The Alcohols
Dr. Sudesh Gyawali
Associate Professor
Alcohol (Ethanol)
• Water soluble, absorbed rapidly from
GIT. Food delays its absorption
• Rapidly crosses biologic membrane
• Most of the alcohol (90%) is metabolized in
liver and rest excreted through lungs & kidney
• Adult metabolize 7-10 g/ hr (Zero order)
Metabolism of Alcohol
Ethanol
(CH3CH2OH)
Alcohol dehydrogenase
Acetaldehyde
(CH3CHO)
Aldehyde dehydrogenase
Acetate
(CH3COO-)
Ethanol actions
1. CNS: Dose dependent CNS depression,
initially apparent stimulant later depression
Blood Alcohol Concn Clinical effects
(BAC) in mg/dl
50-100 Sedation, relieves anxiety, &
foster feeling well being,
slower reaction time
100-200 Impaired motor function,
slurred speech, ataxia
200-300 Emesis, stupor
300-400 Coma
>500 Respiratory depression, death
Ethanol actions contd…..
2. CVS:
Cutaneous vasodilation and flushing
Large doses- myocardial & VMC depression
3. Respiratory depression
4. GIT:
Increase appetite & gastric acid secretion
Cause gastritis & aggravation of peptic
ulcer
5. Kidney: Inhibit ADH action → Diuresis
6. Body temperature: sense of warmth due to
cutaneous & gastric vasodilation.
Consequences of chronic alcoholism
1. Liver and GIT:
Fatty degeneration of liver, which may
progress to alcoholic hepatitis & cirrhosis
Reversible injuries to small intestine
causing weight loss & multiple vitamin
deficiencies
2. Tolerance and dependence
3. Neurotoxicity:
Distal paresthesias of hands & feet, gait
disturbances, ataxia, dementia
Wernicke- Korsakoff syndrome
Consequences of chronic alcohol… contd….
Wernicke- Korsakoff syndrome
Uncommon but important entity
Characterized by paralysis of the external eye
muscles, ataxia, and a confused state that can
progress to coma and death.
Associated with thiamin deficiency in chronic
alcoholics so treated with thiamin. The
thiamin therapy do not correct chronic
disabling memory disorder – Korsakoff’s
Consequences of chronic alcohol… contd….
4. Coronary Heart disease (CHD):
Moderate alcohol consumption may
prevent CHD
May increase HDL level, have anti-oxidants
and may also inhibit inflammatory
processes in atherosclerosis
French paradox and J shaped relationship
5. Folic acid deficiency, electrolyte imbalance,
hypoglycemia
6. Increase risk of cancer (mouth, upper GIT, liver)
Consequences of chronic alcohol… contd….
7. Alcohol during pregnancy:
Fetal Alcohol Syndrome
Intra uterine growth retardation
Microcephaly
Poor coordination
Under-development of midfacial region
(flattened face)
Minor joint abnormalities
More severe cases- congenital heart defects and
mental retardation
Consequences of chronic alcohol… contd….
FETAL ALCOHOL SYNDROME
Therapeutic uses of Ethanol
1. Antiseptic (>70% solution)
2. Treatment of methanol poisoning
3. Trigeminal and other neuralgias
4. Prevent bedsores
Acute alcohol intoxication
Concentration dependent effects. Approx
600 ml can be fatal in 70 Kg individual
COMA: CNS depression
Hypoglycemia, Hypomagnesaemia, Acute
hepatitis
Treatment of acute intoxication
Vital functions (Respiration &
Cardiovascular)
Inj. glucose
Inj. thiamine 100 Mg
Inj. Magnesium sulfate
Electrolytes (on severe vomiting)
Treatment of chronic alcoholism
1. Psychotherapy, occupational therapy and
rehabilitation
2. Drug therapy
a) Benzodiazepam- prevent and treat
withdrawal syndrome
b) Disulphiram- cause aversion to alcohol
c) Naltrexone (opioid antagonist)- reduce
alcohol craving (maintain abstinence)
d) Acamprostate- reduces relapse rate
Mechanism of disulphiram
Ethanol
(CH3CH2OH)
Alcohol dehydrogenase
Acetaldehyde
(CH3CHO)
Aldehyde dehydrogenase
Acetate
(CH3COO-)
Methanol poisoning
Occur when methylated sprit or adulterated
liquor is consumed
It converts to formaldehyde and formic acid
→ acidosis and retinal damage
Signs/ Symptoms: nausea, vomiting,
abdominal pain, headache, vertigo,
hypotension, convulsion, coma, retinal
damage (like being in a snow-strom), blindness
Odor of formaldehyde may be present on the
breath or in the urine
Methanol (CH3OH)
Alcohol dehydrogenase
Formaldehyde (H2CO)
Aldehyde dehydrogenase
-
Formate (HCOO )
Folate dependent pathway
CO2 + H2O
Treatment of Methanol poisoning
1. Patient is kept in dark room to protect the
eyes from light
2. Maintain ABC (Respiration is important)
3. Gastric lavage
4. I.v. Sod. Bicarbonate to correct acidosis
5. Ethanol 10 % is given by nasogastric tube
6. Haemodialysis
7. Calcium leucovorin i.v. to ↑ metabolism of
formate, Fomepizole (orphan drug).
Rational of use of ethanol in methanol poisoning
