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Questions and Answers
What is the primary route of elimination for carbon monoxide in the body?
What is the primary route of elimination for carbon monoxide in the body?
At what percentage of COHb saturation might a person experience drowsiness and emotional instability?
At what percentage of COHb saturation might a person experience drowsiness and emotional instability?
Which condition can lead to the most rapid elimination of carbon monoxide from the body?
Which condition can lead to the most rapid elimination of carbon monoxide from the body?
What is the first step in treating carbon monoxide poisoning?
What is the first step in treating carbon monoxide poisoning?
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What is a classic postmortem finding in fatalities due to carbon monoxide poisoning?
What is a classic postmortem finding in fatalities due to carbon monoxide poisoning?
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What is the main reason organophosphate insecticides were developed?
What is the main reason organophosphate insecticides were developed?
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Which symptom is NOT associated with mild intoxication of carbon monoxide?
Which symptom is NOT associated with mild intoxication of carbon monoxide?
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Which of the following classes of insecticides includes those derived from nerve gases?
Which of the following classes of insecticides includes those derived from nerve gases?
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What is the primary method by which alcohol is absorbed into the bloodstream?
What is the primary method by which alcohol is absorbed into the bloodstream?
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What percentage of absorbed alcohol occurs in the small intestine for a fasting individual?
What percentage of absorbed alcohol occurs in the small intestine for a fasting individual?
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Which type of beverage is absorbed most rapidly?
Which type of beverage is absorbed most rapidly?
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Which of the following is NOT a cause of ethanol poisoning or death?
Which of the following is NOT a cause of ethanol poisoning or death?
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Ethanol concentration in most distilled beverages typically ranges from:
Ethanol concentration in most distilled beverages typically ranges from:
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How does the presence of food in the stomach affect alcohol absorption in non-fasting individuals?
How does the presence of food in the stomach affect alcohol absorption in non-fasting individuals?
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What happens to ethanol once it is absorbed into the bloodstream?
What happens to ethanol once it is absorbed into the bloodstream?
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What factor can significantly affect peak blood alcohol concentrations?
What factor can significantly affect peak blood alcohol concentrations?
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What is the primary mechanism of action of organophosphates (OPs)?
What is the primary mechanism of action of organophosphates (OPs)?
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Which of the following is a common sign or symptom of organophosphate poisoning?
Which of the following is a common sign or symptom of organophosphate poisoning?
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What is the consequence of organophosphate-induced delayed neuropathy (OPIDN)?
What is the consequence of organophosphate-induced delayed neuropathy (OPIDN)?
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Which of the following compounds is associated with Intermediate Syndrome (IMS)?
Which of the following compounds is associated with Intermediate Syndrome (IMS)?
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What could potentially lead to death in organophosphate poisoning?
What could potentially lead to death in organophosphate poisoning?
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Which symptom is associated with chlorinergic crisis following organophosphate exposure?
Which symptom is associated with chlorinergic crisis following organophosphate exposure?
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Which route of exposure is NOT associated with organophosphates (OPs)?
Which route of exposure is NOT associated with organophosphates (OPs)?
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What is a notable feature of the Intermediate Syndrome (IMS) that differentiates it from acute cholinergic crisis?
What is a notable feature of the Intermediate Syndrome (IMS) that differentiates it from acute cholinergic crisis?
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What is a common sign of alcoholism?
What is a common sign of alcoholism?
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Which type of corrosive agent is known to cause liquefactive necrosis?
Which type of corrosive agent is known to cause liquefactive necrosis?
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What is one of the primary sources of carbon monoxide exposure?
What is one of the primary sources of carbon monoxide exposure?
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Which organ is most susceptible to the toxic effects of carbon monoxide due to high oxygen demand?
Which organ is most susceptible to the toxic effects of carbon monoxide due to high oxygen demand?
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What type of necrosis is most commonly associated with acid ingestion?
What type of necrosis is most commonly associated with acid ingestion?
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What is the impact of benzodiazepines during alcohol detoxification?
What is the impact of benzodiazepines during alcohol detoxification?
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Which of the following symptoms is NOT typically associated with corrosive agent poisoning?
Which of the following symptoms is NOT typically associated with corrosive agent poisoning?
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What condition is characterized by the presence of Mallory bodies?
What condition is characterized by the presence of Mallory bodies?
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What is the primary site for alcohol metabolism in the body?
What is the primary site for alcohol metabolism in the body?
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Which enzyme converts alcohol to acetaldehyde during alcohol metabolism?
Which enzyme converts alcohol to acetaldehyde during alcohol metabolism?
