On weekends or holidays, the number of patients with ethanol poisoning treated in our department increases significantly. Sometimes, we have to treat five or six patients with ethanol poisoning in one night shift. When they come to the hospital, they are all drunk, some with red faces and red ears, shouting loudly; Some require assistance and vomit incessantly; Some are already unconscious and sound asleep; Some even have unstable vital signs and are in imminent danger... As an emergency department doctor, on the occasion of New Year's Eve and Spring Festival, I would like to educate the general public about ethanol poisoning, with the aim of reminding them not to drink too much and to be alert to ethanol poisoning.
The concept of acute alcohol poisoning: a state of central nervous system dysfunction that occurs after consuming a large amount of alcohol or alcoholic beverages in a short period of time, often manifested as abnormal behavior and consciousness. In severe cases, it can damage organ function, leading to respiratory and circulatory failure, and ultimately endangering life.
Mechanism of ethanol poisoning: Ethanol is lipophilic and can pass through the blood-brain barrier.
1. It acts on the benzodiazepine-R aminobutyric acid receptor in the brain, weakening its inhibitory effect on the central nervous system. Patients exhibit symptoms such as euphoria, excitement, talkative behavior, rap, emotional instability, irritability, and may exhibit rude or aggressive behavior during the excitatory phase.
2. Inhibit cerebellar function, resulting in uncoordinated muscle movements, clumsy movements, and unstable gait in patients - ataxia phase.
3. Acting on the reticular structure, the patient falls into a coma or coma - coma phase.
4. Inhibit the medullary center and cause respiratory and circulatory failure.
In addition, ethanol inhibits hepatic gluconeogenesis - hypoglycemia; Inhibiting the activity of sodium potassium ATPase on the myocardial cell membrane - arrhythmia...
Ethanol poisoning hazards:
1. Various accidental injuries: After drinking a large amount of alcohol, patients may have clumsy movements, unstable gait, and are prone to falls, leading to skin and soft tissue damage, fractures, and brain injuries; Drunk driving is prone to accidents, and many of the accident patients admitted to the emergency surgery department are caused by drunk driving, with five or six or even more than ten of them suffering from head injuries, bleeding, and unbearable suffering. It is truly harmful to both oneself and others; The author has also treated two patients with severe burns, who were found to have been drinking alone and had their clothes burned by the stove or fallen into a pit after drinking; After drinking alcohol, the central nervous system of patients in deep coma is inhibited, and they cannot urinate independently. Over time, the patient's bladder is swollen and requires surgical treatment; Some patients have strong courage after drinking alcohol, and it is not uncommon for them to drink sleeping pills, pesticides, etc; Some people engage in fights and brawls after drinking, violating laws and regulations, and endangering society.
2. Respiratory system damage: Patients with alcohol poisoning have poor self airway protection function, and vomit easily falls into the airway during vomiting, leading to pneumonia and even suffocation and death.
3. Digestive system damage: Ethanol enters the stomach, stimulating the gastric mucosa and causing acute erosive hemorrhagic gastritis. Patients experience abdominal pain, nausea, vomiting, and vomiting, vomiting coffee like liquid or even pale red blood. Excessive blood loss leads to acute hemorrhagic anemia, while reduced effective circulating blood volume leads to hypovolemic shock. After severe vomiting, vomiting bright red blood accompanied by abdominal tearing pain indicates esophageal and cardia mucosal tearing. Patients with pre-existing gastric ulcers or cirrhosis may experience acute gastrointestinal bleeding, acute gastrointestinal perforation, acute peritonitis, etc. after drinking alcohol. The condition is dangerous, difficult to treat, and the prognosis is poor. There are also many patients without underlying liver disease who suffer from acute liver injury after drinking alcohol. Blood tests show significant increases in transaminase and bilirubin levels. Alcohol induced acute pancreatitis: After carefully inquiring about the medical history of some patients with acute abdomen whom the author treated, it was found that alcohol consumption was a contributing factor. Upon examination, serum amylase levels were significantly elevated. Acute pancreatitis caused by alcohol consumption can range from mild edematous pancreatitis to severe hemorrhagic necrotizing pancreatitis.
