Alcohol Intoxication, Its Associated Pathology and Alcohol Withdrawal
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Alcohol, and alcohol intoxication. I am sure you must know one friend in college who always drank a lot of alcohol, and always made you do some cleaning whenever they throw up, or that friend that turned you into a support system whenever they were done with several glasses. I guess you remember? Today, I will be discussing Alcohol and alcohol intoxication. Alcohol intoxication occurs when a person has consumed a sufficient amount of alcohol beyond their limit to cause a range of physical and cognitive effects. Alcohol intoxication leads to Stupor (a state of reduced consciousness or responsiveness to external stimuli. Characterized by a diminished level of awareness and decreased ability to respond to their environment), Ataxia (a neurological condition characterized by lack of coordination and balance, caused by damage to the cerebellum or other parts of the nervous system responsible for controlling movement), and Slurred speech. When a person is intoxicated with alcohol, there is the toxicity of the cerebellar neurons. This is why people who are intoxicated with alcohol find it difficult to walk since the cerebellum is responsible for the coordination of motor movement.
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Alcohol works through the GABA system causing the GABA-mediated agonist and NMDA (N-methyl-D-aspartate) inhibition. Alcohol causes inhibition by agonizing GABA thereby turning on an inhibitory neurotransmitter and decreasing excitation by inhibiting (N-methyl-D-aspartate). Causes inhibition of motor neurons which causes a decrease in speech, movement, and mental capacity by inhibiting the central nervous system by agonizing GABA and turning off an excitatory neurotransmitter in glutamate by targeting an NMDA inhibitor. There is a high-yield association between alcohol intake and the cause of other diseases and pathology because it is no doubt that alcohol doesn't affect the neurological system alone, it affects so many other systems or organs causing a lot of diseases or disorders such as Dilated Cardiomyopathy, Cirrhosis, Esophagus Varice, Aspiration Pneumonia, and Fetal Alcohol Syndrome. Let me do a one-by-one overview of these disorders.
- Dilated Cardiomyopathy
This is a disorder that occurs as a result of weakened heart muscles causing an excessively enlarged ventricle, which leads to a backup of fluid in the cardiovascular system leading to symptoms such as Peripheral Edema, Jugular venous distension (JVD) and could lead the heart not functioning properly, S3 heart sound, and eventually heart failure. Alcohol can cause Dilated Cardiomyopathy.
- Cirrhosis
Cirrhosis is an Alcohol-Related Liver disease where the liver tissue is replaced with scar tissue. This is a progressive disease of the liver that isn't reversible leading to liver cell failure, and portal hypertension. Patients with Cirrhosis can show symptoms such as Esophageal Varices, peptic ulcer, splenomegaly, Jaundice, Anemia, Hepatic hypertension, ankle edema, and scleral icterus.
- Wernicke-Korsakoff (WK) syndrome
Wernicke-Korsakoff (WK) syndrome is associated with chronic alcohol misuse and alcohol use disorder. It damages the mammillary bodies with Wernicke starting first and Korsakoff next. During Wernicke disease, the deficiency can be treated if the alcohol intake is stopped early and the thiamine deficiency is treated quickly but if the deficiency isn't treated fast enough, it could lead to Korsakoff syndrome where the disease is irreversible. Alcohol causing thiamine deficiency, leading to mammillary body toxicity would cause symptoms such as Internuclear optimal plasia, and memory loss in Korsakoff syndrome (anterograde amnesia) which is irreversible.
- Alcoholic Pancreatitis
Alcohol can cause damage to the pancreatic tissue causing pancreatitis. It is responsible for about 17% to 25% of total cases of pancreatitis and patients show symptoms that include; Anorexia, steatorrhea, and Acute abdominal pain. On observation, if the patient isn't a fat, fertile, 40 years old female, there is a high chance that the pancreatitis isn't a result of gallbladder but alcohol.
- Esophageal Varices
You must have seen me write this above but I will like to discuss it too. Actually, it has to do with enlarged veins in the esophagus. It is can be triggered by excessive use of alcohol and it is associated with Alcoholic Cirrhosis, as the patient may vomit a lot of blood.
- Aspiration Pneumonia
Patients who can't protect their airways suffer from Aspiration pneumonia. It is an inflammation and infection of the lungs, allowing contents to go through the trachea instead of the esophagus and this can be a result of drug intoxication and alcohol intoxication.
- Fetal Alcohol Syndrome
This is a disorder that affects infants from when they were fetuses. It is caused by mothers who drink alcohol while being pregnant. Children will have thin lips, Smooth philtrum, and Nasal bridge abnormality.
Alcohol Withdrawal
When a person takes alcohol at a moderate level, there is a balance between GABA and NMDA. The person gets a little excited and a little inhibited but when the person takes excessive alcohol, there is a downregulation in the GABA receptors as a result of Ligand bombarding. There will be a decrease in the level of GABA agonist causing full excitation as a result of more NMDA (glutamate). This could lead to showing signs of neurotoxicity/neuro excitation such as seizures. In the first 24 hours of the withdrawal, patients start to experience autonomic hyperactivity with symptoms such as tremors, anxiety, hypertension, and tachycardia. In about 48 hours, patients with alcohol withdrawal could experience seizures and visual hallucinations. At about 72 hours, they start to experience Delirium Tremens where patients start to see symptoms such as seizures associated with psychosis, and disorientation. Treatment is Benzodiazepines (diazepam, oxazepam, chlordiazepoxide), as Benzodiazepine is a GABA agonist.
National Library of Medicine - Alcoholic Cardiomyopathy
National Institute on Alcohol Abuse and Alcoholism - Wernicke-Korsakoff Syndrome
Adementia.org.au - lcohol related dementia and Wernicke-Korsakoff syndrome
NHS - Alcohol-related liver disease
National Library of Medicine - Alcoholic Liver Disease: Pathogenesis and Current Management
National Library of Medicine - Alcoholic Pancreatitis
National Library of Medicine - Pathophysiology of alcoholic pancreatitis: An overview
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