Mar 05, 2018
Alcoholism chronic is a mental illness caused by prolonged intoxication of the body with alcohol and, as a result, toxic damage to the brain and internal organs. It develops gradually from domestic drunkenness, which contributes to the pathological predilection for alcohol, while the forms of alcoholic intoxication become heavier.
Alcoholic intoxication is characterized by mental, neurological and somatic disorders of varying depths.
There are three stages of alcohol intoxication.
The first stage is easy intoxication: high spirits, cheeky behavior, talkative;hyperemia of the face, shine of the eyes, tachycardia, tremor of the fingers, violation of the coordination of precise movements. Subjective sensation of facilitation of thought processes. The disappearance of a sense of self-doubt, but objectively - a decrease in the productivity of thinking and criticism.
Second stage( intoxication of moderate severity): euphoria, gabbling, disinhibition of drives, rudeness, anger, loss of control over one's actions. Appearance of dysarthria, unsteadiness of gait. Increased hyperemia, the appearance of cyanosis.
The third stage( severe intoxication): a sharp obstruction of mental processes, drowsiness, impaired coordination of movements, narrowing of the pupils. There may develop a hysterectomy followed by amnesia( more often with chronic alcoholism).
Alcoholism is characterized by the emergence of the dependence of the mental and physical state of alcohol consumption, i.e., the desire to alleviate the condition by repeated alcohol intake. As a result, self-control over consumption is lost, tolerance( sensitivity) to alcohol is increased in the first stages of alcoholism and decreases in the third stage. Termination of alcohol intake leads to the development of the syndrome of abstinence( withdrawal) with an uncontrollable desire to get drunk. In patients, mood is reduced down to a depressed state with anxiety, fear, sleep disturbance, auditory and visual hallucinations more often at night. There is weakness, sweating, tachycardia, dizziness, tremor of the extremities, gastrointestinal, and in severe cases, cardiac disorders and disorders of liver function. There are severe forms of intoxication( co-morbid and comatose) followed by amnesia( loss of memory), drinking-bouts and degradation of the person.
There are three stages of chronic alcoholism.
The first stage of -, increased tolerance, loss of control over alcohol consumption, the appearance of severe forms of intoxication with amnesia, a pathological attraction to alcohol, but without abstinence. Asthenia with increased fatigue, irritability, mood swings down, insecurity, decreased efficiency.
The second stage: further increase tolerance to alcohol, the full development of the addiction syndrome and the emergence of abstinence with an uncontrollable uncontrolled desire for alcohol, pseudosales or a long-term uninterrupted drunkenness. The ability to work is very low, they quickly become tired. Patients change their character: inconstancy, falsity, rudeness, selfishness appear. Intellect and criticism decrease, memory worsens. Characterism is incontinence, a tendency to hysterical reactions.
In the third stage of the , true binges appear( which is associated with a decrease in tolerance to alcohol);due to alcohol intolerance, the patient stops drinking after a week, and then starts to drink again. Intoxication is often co-morbid with subsequent amnesia. Abstinence is pronounced, accompanied by severe intoxication with somato-vegetative disorders. Alcoholic degradation of personality is revealed. There may be epileptiform seizures, alcoholic psychoses, somatic disorders: alcoholic cardiopathy, hypertension, liver and kidney damage, chronic gastritis. Neurological examination reveals irregularity of tendon reflexes, autonomic dystonia, and sometimes polyneuritis.
The diagnosis of chronic alcoholism is based on alcohol dependence syndrome with loss of self-control over the nature of drunkenness, the presence of withdrawal syndrome, and also on the basis of alcoholic personality changes. An anamnesis, according to the patient, must be supplemented with information from relatives, as well as from the place of work and place of residence. The course of chronic alcoholism is mostly progredient, so early detection of the disease and active treatment are necessary.
Treatment of chronic alcoholism is carried out in a narcological clinic or outpatient in a narcological office. Drug therapy begins with the relief of intoxication or withdrawal. Disintoxication and restorative therapy is carried out( 40% glucose solution IV, unitiol 5% 5 ml IM three times a week, vitamins B1, B6, B12, ascorbic and nicotinic acids w / m, aloe extract, duplex p / c, methionine inside) in combination with cardiac agents( cordiamin, caffeine, with pain in the heart - nitroglycerin, validol under the tongue).To relieve anxiety, anxiety, sleep disturbances after detoxification, neuroleptics are prescribed: aminazine, levomepromazine( tizercin), diazepam seduxen 5 mg 3-4 times a day, trioksazin 0.3 g 2-3 times a day.