4. Drinking alcohol causes cerebral hemorrhage. Some patients were unconscious when they came to the hospital for treatment, and after comprehensive treatment such as intravenous infusion and sobering up, the degree of coma even worsened. As a result, a head CT scan was performed and cerebral hemorrhage occurred. Such cases are not uncommon.
5. Alcohol inhibits hepatic gluconeogenesis, stimulates insulin secretion, leading to hypoglycemia in patients, resulting in cold sweats, hunger, hand tremors, palpitations, dizziness, lack of concentration, fatigue, and in severe cases, coma and convulsions.
6. The patient vomits after drinking alcohol, resulting in a significant loss of electrolytes and symptoms such as low blood potassium and low blood sodium. Some patients are pushed in by flatcars when they come to the hospital. They are mentally clear, weak, and unable to walk. Upon examination of serum electrolytes, severe hypokalemia is not uncommon.
7. After drinking alcohol, taking cephalosporins and other antibiotics (such as cefoperazone, ceftriaxone, cefazolin, metronidazole, tinidazole, metronidazole, ketoconazole, furazolidone, nitrofuran, chloramphenicol, etc.) can cause a disulfiram like reaction: ethanol is oxidized to acetaldehyde in the body by ethanol dehydrogenase, and acetaldehyde is then converted to acetic acid and aldolase A by acetaldehyde dehydrogenase. Antibiotics such as cephalosporins inhibit the activity of acetaldehyde dehydrogenase, leading to the accumulation of acetaldehyde in the body and the occurrence of disulfiram like reaction. Mild cases may include weakness, dizziness, drowsiness, hallucinations, flushing, headache, nausea, vomiting, and decreased blood pressure. Severe cases may include respiratory depression, convulsions, shock, and even cardiac and respiratory arrest. Author's suggestion: It is relatively safe to take cephalosporins and other drugs 30 hours after drinking alcohol (because the half-life of alcohol is about 6 hours, and it takes about 5 half lives in the body for alcohol to be basically cleared by the body). So, how long should cephalosporins and other antibiotics be used before drinking alcohol? This is related to the half-life of antibiotics. The half-life of cefoperazone is 2 hours, and the half-life of ceftriaxone is 8 hours. These antibiotics generally need to go through 5 half lives in the body to be cleared by the human body. Therefore, it is recommended to use cephalosporins and other antibiotics for 3-5 days, preferably 7 days, before drinking alcohol for safety.
8. Alcohol poisoning can cause rhabdomyolysis and acute kidney injury: After drinking alcohol, the patient becomes unconscious, physically inactive, and experiences muscle compression. In addition, hypokalemia and other factors can easily trigger acute rhabdomyolysis, resulting in muscle soreness, soy sauce like urine, and a large amount of hemoglobin blocking the renal tubules, leading to acute kidney injury. The patient has little or no urine and requires renal replacement therapy.
9. Wernicke's encephalopathy: Some long-term drinkers substitute alcohol for meals or even skip meals for several days, leading to nutritional deficiencies. Vitamin B1 deficiency can cause Wernicke's encephalopathy, which can manifest as extraocular muscle paralysis, mental abnormalities, ataxia, etc.
10. Methanol poisoning: The quality of alcohol on the market cannot be guaranteed, and some unscrupulous merchants profit from blending methanol into fake alcohol. There are occasional cases in the emergency department where methanol poisoning is diagnosed after drinking alcohol, and clinical manifestations include central nervous system damage, eye damage, metabolic acidosis, and so on.
Alcohol poisoning poses serious risks, and once addicted to drinking, it is difficult to quit. Alcohol poisoning hospitalization medical insurance does not reimburse it. As New Year's Eve and Spring Festival approach, the author hereby calls on: alcohol tolerance does not represent true ability, a healthy life is the winner!