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How to deal with patients with acute alcoholism?
How to deal with patients with acute alcoholism? Diagnosis of alcoholism is not difficult. There is an obvious history of drinking accompanied by psychiatric and neurological symptoms. As clinicians, we need to master how to judge the severity of patients and the principles of treatment after acute alcoholism.
Grading of acute alcoholism
1. Mild (simple drunkenness) alcoholism
Nervous system manifestations with only emotional and language excitement, such as incoherent speech but no aggressive behavior, can walk, but have mild motor incoordination, sleepiness can be awakened, simple answering is basically correct, and neural reflexes are normal.
2. Moderate alcoholism
It is manifested in the following aspects:
1) Have manic or aggressive behavior that cannot be relieved by language or psychological counseling
2) Severe ataxia with unconsciousness and weakened neural reflexes
3) Have hallucinations or seizures
4) Blood biochemical tests have the following manifestations of metabolic disorders such as acidosis, hypokalemia, and hypoglycemia.
5) On the basis of mild poisoning, complicating with obvious impairment of organ function, manifestations such as arrhythmia related to alcoholism (frequent premature beats, atrial fibrillation or atrial flutter, etc.), manifestations of myocardial injury (ST-T abnormality, myocardial enzyme 2 Times higher than that) or upper gastrointestinal bleeding, pancreatitis, etc.
3. Severe alcoholism
1) Appearance of insufficient microcirculation perfusion, such as pale face, clammy skin, slightly purple lips, rapid heart rate, weak or untouchable pulse, blood pressure lower than 90/60, mmHg or shock, etc.
2) Severe manifestations of metabolic disorders such as acidosis (pH≤7.2), hypokalemia (serum potassium≤2.5, mmol/L), hypoglycemia (blood sugar≤2.5, mmol/L).
3) Acute insufficiency of important organs such as heart, liver, kidney and lungs.
Complications of alcoholism
1. Inducing heart disease or arrhythmia: Alcohol can excite the respiratory center, leading to increased blood pressure, complicated by cerebrovascular accidents, cerebral hemorrhage, brain herniation, etc.;
2. Hypoglycemia: It is one of the most serious complications of acute alcoholism. After drinking, the conversion of lactic acid to pyruvate will be inhibited, the effect of gluconeogenesis will be weakened, and the mobilization of liver glycogen will lead to hypoglycemia.
3. Pancreatitis: Drinking a lot of alcohol can lead to an increase in triacylglycerol in the blood. When the concentration is greater than 11.29 mmol/l, it is easy to induce pancreatitis.
4. Aspiration pneumonia or suffocation: As the patient aspirated vomit, sputum, etc., aspiration pneumonia or foreign body aspiration suffocation may occur.
5. Metabolic disorders: can cause hypokalemia, hypomagnesemia, hypocalcemia, metabolic acidosis, etc.
6. Gastrointestinal bleeding: Alcohol can cause acute gastric mucosal damage and lead to upper gastrointestinal bleeding.
Patients with alcoholism need to have a careful physical examination to understand whether they have a history of trauma, whether they have taken certain drugs, and initially judge the patient’s condition and severity, such as the patient’s mind, pupils, pulse, respiratory rate, heart rate, blood pressure, etc., If necessary, relevant laboratory tests are required, such as electrolytes, electrocardiogram, B-ultrasound, and head CT.
Treatment of acute alcoholism
Mainly to prevent aspiration and help patients sober up as soon as possible, maintain water, electrolyte, and acid-base balance. For patients with acute alcoholism in lethargy and coma, airway and ventilation function need to be assessed, and tracheal intubation is required if necessary.
1. General treatment
People with mild alcoholism can stay in bed, keep warm, drink some tea and coffee to sober up, or eat more pears, watermelon, drink some mung bean soup, honey water, etc., which also have a good anti-drinking effect. Patients with acute alcoholism in a short time can also use vomiting or gastric lavage to reduce the absorption of alcohol.
2. Keep the airway open
When severe alcoholism occurs, the poisoned person may experience nausea, vomiting, lethargy, and shock. At this time, we must pay attention to helping the poisoned person to clean up the vomit. Never let him sleep alone, otherwise the patient may have vomit that blocks the respiratory tract during sleep. Asphyxia died, the patient’s head can be tilted to one side. If the poisoned person has weak breathing and shock, he can also take oxygen.
3. Naloxone: Promote recovery
If a person with severe alcoholism has entered a drowsy state, naloxone can be injected intravenously, 0.4-0.8 mg intravenous bolus or intravenous drip for moderate naloxone patients, 0.8-1.2 mg for severe patients, more than once a day Once used, it has a good effect on acute alcoholism.
4. Metadoxine: Promote alcohol metabolism
It is suitable for moderate to severe patients with aggressive behavior and emotional abnormalities. It is generally 0.9g, intravenously administered, and is forbidden for breastfeeding and bronchial asthma patients.
5. Proton pump inhibitors,
such as omeprazole or pantoprazole
It can be used for gastric mucosal injury or gastrointestinal bleeding. It can inhibit gastric acid and protect the gastric mucosa from damage. It can be routinely applied to patients with obvious gastrointestinal symptoms.
6. To prevent hypoglycemia,
50% glucose, vitamin B6, vitamin C, etc. can be injected intravenously to accelerate the oxidation of ethanol in the body.
7. Mannitol dehydration can be given for cerebral edema,
hemodialysis can be used to promote the elimination of ethanol from the body in severe acute poisoning. Dialysis indications: blood ethanol content is greater than 108mmol/l (500mg/di), accompanied by acidosis or taking other suspicious drugs at the same time Need to consider dialysis.
Acute alcoholism generally has a good prognosis. Patients with heart, liver and kidney disease who are in a coma for more than 10 hours, or whose blood concentration is greater than 87mmol/l (400mg/di), have a poor prognosis. Long-term drinking can lead to toxic encephalopathy and peripheral nerves. , Liver, myocardial and other pathological changes and malnutrition, the prognosis is related to the type and degree of the disease.
(source:internet, reference only)