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At what blood alcohol concentration (BAC) level do individuals typically experience nausea and ataxia?
At what blood alcohol concentration (BAC) level do individuals typically experience nausea and ataxia?
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What percentage of a dose of ethanol is typically excreted unchanged in urine?
What percentage of a dose of ethanol is typically excreted unchanged in urine?
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What is one of the potential secondary causes of death in acute alcohol intoxication?
What is one of the potential secondary causes of death in acute alcohol intoxication?
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Which of the following is not a physiological effect of long-term alcohol abuse?
Which of the following is not a physiological effect of long-term alcohol abuse?
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What effect does alcohol primarily have on the central nervous system?
What effect does alcohol primarily have on the central nervous system?
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Which of the following describes alcoholism?
Which of the following describes alcoholism?
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Study Notes
Specific Poisonings
- Ethyl alcohol (ethanol) is the active constituent in alcoholic beverages.
- Ethanol concentration varies across different beverages:
- Beers: 4% to 5%
- Wines: 7% to 12%
- Cordials: 20% to 40%
- Distilled beverages (whiskey, vodka, rum): 40% to 60%
- Ethanol is a clear, volatile liquid that burns easily and has a slight characteristic odor.
- It's highly soluble in water, mixing in all proportions.
Causes of Poisoning or Death
-
Accident:
- Direct effect on body tissues
- Inhalation of vomitus
- Ingesting other poisons or drugs
- Associated pathology in organs (e.g., drowning, burning, falling)
- Road traffic accidents
- Committing a crime:
- As a catalyst in assaults and homicides
Fate of Ethanol in the Body
- When alcohol is consumed, it is diluted by stomach juices and quickly distributed throughout the body.
- Ethanol doesn't require digestion before absorption into the bloodstream.
- Some diffuses directly into the bloodstream through the stomach wall.
- The remainder enters the small intestine for rapid absorption and circulation.
Alcohol Absorption
- Alcohol is absorbed from all parts of the gastrointestinal tract via simple diffusion into the blood.
- The small intestine is the most efficient absorption region due to its large surface area.
- Absorption speed varies based on the type of beverage and the person's stomach state.
- Fasting individuals: 20-25% from the stomach, 75-80% from the small intestine; peak blood alcohol concentrations in 0.5-1.0 hours.
- Non-fasting individuals (presence of food, especially fatty foods): delayed absorption; peak concentrations in 1.0-6.0 hours.
- Alcohol with carbonated beverages: absorbed more rapidly.
Alcohol Distribution
- Absorbed alcohol is distributed to all parts of the body.
- Distribution is proportional to the water content of tissues and organs.
- Greater concentration in blood and brain, with lower concentration in fat and muscle.
Alcohol Metabolism & Elimination
- Over 90% of alcohol is metabolized in the liver, oxidizing it to acetaldehyde and then acetic acid, releasing carbon dioxide and water.
- Alcohol dehydrogenase (ADH) converts alcohol to acetaldehyde, a highly toxic substance.
- Aldehyde dehydrogenase transforms acetaldehyde into acetic acid.
- Acetic acid is finally oxidized to CO2.
- Metabolism rate depends on alcohol use history; heavy drinkers metabolize faster than light drinkers or nondrinkers.
- Approximately 5-10% of a dose of ethanol is excreted in the urine unchanged.
- The remainder is eliminated via excretion in breath, sweat, milk, and saliva.
Primary Pharmacological Effect of Alcohol
- Alcohol is a central nervous system (CNS) depressant.
- The degree of CNS impairment corresponds to the concentration of blood alcohol.
Signs and Symptoms of Acute Alcohol Intoxication
- Symptoms depend on blood alcohol content (BAC).
- BAC ranges and associated clinical manifestations are shown in the table on page 14.
Causes of Death
- Most deaths from acute alcohol intoxication occur when BAC exceeds 300mg%.
- Death can result from direct depressive effects on the brain stem's respiratory centers or secondary events (accidents like traffic accidents, falling, inhalation of vomitus).
Alcoholism
- Alcoholism is a disabling, addictive disorder.
- It entails compulsive and uncontrolled alcohol consumption despite adverse effects on the drinker's health, relationships, and social standing.
- Long-term alcohol abuse leads to physiological changes in the brain, including tolerance and dependence.
- Alcoholism involves a cycle of tolerance, withdrawal, and excessive alcohol use.
- Alcohol damages nearly all organs in the body.
- Detoxification is conducted to help the addict withdraw from alcohol, often using cross-tolerance drugs like benzodiazepines to manage withdrawal symptoms.
