ALCOHOLIC INTOXICATION, acute drunkenness, — the state resulting from alcohol intake.
And. the lake is followed by passing changes of behavior that is connected with ratio distortion of processes of excitement and braking. Arising at And. the lake is contagious, motor, speech excitation, loss of self-checking and critical evaluation of a situation, weakening of inhibitory effects cause the frequency of commission of asocial acts (see Alcoholism, effects of alcoholism). At frequent, unlimited alcohol intake for the purpose of obtaining euphoric effect And. the lake can develop the pathological addiction which is followed by mental and somatoneurologic disturbances (see. alcoholism ).
Mechanism of effect of alcohol. In process of absorption from a stomach and intestines concentration of alcohol in blood increases, reaching (at one-time reception) a maximum on the second hour after reception, then gradually falls. Degree of intoxication (subjective feelings and objective expression) is higher on raising of a curve, than at the same concentration of alcohol in blood on its recession. To 10% of alcohol it is allocated from an organism (through lungs, kidneys, skin) not changed, other quantity is oxidized systems of alcohol dehydrogenase and a catalase. Oxidation rate (Vidmark's coefficient) — to 8 ml of absolute alcohol an hour. By histochemical and radiological methods of a research in clinic and an experiment it is shown that traces of one-time reception of an average dose of ethanol are found in the healthy person in an organism within two weeks though from blood alcohol disappears to 4 — to the 5th hour. Overseeing marked With 14 disproves the existing ideas of that. that one-time alcohol intake acts only on c. N of page, in particular on a cerebral cortex. At the first reception the greatest concentration of alcohol is found in a liver and cross-striped muscles, and then in c. N of page, first of all in subcrustal educations and a cerebellum, then in bark. At the subsequent alcohol intake ethanol concentrates in c more and more. N of page.
Intoxication is characterized by excitement of underlying structures of c. N of page at decrease in functions of the highest. Pathophysiological researches show that small doses of alcohol cause only stimulation dientsefalyyuy areas; with increase of a dose signs of excitement of bark appear. Only high doses lead to braking of bark; limit, lethal doses cause consecutive braking of underlying educations, diencephalic area, the centers of a myelencephalon.
The narcotic effect of alcoholic beverages is a result of impact not only on c. N of page (alcohol gets through a gemato-entsefalrgchesky barrier), but also on peripheral nervous educations that changes the general vegetative background.
Clinic of alcoholic intoxication. Speed of emergence of the first signs of intoxication depends on the fortress of drink and a degree of admission of a stomach food; at reception next the heart even low alcohol drinks absorbability of alcohol a mucous membrane above. Degree of intoxication is defined by amount of absolute alcohol on 1 kg of body weight, individual portability and a psychophysical condition of the person during alcohol intake. At fatigue and exhaustion small doses can cause strong intoxication; in a condition of mental tension the intoxicating effect of alcoholic drinks decreases. The children, old men and persons suffering from organic lesion of c. N of page, diseases of a liver, stomach (including after a resection of a stomach) and endocrine frustration (except for diabetes and a hyper thyroidism), are especially sensitive to effect of alcohol. Women at the age of 20 — 30 years are more tolerant to alcohol, than men at the same age. With age portability of alcohol at women decreases; men are rather hardy up to 50 years inclusive. It is approximately considered to be weak degree of intoxication concentration of alcohol in blood to 20/00, average — to 30/00, heavy — above. Concentration of alcohol in blood higher than 50/00 is considered deadly. But at equal concentration degree of intoxication of subjects can differ considerably. So, patient hron. alcoholism in the second stage shows high portability of alcohol, and intoxication at it is hardly noticeable even at high concentration of alcohol in blood.
