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ALCOHOL
While some patients readily declare alcohol abuse, many do not. There are a number of common presentations that oblige the doctor to inquire carefully about the possibility of alcohol abuse.
These are most readily grouped into medical
(e.g. falls, fits, head injuries, haematemesis
or jaundice), psychiatric (e.g. panic attacks,
amnesic black-outs, confusional states and
deliberate self-harm) and social (e.g. road
traffic accidents, as the victim or perpetrator
of violent crime, domestic violence or
rough-sleeping).
These may be the current
presenting complaint or prominent in the past
history. It is estimated that up to 20 per cent
of UK medical admissions are for conditions
caused by alcohol misuse, yet too few medical
admissions have their drinking habits
adequately assessed.
Assessment of alcohol
misuse has three aims: to quantify use; to
catalog any alcohol-related problems the patient
has; and to detect alcohol dependence syndrome
if present.
Quantifying use by direct
questioning is not always doomed to fail. The
aim is to establish how many units the
individual consumes in a typical week (or in a
'heavy session' if the pattern is binge-drinking
rather than regular drinking). One unit of
alcohol is a small glass of 13 percent wine or a
half-pint of 3 percent lager.
Consumption
exceeding 14 units per week for a woman, or 21
units per week for a man, will inevitably prove
harmful to health in the long term. A high
percentage of the UK population, including many
teenagers, currently exceeds these recommended
limits.
The distinction between
alcohol-related problems and alcohol dependence
(addiction) is very useful. Alcohol dependence
syndrome consists of:
• Withdrawal symptoms –
tremor, sweating, retching and anxiety
•
Relief drinking – drinking alcohol specifically
to avoid or reduce withdrawal symptoms, perhaps
in the morning
• Tolerance – requiring
ever-increasing quantities of alcohol to achieve
the same effect
• A stereotyped pattern of
drinking taking precedence over other activities
• Craving
• Rapid reinstatement after
abstinence, i.e. immediately resuming heavy
drinking after a period of abstinence
Alcohol-related problems should be
systematically sought and cataloged in the past
medical history, past psychiatric history and
social history.
Medical problems include
gastrointestinal irritation and bleeding,
cirrhosis, epileptic fits, head injuries,
accidents, fractures, osteoporosis,
gynaecomastia, testicular atrophy, neuropathy,
pancreatitis and diabetes mellitus.
Psychiatric problems include anxiety, panic
attacks, agoraphobia, dysphoria, deliberate
self-harm, delirium tremens, amnesic black-outs,
alcoholic hallucinosis, morbid jealousy,
Wernicke's encephalopathy, amnesic syndrome and
dementia.
Social problems involve debt, dismissal from
accommodation, work and relationships,
drink-driving offences, shoplifting and domestic
violence.
The features of alcohol dependence
can develop insidiously in the absence of any
alcohol-related problems in some people,
classically in the wealthy professional who
comfortably affords the alcohol, and is
generally well nourished and well supported.
Conversely, it is possible to accrue several
alcohol-related problems in a single evening of
heavy drinking with no alcohol dependency at
all.
Please see also our Toxilact data base which is in the following language versions:
Toxilact Deutsche Sprachversion
Toxilact Nederlandstalige versie
Toxilakt έκδοση στην ελληνική γλώσσα
Toxilact English language version
Toxilact magyar nyelvű változat
Toxilact versione in lingua italiana
Toxilact polska wersja językowa
Detailed medical information on more common causes of acute abdomen
Intestinal Pain
Acute Appendicitis
Peritoneal Pain
Pain from Vascular Causes
Retroperitoneal Pain
Abdominal Pain from Intoxication
Toxicological risk during lactation
Toxicological lactation category I - the drug and/or its metabolites are either not eliminated through breast milk or are not toxic to the newborn and cannot lead to the development of absolutely any toxic reactions and adverse consequences for his health in the near and long term. Breast-feeding does not need to be discontinued while taking a given drug that falls into this toxicological lactation category.
Toxicological lactation category II - the drug and its metabolites are also eliminated through breast milk, but the plasma:milk ratio is very low and/or the excreted amounts cannot generate toxic reactions in the newborn due to various reasons, including degradation of the drug in the acid pool of the stomach of the newborn. Breastfeeding does not need to be discontinued while taking this medicine.
Toxicological lactation category III - the drug and/or its metabolites generate in breast milk equal to plasma concentrations or higher, and therefore the possible development of toxic reactions in the newborn can be expected. Breastfeeding should be discontinued for the period corresponding to the complete elimination of the drug or its metabolites from the mother's plasma.
Toxicological lactation category IV - the drug and/or its metabolites generate a plasma:milk ratio of 1:1 or higher and/or have a highly toxic profile for both the mother and the newborn, therefore their administration is incompatible with breastfeeding and it should to stop completely, and not just for the period of taking the drug, or to look for a less toxic therapeutic alternative.