Dr. Chetan Lavu Karekar
Chronic alcohol poisoning is rampant all over the world. Addiction to alcohol may be due to mental stress, unemployment, failure in love, loss of self-esteem, poverty, marital disharmony, etc. Chronic alcohol addiction is commonly seen in lower socioeconomic strata and it causes abnormal physical and mental behaviour. The addict may steal things to get money for drinking. He may become quarrelsome and beat his wife and children. He may resort to criminal behavior and commit homicide or suicide. The patient suffering from chronic addiction to alcohol suffers from loss of appetite, nausea, vomiting, especially in the morning, and diarrhoea. Due to chronic damage to liver, jaundice may be seen. Tremors of tongue and hands may be seen. Loss of memory, insomnia, impaired power of judgement, confusion and abnormal mental behaviour are seen. Features of malnutrition and chronic vitamin deficiencies are seen. Chronic alcoholic myopathy and neuropathies are seen later in addiction. Dementia may be seen in later stages.
Ethyl alcohol is one of the most common inebriant poisons used all over the world, mostly as a social drink. It is colourless, transparent, volatile liquid, having a characteristic smell and a burning taste. It is very commonly used as a solvent for fats, resins, volatile oils, etc. It is also commonly used as base in liquid medicines.
In cough syrups, it is found in very high concentration. Some ayurvedic medicines contain very high concentration of alcohol as well and are commonly abused.
In alcoholic drinks, the percentage of alcohol is very high. Absolute alcohol contains about 99.95% alcohol. Rectified spirit contains about 90 per cent while industrial methylated spirit or denatured alcohol contains 95% alcohol and 5% wood naphtha. Rectified spirit used in clinical practice also contains minor quantity of copper sulphate, which is added to make it unfit for ingestion.
Acute poisoning results from consumption of alcoholic beverages in large doses or small doses over a period of time. The following clinical features are noticed.
The first symptoms are sense of well-being, self-confidence and exhilaration. Alcohol in small doses cause inhibition of social inhibitions. The person becomes talkative. He may become argumentative, show carefree behaviour, become sentimental, sad or depressed. Gradual loss of self-control is seen. These symptoms are seen when concentration of alcohol in blood is about 80–100 mg per 100 ml of blood.
If alcohol concentration rises further, there is a stage of confusion, perception becomes dull and there is muscular incoordination. The gait becomes staggering. The voice becomes slurred and speech is incoherent. The vision becomes blurred and stupor follows. There may be severe nausea and vomiting which may relieve the poisoning. These symptoms are seen in blood concentration 100–200 mg per 100 ml of blood.
If alcohol concentration goes beyond 180–200 mg, the person starts having severe sleep, severe headache and gradually passes into a stage of unconsciousness and finally into deep coma leading to death.
Death may also occur if blood alcohol level goes above 250-300 mg per 100 ml of blood. Alcohol levels above 300 mg per 100 ml of blood are fatal. Fatal dose depends on age, sex and health of the individual while chronic users can tolerate high doses.
If alcohol is consumed faster, less dose is required. About 150–250 ml of absolute alcohol may be an average fatal dose for an adult. The consumption of full bottle (750 ml) of whisky can cause death.
It has been reported that there is increased incidence of road traffic accidents if a person drives under the influence of alcohol. It puts him and others in grave threat of accidents.
When a person who is addicted does not imbibe alcohol for a period of time, he gets withdrawal reactions like tremors, sweating, headache, insomnia. Persons become very agitated and demand alcohol. They start having hallucinations and seizures. Tonicclonic convulsions may also be seen.
In India, it is an offence to drive under the influence of alcohol vide Section 185 of Motor Vehicle Act in which a person can be fined and may undergo imprisonment ranging from 6 months to 2 years.
Many countries have set different blood alcohol concentration levels for allowing people to drive while under intoxication of alcohol.
The limit is 20 mg per cent in Poland and Sweden, 50 mg per cent in Finland, Norway and Netherlands, 80 mg per cent in Denmark, Germany, UK, France, and Switzerland, 100 mg per cent in Ireland and 80 to 150 mg per cent in different states of USA. In India, the statutory limit is fixed at 30 mg per cent. But since breath analysing facilities are not available all over India, most drivers are being convicted only on the basis of medical examination.
Breath analyser are instruments in which a person who is accused of driving under the influence of alcohol is asked to exhale the air from lungs by the police.
Previously, the person was asked to blow into a plastic balloon which contained a solution of dichromate-sulphuric acid which would turn into green colour if alcohol concentration was more than certain level. Now we have sophisticated breath analysers which can sense alcohol levels with a very minute exhaled air and even in unconscious drivers by keeping them near their nose. The breath analyser directly gives the reading in blood alcohol concentration. It is based on the formula that 2100 ml of respired air contains the same amount of alcohol as present in one ml of blood.