The first subjective signs of alcoholic intoxication — feeling somatic, in process of strengthening and expansion creating a mental condition of euphoria. There is gloss of scleras, a hyperemia of the person, hypersalivation, a hyperhidrosis, pulse is slowed down, the vascular and muscle tone decreases. The feeling of heat, pleasant muscular weakness is expressed, appetite increases. The condition of the general psychophysical satisfaction, raising of mood is noted; a mental and physical activity decreases, brightness of sensual impressions, an emotional saturation increases. Later a nek-swarm time (10 — 30 min.) pupils extend, weakness of convergence, increase of an urination, increase in a diuresis, increase in a pain threshold is observed; are possible dryness in a mouth, pallor of integuments. Pulse and blood pressure are leveled. At functional weakness, insufficiency of cardiovascular system tachycardia and hypertensia are possible. A mental and physical activity increases against the background of disorder of quality of functions, including the highest, cortical. The movements are badly coordinated, razmashist, are expressed a dizmetriya, disturbance of balance (ataxy). The thin movements, a mimicry are broken — the person drunk sometimes becomes masklike. In certain cases at considerable intoxication convergence is broken, the strabismus, a diplopia appear. The speech is loud, greased. Associations are accelerated, but superficial associations prevail (according to the accord, contiguity). Decline in quality of mental processes is shown in disorders of concentration of attention. The criticism to the words and actions disappears. There is a revaluation of the qualities and opportunities, egocentric fixing of experiences. The controlled instincts and the hidden features of the personality are shown until then. So, saturated, significant experiences reveal affektivno (jealousy, vanity, offenses and so forth).
At easy degree of intoxication clinically visible manifestations either are absent, or are close to clinic And. moderately severe lake. However effects do not happen next day.
At intoxication of average degree got drunk makes an impression of the person who is stirred up with lower, than actually, intelligence. If the amount of alcohol is not overdosed, intoxication gradually turns into drowsiness, slackness; if intoxication fell on evening hours, there comes the deep sleep. During the awakening after moderately severe intoxication the postintoksikatsionny state (hangover) — slackness, weakness, lack of appetite, weight in the head, reduced mood, sometimes melancholy, discontent with and to people around, irritability is expressed. Mental and physical effeciency is reduced: comprehension and concentration of attention, slow rate of mental processes are complicated, the muscle tone is lowered, coordination of movements is broken.
At heavy degree of intoxication orientation in surrounding is lost, the speech is slowed down, alternates pauses, communication of experiences is lost, emotions smooth out, mimic and verbal expressiveness disappears. In 2/3 cases vomiting as defense reaction of an organism develops. With increase of intoxication disturbance of consciousness goes deep, breath urezhatsya (possibly breath like Cheyn — Stokes), becomes hoarse, the cardiovascular tone, reflex irritability falls, reactions to external irritations disappear, there is an obezdvizhennost, muscular relaxation, the oglushennost, a sopor, and sometimes a coma develops. Death can come from paralysis respiratory or vasomotor centers, and also in a condition of an alcoholic coma. It is easy to diagnose an alcoholic coma on the specific smell proceeding from the patient. However in all cases of an alcoholic coma it is necessary to exclude a possibility of a diabetic coma (see) against the background of an easy drunkenness, an acute injury of c. N of page. The mixed alcoholic and barbituric coma clinically is not diagnosed; it is necessary to make a laboratory research and to watch the patient after escaping of a coma.
Next day after a serious poisoning working capacity falls, the hypodynamia, mental and somatic (cardiovascular) weakness, anorexia is expressed; the mood depressive — is noted narcotic amnesia (see an alcoholism). Within several days frustration of a dream is possible (hypnotic drugs are contraindicated).
Easy and average degrees of alcoholic intoxication at healthy faces are not followed by amnesia.
During the saving the general scheme of development of symptoms manifestation of intoxication is so individualized, as well as the personality; the constitution, emotional features matter, and the behavior in an ebrietas depends on the level of intellectual development and culture. At the corresponding predisposition (antisocial, aggressive tendencies), affective excitability and loss of control of the behavior in an ebrietas conditions for offenses are created. Lose self-checking in an ebrietas of the person which have social installations, a regulation are not expressed, or alcoholics who have a dissociation of control of the behavior, a physical activity and finicality it is very big. It is necessary to provide those cases when the person intentionally takes alcoholic drinks with the purpose to reduce self-checking, to get rid of alarming fears and to take long ago the conceived «resolute» action in assessment of the behavior which got drunk.
In some cases an acute drunkenness not usual, but pathological intoxication can develop (see. Alcoholic psychoses ).
