醫學筆記匯整 ED Notes

 Stages of alcohol withdrawal syndrome : 
 

1. Minor withdrawal symptoms : 6-36 hr
   tremor, anxiety, palpitation, headache, diapheresis, N/V
    
2. Seizures (rum fits) : 6-48hr
   tonic clonic, status rare
    
3. Alcohol hallucinosis : 12-48 hr
   visual, auditory, intact orientation
    
4. Delirium tremens : 48-96 hr
   agitation, HR BP increased, fever, diaphoresis

Ethanol and isopropanol 異丙醇 are the most common alcohols ingested;
their principal effects are GI irritation and intoxication; and they do not produce metabolic acidosis.
Methanol and ethylene glycol 乙二醇 are toxic alcohols. 

每一單位的酒精=10公克的純酒精量=1瓶350罐裝啤酒=1/4瓶保利達
標示的酒精濃度（只取數字）* 所喝的份量（以公升計）＝酒精單位
ex. 一罐 5％酒精濃度的330毫升啤酒 : 5 * 0.33＝1.65 個酒精單位

Ethanol is a CNS depressant, 增強抑制性的 GABA
因為 tolerance, blood ethanol levels correlate poorly with degree of intoxication
一般沒有喝酒習慣的酒精濃度 400-500 可能會 respiratory depression
但酗酒的可能才 minimally intoxicated

酒精造成 Peripheral vasodilation : causes heat loss, 更容易 hypothermia 
也會 orthostatic hypotension and reflex tachycardia

Hypoglycemia, Alcoholic Ketoacidosis

Inebriation 喝醉 
Euphoria or agitation and combativeness.
Slurred speech, nystagmus, ataxia, decreased motor coordination, N/V 
Respiratory depression and coma

 Diagnosis 

Ethanol-intoxicated patients often have other disease processes,
such as infections, traumatic injuries
Liver disease, pancreatitis, hypoglycemia, 
concomitant drug use

Ethanol ingestion is the most common cause of an osmolar gap
and may be associated with a mild metabolic acidosis,

but significant anion gap metabolic acidosis suggests the presence of
lactic acidosis, ketoacidosis, or methanol or ethylene glycol toxicity
嚴重的 AG 代謝酸不要想酒精 !!


 Treatment 
就是等到他醒
若有 Hypoglycemia -> glucose, 不等 B1 
沒有 Hypoglycemia -> B1 + Glucose
低鉀, 低鎂, 低磷

Fluid administration does not hasten alcohol elimination
所以 Hydration 其實沒有意義

缺 Vit B1 的 complication : 

Wernicke' s encephalopathy 急性期 : abnormal mental status, ataxia, and nystagmus,
Confusion, Ophthalmoplegia, Ataxia
nd requires daily treatment with thiamine, 100 milligrams, until normal diet is resumed.

Korsakoff 慢性期 : Memory loss, Confabulation 虛談