroencephalogram.

Differential diagnosis of alcohol poisoning is carried out with craniocerebral trauma, received against the background of intoxication, coma of another genesis (thyroid, diabetic, uremic), cardiogenic shock, vascular accidents (infarction, stroke), drug poisoning and drugs. The most complex cases are cases of development of somatic coma in the presence of alcohol poisoning or mixed intoxications.

[20], [21], [22], [23]

Treatment of the alcohol poisoning

Many are lost and do not know what to do with alcohol poisoning. After all, you need to take urgent measures, remove intoxication, in order to prevent a fatal outcome.

Prevention

The most effective preventive measure against alcohol intoxication - a sober way of life, however, do not drink at all for most citizens does not work.

Therefore, in order to avoid poisoning with alcohol you need at least not to drink on an empty stomach and not having a snack. Before the planned feast, try to eat high-calorie food (at least a sandwich with butter).

Do not consume large amounts of alcohol in a short period of time, be sure to eat every dose.

Do not drink during periods of acute and exacerbation of chronic diseases, during medication, fatigue, do not "wash down" stress.

Try not to mix different alcoholic beverages and avoid the use of products of questionable quality.

[24]

Forecast

According to statistics, the death rate from alcohol poisoning is quite common, however, people who did not receive medical care in a timely manner became victims of such cases.

According to reanimatologists, who get patients in a state of alcoholic coma, the most frequent outcome of treatment (≈90% of cases) is recovery of the patient with complete recovery of body functions, in 9.5% of cases, various complications develop and only 0.5% result in death of the patient .

[25]