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ALCOHOL &

ALCOHOL
INTOXICATION
 Main objective: To recognize the effects of
alcohol on the body
 Specific objectives:
1. To enumerate the different stages of alcohol
intoxication and their features
2. To understand how alcohol intoxication is
diagnosed
3. To explain the role of the doctor in the
investigation of drinking and driving
References
1. Alcohol and Alcoholism. Lecture Notes.
Department of Forensic Medicine,
University of Dundee. 2.02.2011.
http://www.dundee.ac.uk/forensicmedicin
e/notes/alcohol.pdf
2. Alcohol in Simpson’s Forensic Medicine
by Shepherd R, 12th ed. (2003), p159-
163
Alcohol (ethanol, ethyl alcohol)
 The most widely used drug
 Small, water-soluble molecule that is evenly
distributed throughout the body water
 Passes easily through the blood-barrier →
significant depressant effect on cerebral function
 Direct toxic effects on the body tissues
 Significant indirect effects – a common catalyst
in many assaults and homicides
 Addictive drug
Absorption of Alcohol
 Stomach (20%), duodenum & first part of
the jejunum (80%)
 Empty stomach → liver circulation in 30-90
minutes
 Elimination is through the liver & kidneys
→ blood alcohol concentration (BAC) will
depend on the rates of absorption and
elimination
Factors that affect absorption of alcohol
Factors that affect BAC

 Food in the stomach, especially fatty food


 Delays gastric emptying → delays absorption
in the duodenal-jejunal segments of the
intestines
 Fatty food obstructs the contact of alcohol
molecules with the gastric mucosa
 Increase in gastric emptying
 Tolerance to alcohol
 Operative reduction in the stomach size
Factors that affect absorption of alcohol
Factors that affect BAC

 Concentration of alcohol
 Optimum concentration for rapid absorption is about
20%
 Alcohol in weak drinks (e.g., beer, wine) passes
slowly through the mucosa and into the bloodstream
 Stronger drinks irritate the gastric mucosa →
production of excess mucus → coat the stomach
lining → physical barrier to absorption
 Stronger drinks → spasm of the pylorus →
obstruction to emptying → delay in emptying,
absorption
Factors that affect absorption of alcohol
Factors that affect BAC

 Amount of alcohol  Temperature of the


drunk drink
 Speed in drinking  Warm alcohol
 Fast drinker  Body weight
 Type of mixer used  Lighter weight
 Carbonated beverages  Male or female
> water & fruit juices  Female
 Drugs  Pre-menstrually

 Illness  On birth control pills


Elimination of Alcohol
 More than 90% metabolized by the liver
 Long-term high intake of alcohol → liver
damage
 5-8% is excreted unchanged by the
kidneys, sweat, breath
Effects of Alcohol
 Nervous system
depressant
 Depressionis from
above downwards

 Suppression of
inhibition by the
cerebral cortex →
initial excitant effect
Depressant
Effects of Alcohol
 Cortex: orderly social behavior (inhibitory)
 Disinhibition,
talkativeness, show off; reduce
anxiety & pain
 Limbic system: memory
 Loss of memory, confusion, disorientation
 Cerebellum: muscular coordination,
speech
 Incoordination, slurring
Depressant
Effects of Alcohol

 Reticular formation (upper brainstem):


control of consciousness
 Stupor and coma
 Lower brain stem: vital centers
 Death
Alcohol Breaks Brain Connections Needed to
Process Social Cues
http://www.biosciencetechnology.com/news/2013/09/alcohol-breaks-brain-connections-needed-process-social-cues

 Amygdala & orbitofrontal cortex, an


area of the prefrontal cortex
implicated in socio-emotional
information processing & decision
making

