Alcohol Induced Disorders : Clinical Features, Evaluation & Treatment

Alcohol is a depressant of the Central Nervous system. Its active ingredient is Ethyl Alcohol. On standard drink is 1peg- 30ml. Fortified Wines have the highest percentage of alcohol in them. The liver is the main organ responsible for alcohol metabolism. Alcohol use disorder involves having to drink more to get the same effect or having withdrawal symptoms when you rapidly decrease or stop drinking. There are different kind of Alcohol disorders.

Clinical Features of Alcohol Intoxication

• There are different levels of impairment at different blood alcohol concentration levels.
• At 20 to 30 mg/dl- The patient will feel slow motor performance and decrease in thinking ability.
• At 30 to 80 mg/dl- There will be increase in notes and cognitive problems.
• At 80 to 200 mg/dl- There will be incoordination, judgment errors, and mood liability.
• At 200 to 300 mg/dl- The patient will feel nystagmus, slurring of speech, and alcoholic blackouts. Anterograde amnesia will be seen during intoxication.
• If the alcohol intake is more than 300 mg/dl- The vital signs will become impaired and there is risk of death of patient.

Also read: Cardiopulmonary Resuscitation (CPR): Procedure, Steps and Types

Alcohol-Induced Neurocognitive/Amnestic Disorder

• It is associated with long-term alcohol use and they are characterized by disturbance in short-term memory.
• There are important disorders that can be categorized under alcohol-induced amnestic disorder.

1. Wernicke’s Encephalopathy
   • It is acute in onset.
   • The symptoms can be remembered by using pneumonic GOA:
     • Global confusion 
     • Ophthalmoplegia
     • Horizontal nystagmus 
     • Gaze palsy
     • The 6^th nerve palsy is the most common.
     • Ataxia
   • Causes of Wernicke’s Encephalopathy
     • The most important cause of Wernicke’s Encephalopathy is vitamin B1/ Thiamine deficiency.
     • The reason for timing deficiency is poor nutrition and poor absorption of nutrition in chronic Alcoholics. 
     • Thiamine is an important cofactor for several enzymes required in the body for various metabolic purposes.
     •  Due to a deficiency of thiamine, all of these metabolic processes will be halted.
     • Different parts of the brain can get involved in alcohol. These are mammillary bodies, thalamus, hypothalamus, midbrain, pons, and cerebellum.
2. Korsakoff Syndrome
   • The onset of Korsakoff syndrome is chronic.
   • The symptoms of Korsakoff Syndrome are
     • Anterograde Amnesia- means the inability of the patient to form new memories.
     • Retrograde Amnesia- the inability of the patient to recall the old memories.
     • Confabulation- the patient will make false stories to fill the memory gaps and this is purely unintentional.
     • The most common symptoms will be impaired recent memory.
     • The cause of Korsakov syndrome is thiamine or vitamin B1 deficiency.
     • The Brain parts involved are mammillary bodies, thalamus, hypothalamus, midbrain, pons, and cerebellum.

Also Read: Primary Biliary Cholangitis : Pathophysiology, Clinical Features

Alcohol-Induced Dementia

• Some patients will show recent memory impairment, with global cognitive impairment.
• This differentiates it from amnestic disorder.

Alcohol-Induced Sleep Disorder

• Alcohol increases the case of falling asleep but it decreases the sleep latency.
• Alcohol harms sleep architecture and it decreases the REM sleep and deep sleep period.
• The presentation will be more sleep fragmentations with longer episodes of awakening.

Also Read: Diabetic Ketoacidosis : Risk Factors, Clinical Features

Evaluation of Alcoholic Disorders

• Screening tests
  • CAGE Questionnaire
  • AUDIT (Alcohol Use Disorder Identification Test)
  • MAST (Michigan Alcoholism Screening Test)
  • SADQ test (Severity of Alcohol Dependence Questionnaire)
• Laboratory tests
  • Carbohydrate deficit transferrin level (Elevated in heavy drinkers)
  • Gamma glutamine transferase levels (Elevated in heavy drinkers)
  • Aspartate amino transferase level
  • Mean corpuscular volume (Elevated)
  • Uric acid
  • Alkaline phosphatase

Treatment of Wernicke’s Encephalopathy

• Thiamine supplementation is provided. 
• Rapid response will be noticed after parenteral thiamine supplementation.
• It is a reversible condition and ophthalmoplegia can be reversed within hours of thiamine supplementation.
• Residual ataxia remains despite treatment in a small number of cases.
• It is very important to consider that in alcohol disorder-related patients receiving IV glucose, this glucose will be utilized against thiamine as a cofactor and those enzymes are utilized and may precipitate Wernicke’s Encephalopathy.
• Therefore in alcohol disorder patients thiamine should be given first then glucose should be infused.

Also Read: Alzheimer’s Disease: Symptoms, Causes and Treatment

Treatment of Korsakoff syndrome

The treatment of Korsakoff syndrome is supplementation of thiamine for 3 to 12 months.

• Symptoms of Korsakov syndrome may not reverse. The full recovery is seen in only 20% of patients and some have shown partial recovery.
• The Patients who appeared to have Wernicke’s Korsakoff syndrome but did not respond to thiamine are considered Alcohol Pellagra and Encephalopathy patients. These are treated with Niacin.

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