Treatment of an acute drunkenness. Searches of means of sobering did not yield results yet. Intravenous administration of glucose, fructose with ascorbic to - that or rat anti-acrodynia factor, a geminevrina (pyridoxine), cocarboxylase is recommended. For maintenance of cordial activity Cordiaminum, camphor, for initiation of respiratory functions — inhalation of spirit of ammonia, a lobelia, Cytitonum are shown. Treatment of an alcoholic coma to similarly medical intervention at comas of other genesis. However the gastric lavage, parenteral administration of oxidizers — fructose, a tiaminovy complex, especially B1 and B6, and the central analeptics is obligatory. Recently there were messages that the failure from use of Bemegridum in the detoksikatsionny centers increased survival of sobered. It is possible to recommend intravenous injections of 0,25% of solution of potassium permanganate, 1% of solution of methylene blue.
Methods of definition of alcohol in an organism. During the definition of alcohol use qualitative tests in the beginning, at a positive take carry out quantitative definition. Recently quantitative definition without preliminary qualitative is applied.
Qualitative colorimetric tests (definition of alcohol in expired air) are based on ability of ethanol to oxidize various reactants (Rappoport's test, Mokhova — Shinkarenko, Nikla, etc. — see. Alcohol ).
From the quantitative methods giving the chance to establish concentration of alcohol, the greatest distribution was gained a photometric method (for a blood analysis, urine, cerebrospinal fluid, gastric contents) and a method of gas-liquid chromatography (for a blood analysis, urine and expired air).
Forensic medical examination of death at an alcoholic poisoning. Acute fatal poisoning with ethyl alcohol is established in a complex macro - and micromorphological features with data of a judicial and chemical research of biological material (blood, urine, cerebrospinal fluid, etc.). Quite often morphological changes at an alcoholic poisoning happen unsharply expressed, many signs meet also at other types of death. During the opening such signs as a smell of alcohol from internals attract attention (brain), and sharp overflow of a bladder. At an alcoholic poisoning the hyperpermeability of walls of vessels — diapedetic extravasates and quite often ruptures of vessels is noted. In this regard small apoplectic focuses in brain fabric and hemorrhages under a meninx [according to A. Tardieu in 86%], hemorrhages in a mucous membrane of a stomach and a duodenum, under an epicardium, under a pulmonary pleura, in a mucous membrane of a trachea and large bronchial tubes, in nervous trunks, in bark of adrenal glands etc. are found.
Disturbance of a hemodynamics is shown in irregularity of a krovenapolneniye of a myocardium, in wet brain and a soft meninx, pulmonary fabric and other bodies. Puffiness of the person, hypostasis of friable retroperitoneal cellulose and mesentery, cellulose in circles of a bladder and its wall, hypostasis of a bed and wall of a gall bladder, gepato-duodenal sheaf, excess amount of liquid in serous cavities, venous stagnation is often observed.
Lethal doses of ethyl alcohol are extremely variable and individual, they depend on internal and external factors, in particular on individual portability, on age features (old people and children are extremely sensitive to it), on sexual characters, features of a metabolism, meal and its character, on psychoemotional factors, reference functional states and so forth. Death at an alcoholic poisoning can come in the period of a resorption (often during the drinking of drinks of high concentration at bystry speed), at height of the maximum blood alcohol content or during elimination, in some cases at its total disappearance from blood (M. I. Avdeev). Link (To. Linck) provides data on time of approach of death: in the period of a resorption — in 12%, during the early period of elimination — in 52% and at the end of a phase of elimination — in 36% of cases.
Quite often maximum level of blood alcohol content with a relative accuracy should be established indirectly on its content in urine and cerebrospinal liquid; e.g., if in blood contains 1,00/00, and in vesical urine and cerebrospinal liquid close to 5,00/00, then it is possible to assume that for some number of hours before death blood alcohol content was around 5,00/00 (usually slightly lower). There is a method of retrospective definition of concentration of alcohol with use of coefficient the Look brand. However, considering identity of processes of oxidation, increase and irregularity of oxidation of alcohol in an organism abusing it, this method cannot be considered reliable.
Deaths of poisonings with alcoholic drinks depend not only on the quantity drunk, impurity and additives to it, but also on the level of products of partial oxidation (acetic aldehyde, etc.) ethanol.
I. N. Pyatnitskaya; V. A. Balyakin (court.).