After elimination of abstinence phenomena and improvement of somatic state, antialcohol therapy is carried out. To suppress craving for alcohol, conditional reflex therapy with apomorphine is used to develop a negative reflex to the taste and smell of vodka. The course of treatment - 10 sessions. In the first session, enter 0.1-0.2 ml of a 1% solution of apomorphine. The patient is given 80 ml of vodka, offering to sniff and rinse the mouth, and then drink. With a weak emetic reaction after 2 days, the session is repeated, increasing the dose of apomorphine. The maximum dose at the end of the course is 0.4 ml PO.To increase the emetic reaction, large doses of apomorphine are used in combination with the emetic mixture( castor oil and fish oil - 60 g, copper sulfate - 0.6 g, sodium sulfate - 30 g, distilled water - 200 ml).Patients take 200 g of this mixture and drink a few sips of vodka;then 0.4 mg & gt;1% solution of apomorphine n / k. In patients, there is a pronounced emetic and vegetative reaction;at this time they are given a sniff of vodka and rinse her mouth. The reaction time is up to 40 min. The most common complication is collapse. For its prevention after the initiation of an emetic reaction, a cordiamine - 2 ml and caffeine - 1 ml of a 10% solution of c / k is administered. After 2-3 days cause repeated reactions, only 5-6 sessions. In some patients aversion to alcohol is detected after the first session.
After the formation of a conditioned reaction to alcohol( aversion, nausea, urge for vomiting, face hyperemia, tachycardia), patients are assigned daily teturam 0.25-0.5 g per day for 2 months, and then for 5 days, taking the drug and 3day break. At the same time, general restorative therapy is performed. Patients can be treated out-patient, but they must be constantly under medical supervision.
In the last 3 decades, in the treatment of chronic alcoholism, sensitizing agents have been used, under the influence of which liquor intolerance is developed, fixed by a conditioned reflex method. Sensitizing drugs include teturam( antabus), ciamide, metronidazole( trichopolum), furazolidone, pyrroxane and furadonin. The most common of these is the domestic drug teturam( antabus).Treatment begins with arresting alcohol abstinence or intoxication. Then the course of alcoholic-teturic sessions is conducted, then patients are prescribed maintenance therapy with teturam 0.25-0.3 g per day( no more than 0.5 g);after 6 days of taking the drug make a break 2-3 days. After several months, the following mode of taking teturam is recommended: 2 weeks - reception, 2-3 weeks - break. Sensitizing drugs are used in new medicinal forms - for intramuscular injections and for subcutaneous implantation. For intramuscular injections, teturam is released in solution under the name "aprofid", and for subcutaneous implantations - "pleater"( "Esperal").
In some cases, there is intolerance to furadonin( pruritus, dermatitis).
Sensitizing and conditioned reflex treatment of chronic alcoholism can successfully be combined with hypnosuggestive therapy. Each type of treatment should be supported by the requirement of categorical refusal to drink alcohol throughout life. Systematic psychotherapeutic conversations with the patient are necessary. To relatives and friends it is recommended to create for the patient in a life and at work such conditions which would exclude the use of alcoholic drinks.
Antialcoholic therapy is most effective in the first stage of chronic alcoholism and is less effective in the third stage, which is characterized by the degradation of the personality with the formation of organic changes in the brain( alcoholic encephalopathy).In the fight against chronic alcoholism, an important role is played by preventive measures - active detection of alcoholics and persons who drink alcohol excessively, taking them into account and dispensary observation to prevent the development of alcohol dependence syndrome or for timely treatment. This is the specialty of the narcological service set up in the country( narcological clinics, narcological dispensaries, drug treatment rooms at polyclinics, MSU, at industrial enterprises).
