The Alcohols

The Alcohols

Alcohol, primarily in the form of ethyl alcohol (ethanol), has occupied an important place in the history of humankind for at least 8000 years. In Western society, beer and wine were a main staple of daily life until the 19th century. These relatively dilute alcoholic beverages were preferred over water, which was known to be associated with acute and chronic illness. They provided important calories and nutrients and served as a main source of daily liquid intake. As systems for improved sanitation and water purification were introduced in the 1800s, beer and wine became less important components of the human diet, and the con-sumption of alcoholic beverages, including distilled preparations with higher concentrations of alcohol, shifted toward their present-day role, in many societies, as a socially acceptable form of recreation.

Today, alcohol is widely consumed. Like other sedative-hypnotic drugs, alcohol in low to moderate amounts relieves anxiety and fosters a feeling of well-being or even euphoria. However, alcohol is also the most commonly abused drug in the world, and the cause of vast medical and societal costs. In the United States, approximately 75% of the adult population drinks alcohol regularly. The majority of this drinking population is able to enjoy the plea-surable effects of alcohol without allowing alcohol consumptionto become a health risk. However, about 8% of the general popu-lation in the United States has an alcohol-use disorder. Individuals who use alcohol in dangerous situations (eg, drinking and driving or combining alcohol with other medications) or continue to drink alcohol in spite of adverse consequences related directly to their alcohol consumption suffer from alcohol abuse. Individuals with alcohol dependence have characteristics of alcohol abuse and additionally exhibit physical dependence on alcohol (toler-ance to alcohol and signs and symptoms upon withdrawal). They also demonstrate an inability to control their drinking and devote much time to getting and using alcohol, or recovering from its effects. The alcohol-use disorders are complex, with genetic as well as environmental determinants.The societal and medical costs of alcohol abuse are staggering. It is estimated that about 30% of all people admitted to hospitals have coexisting alcohol problems. Once in the hospital, people with chronic alcoholism generally have poorer outcomes. In addi-tion, each year tens of thousands of children are born with mor-phologic and functional defects resulting from prenatal exposure to ethanol. Despite the investment of many resources and much basic research, alcoholism remains a common chronic disease that is difficult to treat.

Ethanol and many other alcohols with potentially toxic effects are used as fuels and in industry—some in enormous quantities.

 CASE STUDY

An 18-year-old college freshman began drinking alcohol at 8:30 pm during a hazing event at his new fraternity. Between 8:30 and approximately midnight, he and several other pledges consumed beer and a bottle of whiskey, and then he consumed most of a bottle of rum at the urging of upper classmen. The young man complained of feeling nauseated, lay down on a couch, and began to lose consciousness. Two upperclassmen carried him to his bedroom, placed him on his stomach, and positioned a trash can nearby. Approximately 10 minutes later, the freshman was found unconscious and covered with vomit. There was a delay in treatment because the upperclassmen called the college police instead of calling 911. After the call was transferred to 911, emergency medical technicians responded quickly and discovered that the young man was not breathing and that he had choked on his vomit. He was rushed to the hos pital, where he remained in a coma for 2 days before ulti mately being pronounced dead. The patient’s blood alcohol concentration shortly after arriving at the hospital was 510 mg/dL. What was the cause of this patient’s death? If he had received medical care sooner, what treatment might have prevented his death?

CASE STUDY  ANSWER

This young man exhibits classic signs and symptoms of acute alcohol poisoning, which is confirmed by the blood alcohol concentration. We do not know from the case whether the patient was tolerant to the effects of alcohol but note that his blood alcohol concentration was in the lethal range for a nontolerant individual. Death most likely resulted from respiratory and cardiovascular collapse prior to medical treatment, complicated by a chemical pneumoni-tis secondary to aspiration of vomitus. The treatment ofacute alcohol poisoning includes standard supportive care of airway, breathing, and circulation . Intravenous access would be obtained and used to adminis-ter dextrose and thiamine, as well as other electrolytes and vitamins. If a young, previously healthy individual receives medical care in time, supportive care will most likely be highly effective. As the patient recovers, it is important to be vigilant for signs and symptoms of the alcohol withdrawal syndrome.