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ALCOHOL


 It is a transparent, colorless, volatile liquid having a spirit like odour and burning taste. The term alcohol in popular use refer to Ethyl alcohol. Which is present various fermented and distilled beverages. This group of poison are characterized by two set of symptoms ie Excitement and narcosis, The stage of excitement being well marked in some and that of narcosis in others.

Sign and symptoms:-
 Ethyl alcohol depresses the central nervous system. It first depresses the higher centers which control judgement and behaviour. (stage of excitement)
Then the motar centers (stage of incordination) and finally the vital centers in the medulla (stage of narcosis).

1. Stage of excitement:-
 This is a feeling of well being and pleasure resulting from inhibition of the higher centers. The drinker converse well, laugh and smiles readily and become angry easily. He may disclosed secrets. He may behave in obscene manner or talk in vulger languages.

2. Stage of incordination:-
 There is incordination of thoughts, speech and action which manifest as impaired judgement, confusion, slurred speech and staggering gait. The drinker may suffer from hiccups and it untidy in appearence. He may become moroses, irritable depending upon his inherent emotions. Nausea and vomiting are common. The pupil are dilated. Most offences are committed in this stage. Impaired judgement may lead  to accidents, voilence and crime.

3. Stage of narcosis:-
  The patient passes into deep sleep and respond only to strong stimulus. The pulse is rapid, temperature subnormal, breathing stertorous and the pupil may be contracted, however on pinching the face or neck they dilate initially and slowly return to their original size. This is known macewans signs. If this stage last for more than 12 hours death ensures from the paralysis of the cardiac or respiratory center or later from the effect of pulmonary oedema. Death from acute alcoholism is not common recovery occurs with acute depression and gastro intestinal irritation. Which continue for 24 hours or longer. Headache is also present as an hangover effect and is due to cerebral oedema. 

Blood-alcohol level and clinical manifestation:-
 The approximate relationship between the alcohol content of blood and clinical manifest is tabulate-

Percent---  mg-----effect

.03>          30>        not noticeable
.03-.05      30-50     selective impairment
.05-.1        50-100   slight impairment
.1- .15       100-150 under influence
.15-.2        150-200 drunk
.2-.3          200-300 very drunk
.3-.35        300-350 stupor to coma
>.35          350         comatose to death

Fatal dose :-
 This will depend on the age and habit of the patient and strength of the liquor contain. Death may occur from the large quantity taken in a short time. A concentration of .35% or 350mg and above of alcohol in blood is usually sufficient to cause death.

Fatal period:-
 The usually fatal period is 12-24hours. Though death may be delayed for 5-6 days.

Cause of death:-
 Death is due to depression of the respiratory center and cardiac center.

Treatment:-
 The stomach should lavaged with care 5% solution of sodium bicarbonate in warm water. The patient should be kept warm.

Chronic poison:- (Alcohol addiction)
 This results from continued use of alcohol. It is characterized by- 
1. Gradual physical, mental and moral deterioration. 
2. Physical like loss of appetite, lack of personal hygiene, fatty change in the fiver and heart.
3. Alcohol is hepato toxic poison.
4. Three common clinical syndrome which result from chronic alcoholism are-
i.  Delirium tremens
ii. Korsakoff's psycosis
iii. Acute hallucinosis

i. Delirium tremens:-
 It is a stage of excitement with hallucinosis. Which usually last 3-4 days. It is characterized by sleeplessness, marked tremors, excitement, fear and hallucination and occasionaly auditory.

ii. Korsakoff psycosis:-
 It is a syndrome characterized by hallucination, disorentation and multiple nuritis. The patient memory for recent even is lossed. This state last 1 month- 1 year.

iii. Acute hallucinosis:-
 It is a stage of hallucinosis chiefly auditory with lasting from weeks to months. It is a phychriatic emergency. The patient may become suicidal in response to hallucination.


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