 Alcohol reduced the reaction in the


amygdala to threat signals

 Suggests that during acute alcohol


intoxication, emotional cues that
signal threat are not being
Areas of increased brain activity are labeled in processed in the brain normally
yellow, and areas of decreased brain activity are
labeled in blue. (Source: University of Illinois)
 Ability to assess & appropriately
respond to non-verbal message is
impaired
Stages of Intoxication
1. Excitement
 Loquacious, vivacious, sense of well being
 Tendency to lose emotional restraint, to
forget animosities, converse with abandon,
to be less critical, to lose control over one’s
moral integrity
 Still able to pull oneself out of it and to sober
up by the force of will
Stages of Intoxication
2. Confusion
 Tendency to come to grief over longer words due to
slight incoordination, to slur speech, to lose control
over finer movements, slight blurring of vision,
inability to perform coordinated acts (e.g., driving a
car with its quick appreciation of danger)
 Confusion over any problem requiring clear thinking
& concentration
 Emotional upsets more marked, boasting, loud
laughter, coarser jesting, anger, violence stirred by
the surrounding persons
Stages of Intoxication
3. Stupor
 Dead drunk – can only be aroused in response to
strong stimuli
 Tends to not feel any pain even when injured
 May lie with his face flushed, saliva dribbling from
the lips, snoring loudly
 Stupor may be followed by coma and death
 Blood-shot eyes, dilated pupils, rapid bounding
pulse, physical incoordination, jerky eye movements
on lateral gaze
Mimickers of Alcohol Intoxication
 Head injuries
 Hypoglycemia
 Seizure disorders
 Influence of illicit drugs (marijuana, cocaine,
amphetamines, opiates)
 Psychiatric conditions (depression, alcohol
abuse)
 Other illnesses: migraine, stroke, multiple
sclerosis, ketoacidosis, Meniere’s disease
Drinking and Driving
 Alcohol → feeling of physical well-being
while depressing brain function
 Vision
is blurred
 Awareness decreased, especially in the dark
 Judgment impaired
 Impaired ability to judge speed and distance & to
deal with the unexpected
Alcohol Intoxication & Sexual Assault

 Alcohol intoxication → sexual abuse


 ↓inhibitions make sexual assault seem
acceptable
 Victims usually intoxicated at the time of
the attack
 Prevent them from stopping the attack,
avoiding risky situations
 Usually know the perpetrator
 Use of date-rape drugs
Diagnosing Drunkenness
 Alcoholic smell of the breath or of the
vomitus
 Dry furred tongue or excessive salivation
 Irregular behavior
 Congestion of the conjuctivae
 Hesitancy or thickness of speech with
impaired articulation
Diagnosing Drunkenness
 Tremor or error of coordination and
orientation
 History of having taken alcoholic
beverages
Field Sobriety Tests
IRR of “Anti-Drunk and Drugged Driving Act of 2013″)

One-leg stand

Walk and turn test

Horizontal gaze nystagamus


Measurement of Alcohol
 Blood alcohol concentration (BAC)
 Expressed in percentage
 Most useful measure: reflects the
concentration of alcohol currently affecting the
brain
Measurement of Alcohol
 Urine alcohol
 More concentrated than the blood level due to
tubular resorption of water
 Less useful than blood-alcohol measurements
 Ureteric urine concentration varies with the rising
or falling of BAC
 All the urine from the kidneys is pooled in the
bladder → any sample of urine will represent the
mean value over the period of collection n the
bladder
Measurement of Alcohol
 Breath alcohol
 Concentration of the alcohol in the alveolar air is
related to the concentration of the alcohol in the
blood.
 Basis of the breathalyzer test

 3 major type of breath alcohol testing devices:


 Breathalyzer – uses a chemical reaction involving
alcohol that produces a color change
 Intoxilyzer – detects alcohol by infrared spectroscopy
 Alcosensor III or IV – detects a chemical reaction of
alcohol in a fuel cell
How Breathalyzers Work
Principle of Testing

 Alcohol → bloodstream (lung) → membranes of


the alveoli → air (evaporation)
How Breathalyzers Work
Principle of Testing

 Concentration of the alcohol in the alveolar air is


related to the concentration of the alcohol in the
blood
 Exhalation of alveolar air → alcohol is detected by the
breath alcohol testing device
 Blood alcohol concentration (BAC) can be estimated
by measuring the alcohol on the breath
 Ratio of breath alcohol to blood alcohol = 2,100:1
 2,100 ml of alveolar air will contain the same amount of
alcohol as 1ml of blood
How Breathalyzers Work
Principle of Testing