Signs and Symptoms of Alcoholism
- Poor nutrition, weight loss, lack of appetite.
- Liver damage (jaundice, ascites, cirrhosis)
- Pancreatitis
- Peripheral neuritis, tremors
- Insomnia, memory loss, impaired judgment (alcoholic dementia)
- Loss of vitality, recurrent infections
- Increased risk of cardiovascular disease, malabsorption, alcoholic liver disease, and cancer.
Liver Pathology
- Liver Mallory bodies: a characteristic of alcoholic hepatitis (alcoholic hyaline).
- Portal fibrosis: observed along with pericellular fibrosis in alcoholic liver tissue.
Corrosive Agents Poisoning
- Corrosive agents cause significant tissue damage on contact due to chemical action.
- Alkaline agents: cause liquefactive necrosis (deep tissue damage ).
- Acid agents: cause coagulative necrosis (primarily superficial injury) by dehydrating tissues.
- Common strong inorganic acids include sulfuric, hydrochloric, and nitric acid.
- Common organic acids include phenol (carbolic acid), Lysol, and cresol.
- Common strong alkalis include sodium and potassium hydroxide, and ammonia.
Symptoms of Caustics (Corrosive agents)
- Ingestion rapidly results in severe burning and intense dysphagia.
- Associated airway edema can obstruct airways and cause asphyxia.
- Alkali ingestion can lead to esophagus perforation, mediastinitis, and death.
- Acid ingestion can affect the esophagus, but gastric necrosis and perforation with peritonitis are more common.
Carbon Monoxide Poisoning
- Chemical Properties: Colorless, odorless, tasteless gas, slightly lighter than air, produced by incomplete combustion.
- Major Sources: Cigarette smoke, Coal gas, automobile exhaust, defective/ faulty heating appliances (furnaces, stoves, water heaters), and smoke from conflagrations.
- Toxic Effects: CO binds to hemoglobin more strongly than oxygen (200-300 times stronger), generating carboxyhemoglobin (COHb). This renders hemoglobin unable to carry oxygen, leading to hypoxia.
- Disposition of CO: Absorbed through the lungs; eliminated through the lungs without undergoing metabolic processes. COHb is displaced by the mass action of oxygen. Half-lives are 5-6 hours at normal oxygen levels, 30-90 minutes with 100% oxygen, and just 30 minutes under hyperbaric conditions.
- Clinical Effects of CO Toxicity: Symptoms depend on CO concentration in inspired air, individual activity levels, duration of exposure, and COHb accumulation rate. Symptoms vary. Mild to severe and sometimes fatal.
- Treatment: Immediate removal from the environment; high concentrations of oxygen; and, in severe cases hyperbaric oxygen therapy.
- Autopsy Findings: Characteristic cherry-red coloration of blood, fingernails, mucous membranes, visceral organs, and skin.
Organophosphates Poisoning
- Organophosphates are insecticides.
- They are widely used, but degrade fairly quickly in the environment.
- Mechanism of Action: Inhibit cholinesterase. This prevents the breakdown of acetylcholine – resulting in an accumulation of acetylcholine and its corresponding excitation responses in the nervous systems and muscles.
- Exposure Routes: Inhalation, ingestion, dermal absorption.
- Metabolism: In the liver via action of esterases.
- Excretion*: In the urine.
-
Signs and symptoms: Various symptoms from mild to fatal.
- Bronchospasm, bronchorrhea, chest discomfort, wheezing, pulmonary edema
- Loss of consciousness, incontinence, convulsions, respiratory depression
- Tachycardia, hypertension, sweating, lacrimation, rhinorrhea, vomiting, abdominal cramps, diarrhea, miosis (constricted pupils).
- Anxiety, restlessness
- Autopsy findings: External cyanosis, inflamed/ congested mucosa of the stomach and intestines, edema of lungs, brain, and respiratory tract. Low levels of cholinesterase in red blood cells and plasma.
- OPIDN – Organophosphate-Induced Delayed Neuropathy: A rare toxicity. Proximal muscle weakness; numbness/ tingling, pain in the lower legs frequently develops 1-4 weeks after exposure.
- IMS (Intermediate Syndrome): A neurological dysfunction in the 24-96 hours range following exposure. Characterized by weakness of proximal limb muscles.
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Description
This quiz covers the properties of ethanol, its concentration in various alcoholic beverages, and the different causes of ethanol poisoning. Additionally, it discusses the impact of ethanol on the human body and its fate after consumption. Test your knowledge on ethanol and its physiological effects.