The work of the narcological service is conducted in contact with the public, the administration of enterprises, who are well aware of the bad habits of their tenants or fellow workers. The work uses sanitary and educational measures, lecturing on anti-alcohol topics at enterprises, on radio and television. Alcoholic delirium of jealousy. Patients suspect the wife of treason, watch her, demand recognition in adultery;in a state of intoxication become aggressive, can commit socially dangerous actions. They are hospitalized in a psychiatric hospital. Treatment - neuroleptic drugs: aminazine - 200-300 mg / day, trifazin - 20-40 mg / day, haloperidol 20-45 mg / day IM.
The alcoholic hallucinosis develops against the background of abstinence;auditory hallucinations predominate without diminishing consciousness. The patient hears voices( two or several) that either scold or protect the patient. He listens to the voices, refers to them at first for a time, uncritically, perceiving them as real. Often, patients are excited, fearful and, under the influence of hallucinations, perform various, sometimes dangerous, actions.
Patients with acute alcoholic hallucinosis are urgently hospitalized in a psychiatric hospital, where they must be under round-the-clock supervision.
Treatment. Detoxifying agents are used: unitiol, glucose, levomepromazine( tizercin), 50-75 mg / day IM with simultaneous injection of 2 ml of cordiamine. After stopping the excitement with these drugs prescribe antipsychotics antigallutsinatornogo action: haloperidol - 10 mg IM / 3 times a day, trifazin - 10-15 mg IM / 3 times a day, simultaneously prescribe vitamins B and infusion in / in 20 ml40% glucose solution. Neuroleptics are injected intramuscularly until the disappearance of hallucinations, and then applied inside with a gradual decrease in doses. Further, anti-alcohol therapy is carried out.
In a number of cases, the course of a hallucinosis takes on a chronic character, hallucinations can last for years. Patients have a more critical attitude towards them. Hospitalization is necessary.
Treatment - antipsychotics: inside of haloperidol - 30 mg / day, trifluperidol( trisedil) - 0.25 mg / day with a gradual increase in the daily dose to 2-8 mg, triftazine - 60 mg / day, vitamins.
Alcohol delirium( white fever) develops with prolonged drinking or abstinence in the presence of additional harmful substances( somatic diseases, brain trauma, psychogeny, postoperative period).Characterized by a violation of sleep, delirious dullness of consciousness, affect of anxiety, fear and motor excitement. Observed somatic disorders - tachycardia, falling blood pressure, sweating, dyspepsia, a general tremor, an increase in temperature. White fever begins with visual hallucinations at night. As psychosis develops, hallucinations become frightening and fantastic. There comes a confusion of consciousness in the form of delirium with disorientation in the surrounding while preserving the consciousness of one's own personality, with visual hallucinations of a clearly scenic, sometimes frightening character. It is accompanied by a sense of fear, sometimes by fragmentary delusions. Patients are excited, highly talkative, defended from their "visions."At a severe degree of delirium, there are uncoordinated movements( patients "take off", pull off "threads").
Micropsies are often found: patients see small animals, small worms and little men. The course of the disease is acute, lasts for several days and ends either with the exit from a morbid state with incomplete memories, or lethal in the presence of severe cardiovascular insufficiency. Patients are subject to urgent hospitalization in a psychiatric hospital and should be on a bed rest under round-the-clock supervision.
Treatment. Cupping of white fever is carried out with a solution of 0.3-0.4 g of phenobarbital in 20 ml of ethyl alcohol and 150 ml of water;solution is given once, at the same time 2 ml of cordiamine are injected n / k. Further, detoxifying agents are used: unitiol - 5 ml of a 5% solution of IM, glucose - 20 ml of 40% IV, large doses of vitamins B, and B 6, nicotinic acid, cardiac agents. The next day, appoint levomepromazine( tizercin) - 50 mg / day in / m( under the control of blood pressure) or haloperidol - 30 mg / day IM.
Korsakov's psychosis is characterized by memory disorders and polyneuritis. Occurs most often after a white fever. Deep asthenia with severe exhaustion, weakness is noted. The memory is abruptly broken while remembering the past. Patients are not guided in time and in the surrounding, can not in the day report about the events that were in the morning. Criticism to the disease is absent. The course of psychosis is long.
Treatment of - large doses of nicotinic acid, nootropil( piracetam) 0.4 g 3 times a day, vitamins B, null, B 6, restorative therapy, physiotherapy, physiotherapy.