Breathalyzer device contains


1. A system to sample the breath of
the suspect
2. Two glass vials containing the
chemical reaction mixture
3. A system of photocells connected to
a meter to measure the color
change associated with the
chemical reaction
:
How Breathalyzers Work
Principle of Testing

Subject blows into the breathalyzer → air


sample bubbles into a vial containing a mixture
of chemicals → alcohol reacts with the chemical
mix →solution turns from red-orange to green
 Green color correlates to the amount of breath
alcohol
 Breathalyzer measures the extent of the color
change → BAC calculated from extent of color
change
Relation of Blood Alcohol Level to
Degree of Intoxication
 Below 0.05% - not intoxicated
 0.1% - 0.15% - faculties are impaired; unfit to
drive a vehicle with reasonable safety
 0.15% - non-habitual drinkers will be intoxicated
to the extent of staggering
 0.2% - habitual drinkers will be intoxicated to the
extent of staggering
 0.5% - coma
Diagnosing Alcohol Intoxication
 Examination of the blood* and the urine
 BAC*
 Highest level reached an hour after drinking

 Breathalyzer (breath tests)


 Lung excretion of alcohol (5%)
 Ratio of breath alcohol:blood alcoholl= 2.1ml:1
 Uses a chemical reaction involving alcohol that
produces a color change
 degree of the color change is directly related to the level of
alcohol in the expelled air
Alcohol Intoxication
IRR of “Anti-Drunk and Drugged Driving Act of 2013″

 Driving under the influence of alcohol


(DUIA) – refers to the act of operating a
motor vehicle while the driver’s BAC level
has, after being subjected to an ABA test
reached the level of intoxication as
established jointly by the DOH, the
NAPOLCOM and the DOTC…
Alcohol Intoxication
IRR of “Anti-Drunk and Drugged Driving Act of 2013″

 A driver of a private motor vehicle with a gross


vehicle weight not exceeding 4500 kg. a BAC of
0.05% or higher shall be conclusive proof that
said driver is driving under the influence of
alcohol.
 For drivers of trucks, buses, motorcycles and
public utility vehicles, a BAC of more than 0.0%
shall be conclusive proof that said driver is
driving under the influence of alcohol.
Role of the Doctor
 To exclude or confirm natural disease,
injury, or drug (medicinal or prohibited)
intoxication that may mimic alcohol
intoxication
 To carry out clinical testing for alcohol
intoxication, if provided by law
Clinical Signs and Symptoms
 Stage of excitement
 Feeling of well-being, slight excitation
 Actions, speech, emotion are less strained
 Self-confidence develops
 Blunting of self-criticism, self-consciousness,
self- control
 Alcohol “inhibits the inhibition” in the brain
Effects of Alcohol
EUPHORIA EXCITEMENT
 Difficulty  Dulled senses
concentrating  Poor coordination
 Talkative  Drowsy
 Lowered inhibitions  Beginnings of erratic
 Brighter color in the behavior
face  Slow reaction time
 Fine motor skills  Impaired judgment
lacking
Clinical Signs and Symptoms
 Stage of CONFUSION
incoordination or  Exaggeration
confusion emotions
 Nervous control of the  Difficulty walking
body diminished
 Blurred vision
 Blunting of all
perceptive  Slurred speech
mechanisms  Dulled pain
 No muscular
coordination
Clinical Signs and Symptoms
 Stage of narcosis or
coma
 Deep sleep
 Pupils are dilated
 Breathing is slow and
stertorous
 Paralysis of the cardiac
or respiratory center
Effects of Alcohol
STUPOR COMA
 Can’t walk, stand  Unconscious
 Vomiting  Low body
 Unconsciousness temperature
possible  Possible death
 Decreased response  Shallow breathing
to stimuli  Slow pulse
 apathetic DEATH
 Respiratory arrest

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