Women have less body water than men to dilute alcohol as well as lower quantities of the liver enzymes needed to metabolize alco- Case study 1 Jane is a 21-year-old Japanese exchange student at the local university. She is brought to the emergency department by her roommate after an evening gathering of friends at their home. Her roommate states that Jane has been in and out of conscious- ness, and she presents with confusion, slurred speech, poor bal- ance, and memory loss. Her blood alcohol level is tested and found to be 0.14 percent. Jane’s roommate is confused because she thought Jane had fewer than two drinks that evening. The friends had a large meal together before they started drinking, and they were playing board games when Jane started to appear very intoxicated. Jane’s roommate hasn’t known Jane long, since they just moved in together the previous month, and she says she had never seen Jane drink prior to this evening. Jane’s roommate is concerned 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 pre- vent or relieve hangovers, limiting the consumption of alcohol is the only effective remedy. Eating a full meal before drinking alco- hol and alternating alcoholic drinks with nonalcoholic drinks can limit absorption (UC Santa Cruz, 2019). Heavy drinkers who suddenly decrease or stop consuming alco- hol may experience alcohol withdrawal. Alcohol withdrawal symp- toms typically peak within 24 to 72 hours of the last drink and can continue for weeks. Common symptoms include irritability, anxi- ety, depression, mood swings, nightmares, fatigue, and confu- sion. 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 se- vere confusion (Dugdale, 2021). 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 (Edelman & Fiellin, 2016): ● Cirrhosis ● Hypertension ● Stroke
hol, and the effects of estrogen can slow down the rate of alcohol elimination from the body (UC Santa Cruz, 2019).
that maybe Jane took other drugs or was drinking more in her room where other people wouldn’t see her. Jane was given a drug screen, which came back negative for the 10 most commonly abused drugs. Self-Assessment Quiz Question #1 Which of the following factors is most likely to influence Jane’s blood alcohol concentration? a. Eating a large meal prior to drinking. b. Jane’s age. c. Jane’s ethnicity. d. Jane’s living situation. 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 approximately 24 hours. An impending seizure can produce signs such as high blood pressure, increased heart rate, tremors, fever, or overactive reflexes, though seizures can occur without warning. Patients who have experienced one alcohol withdrawal seizure are at a higher risk of having another seizure or progress- ing to alcohol withdrawal delirium (American Society of Addiction Medicine, 2020). An acute state of confusion with impaired cognition, known as delirium, can occur during alcohol withdrawal. It is associated with increased morbidity and mortality, longer hospital stays, and in- creased utilization of health services. Prevention and early recog- nition are especially important in delirium management. Factors known to increase the risk of delirium include cognitive, visual, or hearing impairments; immobility; dehydration; and sleep depriva- tion (American Society of Addiction Medicine, 2020). at a particularly high risk of experiencing adverse effects from medication– alcohol interactions (Edelman & Fiellin, 2016). Unhealthy alcohol use can also cause a number of social and men- tal health consequences. Depression is highly correlated with al- cohol use disorders. Accidents such as falls, burns, and firearm injuries are more common among heavy drinkers, as is unsafe sex, intimate partner violence, homicide, and suicide (Edelman & Fiel- lin, 2016). Alcoholic Liver Disease Alcoholic liver disease covers a spectrum of liver disorders, beginning with steatosis, or fat accumulation in the liver; progressing to hepatitis, or inflammation of the liver cells; and ending with cirrhosis, or irreversible damage to the liver (Patel & Mueller, 2022). Signs and symptoms of liver disease include (American Society of Addiction Medicine, 2020): ● Edema ● Jaundice ● Dark-colored urine ● Itchy skin ● Pale, bloody, or tar-colored stool ● Chronic fatigue ● Confusion ● Nausea or vomiting Heavy alcohol users can present with alcoholic liver disease be- tween 40 and 50 years of age. Liver disease can be progressive, and between 10 to 20 percent of patients with alcoholic hepatitis progress to cirrhosis each year. The management of alcoholic liver disease can vary depending on the extent of disease. Alcohol ces- sation is highly recommended for patients with alcoholic liver dis-
● Cardiomyopathy ● Hypogonadism ● Gastroesophageal reflux ● Osteoporosis ● Sexual dysfunction ● Chronic pancreatitis ● Brain atrophy ● Seizures ● Arrhythmias
Malnourishment is a significant issue associated with chronic al - cohol use, resulting in deficiencies in vitamins A, B, and C; mag - nesium; 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 those of the esophagus, larynx, mouth, liver, colon, and breast. Alcohol use is also associated with a higher risk of developing diabetes and acquiring HIV, and it complicates disease state management because of the effects on medication adherence (Edelman & Fiel- lin, 2016). Alcohol interacts with a number of prescription medications, in- cluding opioids, anticoagulants, anxiolytics, sedatives, and anti- convulsants. Elderly patients and patients with polypharmacy are
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