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  » Alcoholism and treatment  »  Absorption, fate and excretion

Absorption, fate and excretion:

Ethyl alcohol is absorbed as such very rapidly from the stomach, duodenum and jejunum. It passes rapidly through various body membranes and finally gets distributed throughout the body water. Almost half the ingested quantity is absorbed within 15 minutes and the absorption is complete within 1-2 hours. The absorption is delayed by the presence of food in the stomach. It is stored in every tissue and diffuses back into the blood when blood level falls.
In the lung alcohol passes from blood to breath, which smells of alcohol. The ratio of concentrations of alcohol in blood and alveolar air is constant and is about 2,100:1. Because of this high ratio, it is difficult to wash out blood alcohol by artificial ventilation in case of acute alcohol poisoning.
Over 90 to 98 per cent of alcohol is metabolized by the non-microsomal enzymes in the liver. The rest is excreted by the kidney and lungs. Alcohol is first oxidized to carbon dioxide and water by liver as well as other tissues.

(a) CH3CH2OH + DPN
CH3CHO + DPNH + H+
alcohol/dehydrogenase®

(b) CH3CHO ® acetyl coenzyme A ®
CO2 + H2O + Energy
 

Alcohol is metabolized at a constant rate which is independent of blood alcohol concentration but is proportional to the body weight and probably to liver weight; thus an average individual can metabolise about 10 ml. of absolute alcohol in one hour. There is no known method by which one can enhance the metabolism of alcohol. People, who drink regularly metabolise alcohol rapidly because of induction of liver enzymes. They also metabolise many other chemicals rapidly for the same reason.

Is alcohol a food? One gramme of alcohol gives 7.1 calories. Alcohol gives calories only in the form of acetate. Although it can spare carbohydrates and proteins, alcohol cannot act as a complete food, because the calories available for its hourly oxidation are inadequate even for maintenance of basal metabolism. In fact, the chronic alcoholics suffer from various dietary deficiencies.

Therapeutic uses of ethyl alcohol: It is a solvent for various alcohol soluble active ingredients. Therapeutically alcohol has few uses. It is sometimes used:
   - In the symptomatic treatment of fever because of its cooling effect on skin.
   - In the prevention of bed sores as it hardens the skin.
   - As an antiseptic in the concentration of 70 per sent by weight.
   - To wash out phenol in cases of accidental skin contamination.
   - As an appetizer (10%); and
   - In methyl alcohol poisoning (see later).
   - By local injection to destroy a nerve as in trigeminal neuralgia.


Acute Alcoholism

Chemical analyses of a blood and urine can give some idea about the degree of intoxication in an individual, who has ingested alcohol. (Table 4) However, it is difficult to associate a particular blood alcohol concentration with a specific degree of impairment. Consumption of alcohol before driving is hazardous.
After death the detoxification of alcohol ceases and the brain and blood levels of alcohol remain constant for sometime. Hence, post-mortem samples of blood can give reliable estimates about the degree of intoxication at the time of death. Approximately 60 ml. of pure alcohol can produce a fatal effect in an individual of 70 kg. body weight. Coma in an acute alcoholic bout may be due to the CNS depressant effect of alcohol, head injury of severe hypoglycemia which is especially likely to occur in fasting individuals. Hypomagnesimia is common.

The treatment consists of:

  • General nursing care.
  • Maintenance of vital functions.
  • IV glucose 50%, 50 ml, for hypoglycemia; and
  • IV thiamine 100 mg (bolus).
  • IV magnesium sulfate 2-4 g over 1-2 hours.

Death due to acute alcohol poisoning is, however, uncommon.
If the acutely intoxicated patient is not comatose but only rowdy, careful use of a sedative is indicated.