Pathological intoxication is a mental condition that occurs when alcohol is taken in a special condition due to a change in the environment, prolonged insomnia, overwork, emotional overexertion, and recent illness. Can develop when flying in an airplane or moving in a train. Characteristic is the darkening of the consciousness of the type of the twilight: the perception of the surrounding suddenly changes, delusions of persecution, hallucinations, fear appear. In patients, excitement arises with anger, rage, aggression. A characteristic feature is the absence of a disorder of coordination of movements( the patients do not stagger, their gait is sure).The pathological intoxication begins suddenly, proceeds for a short time and also ends suddenly with a very deep sleep, accompanied by amnesia( loss of memory).
Methanol refers to narcotic substances of aliphatic series. However, in addition to alcoholic intoxication, it causes severe poisoning due to the formation of formic acid and formaldehyde in the body.
Toxicity of methanol varies significantly - lethal may be taking from 1 tablespoon to 50-100 ml;a dose of 50-100 ml leads to death in 20-50% of cases. Blindness can come already from taking 7-8 ml of this alcohol.
After initial intoxication, a 12-24-hour period of well-being is observed. Symptoms often appear on the 3-4th day after taking alcohol. Intoxication is weakly expressed. The phenomena of intoxication develop gradually( differentiate from poisoning by atropine, from botulism).
Headache. Shortness of breath is an airy famine. Feeling of heaviness in the head, eyes, chest. Uncertain gait. Nausea. Vomiting, often even from every sip of water. Thirst. Visual impairment. Nystagmus. There can come complete blindness - always in both eyes. The pupils are dilated.
Excitation and motor anxiety arising at the beginning. Later they are replaced by drowsiness.
With comatose form there are epileptiform cramps.
Pulse is frequent. Falling heart activity. The skin is cyanotic. The limbs are cold.
Arterial pressure is initially elevated, then falls rapidly. Collapse, coma.
Increased blood clotting. Severe acidosis. Detection of methanol in washing waters and other biological materials is carried out either by the formation of formaldehyde( the distillate is mixed with sulfuric acid and potassium permanganate) or by the production of methyl ester of salicylic acid.
1. Full rest, warmth, darkening of the room.
2. Rinsing of the stomach with a large amount of warm water, 0.05% potassium permanganate solution, 4% sodium bicarbonate solution.
3. Introduction of competitive antidote - ethanol, maintaining its concentration in the blood within 0,7-1%.Give a drink of 100 ml of 30% ethanol and again every 2 hours for 50 ml to 6 times a day.
When coma intravenously, drip 5% ethanol at a rate of 10-12 g of pure 96% alcohol per hour. The first one-hour dose should be 40-50 grams of rectified ethanol. The daily dose of ethanol is an average of 100 g.
4. As an antidote - 5% ammonium carbonate solution 1 teaspoon every 2 hours 1 / g glass of water for 8-9 days.
Antidotes that restore functional disorders caused by methanol are corazole, pentetrazole( 1-1.5 ml of 10% solution subcutaneously or intramuscularly), cyanocobalamin( 250-500 μg intramuscularly), thiamine bromohydrate( 1-1.5 ml of 5xsolution subcutaneously or in the form of cocktails with glucose), pyridoxine( 2 ml of 2.5% solution intramuscularly).
5. Saline laxative per os( after washing the stomach through the probe, 30 g of magnesium sulfate and 20 g of magnesium oxide are added, dissolved in 150-200 ml of water).
6. Abundant drinking of alkaline solutions. Intravenous 250-400 ml( up to 1000 ml) 4% fresh sodium bicarbonate solution( under the control of urine pH).
7. Forced diuresis( up to 2 liters of isotonic sodium chloride solution, 5% glucose solution, polyglucin intravenously drip against intravenous injection of 80-120 mg of lasix).
8. Bleeding from the ulnar vein in the amount of 300 ml, followed by intravenous injection of 20-40 ml of 40% glucose solution, 2 ml of 5% solution of ascorbic acid and 10 ml of 0.5% solution of novocaine. Novocaine administered 10-15 days, then replaced with vitamin B2.
