Alcohol Sketchy | Toxicology forensic science | Forensic medicine lecture | Forensic Medicine

Alcohol (ethanol) is a central nervous system depressant. Large amounts consumed rapidly can cause respiratory depression, coma, and death. Large amounts chronically consumed damage the liver and many other organs. Alcohol withdrawal manifests as a continuum, ranging from tremor to seizures, hallucinations, and life-threatening autonomic instability in severe withdrawal (delirium tremens). Diagnosis is clinical or based on diagnosis of typical complications (eg, alcohol-related liver disease). Tolerance to alcohol develops rapidly; similar amounts cause less intoxication. Tolerance is caused by adaptational changes of central nervous system cells (cellular, or pharmacodynamic, tolerance) and by induction of metabolic enzymes. People who develop tolerance may reach an incredibly high blood alcohol content (BAC). However, ethanol tolerance is incomplete, and considerable intoxication and impairment occur with a large enough amount. But even people who have developed tolerance may die of respiratory depression secondary to alcohol overdose. Alcohol-tolerant people are susceptible to alcoholic ketoacidosis, especially during binge drinking. Alcohol-tolerant people are cross-tolerant to many other central nervous system depressants (eg, barbiturates, nonbarbiturate sedatives, benzodiazepines). The physical dependence accompanying tolerance is profound, and alcohol withdrawal has potentially fatal adverse effects. Chronic heavy alcohol intake typically leads to liver disorders (eg, fatty liver, alcoholic hepatitis, cirrhosis); the amount and duration required vary (see Alcohol-Related Liver Disease). Patients with a severe liver disorder often have coagulopathy due to decreased hepatic synthesis of coagulation factors, increasing the risk of significant bleeding due to trauma (eg, from falls or vehicle crashes) and of gastrointestinal bleeding (eg, due to gastritis, from esophageal varices due to portal hypertension); alcohol abusers are at particular risk of gastrointestinal bleeding. Chronic heavy intake also commonly causes the following: Gastritis Pancreatitis Cardiomyopathy, often accompanied by arrhythmias and hypertension Peripheral neuropathy Brain damage, including Wernicke encephalopathy, Korsakoff psychosis, Marchiafava-Bignami disease, and alcohol-related dementia Certain cancers (eg, liver, head and neck, esophageal), especially when drinking is combined with smoking Indirect long-term effects include undernutrition, particularly vitamin deficiencies. On the other hand, low to moderate levels of alcohol consumption (≤ 1 to 2 drinks/day) may decrease the risk of death due to cardiovascular disorders (1). Numerous explanations, including increased high density lipoprotein (HDL) levels and a direct antithrombotic effect, have been suggested. Nonetheless, alcohol should not be recommended for this purpose, especially when there are several safer, more effective approaches to reduce cardiovascular risk. #toxicology #forensicmedicine #sketchy