From there, it is slowly metabolized by the liver. A healthy liver typically metabolizes one standard drink per hour, which is equivalent to 12oz of 4% beer, 1.5oz of 80 proof liquor, or 5oz of table wine. The remaining alcohol continues to flow through the bloodstream until the liver is able to process it. 205 The amount of alcohol that was consumed determines the intensity of its effect on the body. Blood alcohol concentration, or the percent of alcohol in the bloodstream, typically increases as more drinks are consumed. Blood alcohol levels of 0.08% or higher are associated with mild balance, speech, and vision impairment, and are considered too high for driving in most states. Between 0.1 and 0.15%, motor coordination and balance are significantly affected, speech may be slurred, and major loss of balance can occur. Concentrations of 0.16 to 0.3% indicate severe intoxication, causing symptoms such as confusion, nausea, vomiting, and needing assistance walking. Blood alcohol concentrations of 0.35 to 0.4% are associated with a loss of consciousness and over 0.4% can cause a coma and increase the likelihood of death by respiratory failure. 205,206 A number of factors can impact a person’s response to alcohol consumption. The presence of food in the stomach can slow the absorption of alcohol; blood alcohol concentrations can be up to three times higher in a person with an empty stomach when compared to someone who ate a meal before drinking. In addition, up to 50% of people of Asian descent are less able to metabolize alcohol due to an inactive liver enzyme needed for metabolism, resulting in more rapid intoxication, flushing, dizziness, nausea, headache, and rapid heartbeat with alcohol use. Gender can also play a significant role on the effects of alcohol. Women have less body water than men to dilute alcohol, lower quantities of the liver enzymes needed to metabolize alcohol, and the effects of estrogen can slow down the rate of alcohol elimination from the body. In addition, with chronic use, tolerance to the CNS effects of alcohol develops, so the functional impact of a specific amount of alcohol can vary. 205 Withdrawal Approximately 8 to 12 hours after consuming alcohol, the body’s reaction to poisoning and withdrawal from alcohol, known as a hangover, begins. This reaction varies in severity based on the amount of alcohol consumed as well as individual factors, and can include headache, nausea, vomiting, fatigue, and depression. While there are a number of home remedies thought to help prevent or relieve hangovers, limiting the consumption of alcohol is the only effective remedy. Eating a full meal before drinking alcohol and alternating alcoholic drinks with non-alcoholic drinks can limit absorption. 205 Chronically heavy drinkers who suddenly decrease or stop consuming alcohol may experience alcohol withdrawal. Alcohol withdrawal symptoms typically peak within 24 to 72 hours of the last drink, and can continue for weeks. Common symptoms include irritability, anxiety, depression, mood swings, nightmares, fatigue, and confusion. Other symptoms,
such as rapid heart rate, sweating, tremor, insomnia, loss of appetite, nausea and vomiting can occur. Severe withdrawal can cause agitation, seizures, hallucinations, and delirium. 207 Patients at risk of developing complicated alcohol withdrawal should be closely monitored. Seizures can occur within 8 to 48 hours after stopping or reducing alcohol use, with risk peaking at around 24 hours. An impending seizure can produce signs such as high blood pressure, high pulse, tremors, high temperature, or overactive reflexes, though seizures can occur without warning as well. Patients who have experienced one alcohol withdrawal seizure are at a higher risk of having another seizure or progressing to alcohol withdrawal delirium. 171 Delirium is an acute state of confusion with impaired cognition that can occur during alcohol withdrawal. It is associated with increased morbidity and mortality, longer hospital stays, and increased utilization of health services. Prevention and early recognition are especially important in delirium management. Factors known to increase the risk of delirium include cognitive, visual or hearing impairments, immobility, dehydration, and sleep deprivation. 171 Complications The unhealthy use of alcohol can cause a number of medical and psychiatric complications, with higher use resulting in more profound effects. Health conditions associated with excessive alcohol use include: 208 ● Cirrhosis ● Hypertension ● Stroke ● Cardiomyopathy ● Hypogonadism ● Gastrointestinal effects such as GI bleeding, gastritis and GERD ● Osteoporosis Malnourishment is a significant issue seen with chronic alcohol use, resulting in deficiencies in vitamins A, B, and C, magnesium, folic acid, carnitine, selenium, zinc, antioxidants, and essential fatty acids. Moderate alcohol use has been associated with a higher risk of certain types of cancer, including cancers of the esophagus, larynx, mouth, liver, colon, and breast. Alcohol use is also associated with a higher risk of developing diabetes or acquiring HIV, and complicates disease state management due to the effects on medication adherence. 208 Alcohol interacts with a number of prescription medications, including opioids, anticoagulants, anxiolytics, sedatives, and anticonvulsants. Elderly patients and patients with polypharmacy are at a particularly high risk of experiencing adverse effects from medication-alcohol interactions. 208 Unhealthy alcohol use can also cause a number of social and mental health consequences. Depression is highly correlated with alcohol use disorders. ● Sexual dysfunction ● Chronic pancreatitis ● Brain atrophy ● Seizures ● Arrhythmias
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Book Code: CA23CME
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