9. Hydrocortisone 125 mg intravenously 2-3 times a day.
10. Subcutaneously 2-4 ml of sulfocamphocaine and 2 ml of 10% caffeine solution. Euphyllin( aminophylline) - 5-10 ml of a 2.4% solution intravenously with bronchospasm.
11. Oxygen. Carbogen.
12. For pains, subcutaneously 1 ml of a 1% solution of morphine.
13. Intravenously 10 ml of a 1% solution of methylene blue.
14. Lumbar puncture with edema of the brain - release 10 ml of cerebrospinal fluid( in severe cases, release 15-20 ml).
15. Urgent admission to the hemodialysis department. Transport in the prone position on stretchers. The most effective is extracorporeal detoxification - hemodialysis and hemosorption.
Ethanol is a narcotic substance belonging to a group of fatty compounds.
In large doses, it leads to a weakening of excitation in the cerebral cortex, suppresses the activity of the spinal and medulla oblongata, depresses the respiratory center, the vasomotor center.
The concentration in the blood of ethanol 1.5 g / l is accompanied by a marked intoxication, 3.5 g / l corresponds to severe intoxication. The concentration of 5.5 g / l is lethal. The lethal dose is 300-500 ml of 96% ethanol.
Unconscious or semi-conscious state. Loss of sensitivity. Shaky gait.
Smell of alcohol from the mouth. Vomiting, alcoholic smell from vomit. Aspiration-obturation phenomena are possible. Bronchorea. Rave. Hallucinations. At first, narrowing, and then dilating the pupils.
Body temperature lowered. Sometimes a collapoid state. Decay of cardiac activity. Rapid pulse. Falling blood pressure.
Shortness of breath. Lung edema may develop. Involuntary excretion of feces and urine. Ethanol is found in the blood, urine, vomit and exhaled air( forensic medical examination).
1. Remove to fresh air. Full rest. Ensure the patency of the airways( intubation of the trachea in coma).
2. Rinse the stomach with plenty of warm water with a weak solution of potassium permanganate or activated charcoal( 2 tablespoons per 1 liter of water).In conclusion, through the probe to introduce a laxative - 30 g of magnesium sulfate, dissolved in 100 ml of water.
3. Introduce antidotes, restoring alcohol-damaged body functions and reducing intoxication.
3.1.Corazole, pentatrazole - 1-1.5 ml of a 10% solution subcutaneously or intramuscularly.
3.2.Pervitin( methamphetamine) - 0.003 g in tablets - or phenamine( amphetamine sulfate) - 1 ml of a 2% solution subcutaneously.
3.3.Choline nitrate together with folic acid;pyridoxine - 1-2 ml of a 2.5% solution intramuscularly.
3.4.Cyanocobalamin 250-500 μg intramuscularly.
3.5.Thiamine bromohydrate - 1-2 ml of a 5% solution subcutaneously or intramuscularly.
4. 3% aqueous solution of ammonia to the nose. Its inside is 5-8 drops per water beaker.
5. Rubbing the body. Warmers. Artificial ventilation of lungs. Oxygen. With deep coma - intubation of the trachea and artificial ventilation of the lungs.
6. Subcutaneously 1-2 ml of 10% caffeine solution. Cordiamine( 1-2 ml subcutaneously every 3 hours).Sulphocamphocaine. At a collapse enter hydrocortisone( 125 mg intravenously) and prednisolone( 60-90 mg intravenously).
7. In severe cases, administer strophanthin( 0.5 ml 0.05% solution in 40-50 ml of 10% glucose solution, slowly or in 500 ml isotonic sodium chloride solution dropwise).
8. Detoxification therapy: forced diuresis - inject intravenously 2-2.5 liters of isotonic sodium chloride solution or its mixture with 5% glucose solution and 40-160 mg of furosemide( lasix) intravenously( into the tube of the system).500-1000 ml of a 4% solution of "atria of bicarbonate is dripped intravenously.
9. When convulsions and deep disorders of microcirculation after a prolonged stay poisoned in the cold, intravenously inject 10,000 units of heparin and the antipsychotic haloperidol( 1 ml of 0.5% solution intramuscularly, strict control of blood pressure!).
10. Control of pulmonary edema.
11. Prophylactic administration of antibiotics to prevent aspiration pneumonia.
12. Hospitalization in a therapeutic hospital, intensive care unit.