Alcoholism refers to mental and physical disorders caused by excessive or long-term alcohol consumption, and is divided into acute and chronic. Acute alcoholism refers to the state of intoxication produced by drinking large amounts of alcohol at one time, while chronic alcoholism refers to the damage caused by long-term heavy drinking to the nervous tissue, liver, heart, endocrine glands, systemic malnutrition, reduced enzyme activity and vitamin deficiency, and more importantly, the body’s dependence on alcohol. Western countries have a high incidence of alcoholism, and it is reported that about 10% of men and 3-5% of women have had various social, psychological and medical problems caused by alcoholism during their lifetime. The annual per capita consumption of pure alcohol in Russia reaches 8 liters, and more than 30,000 people die from alcoholism due to excessive drinking. Although the incidence of alcoholism in China is lower than that in western countries, the incidence seems to be increasing in recent years, causing various social security, traffic safety, sudden death and disability problems involving medical and legal aspects, which should be taken seriously. Pathogenesis】 Alcohol is a neurophilic lipid-soluble substance that easily crosses the blood-brain barrier and has different effects on the center depending on the dose. Small doses can reflexively cause neuroexcitation, while large doses have an inhibitory effect on the central nervous system. At the same time, the presence of dopamine in the brain can also promote the pleasure of drinking, which can make people forget fatigue, pain, pain relief, escape from reality, and play the role of “mental anesthetics”. For non-drinkers, only blood alcohol concentrations of 10.85-32.55mmol/L (500-1500mg/L) can cause significant neurological depression, while for long-term alcoholics, some people with blood alcohol concentrations of 325.5mmol/L (15g/L) can still tolerate it. The main harm of alcohol to the body is to interfere with carbohydrate and fat metabolism in the process of catabolism, inhibit the activity of enzymes, and make energy production obstacle. Acetaldehyde, a metabolite of ethanol oxidation, is directly toxic to the body and can damage the structure of the brain and important organs. In addition, alcohol can also affect the balance and stability of the internal environment, leading to nutritional disorders, hyperuricemia, hypoglycemia and metabolic acidosis. Clinical manifestations】 According to the size of one drinking and the length of time of drinking, the clinical manifestations can be divided into two categories: acute alcoholism and chronic alcoholism. Acute alcoholism can be clinically divided into two categories: simple and pathological alcoholism, the latter of which is roughly the same as the former, but often occurs in those individuals who have specific physical reactions to alcohol, and its diagnosis has important legal significance, so it needs to be diagnosed carefully. The symptoms that most people experience after a single overdose of alcohol are divided into two periods, the euphoric period and the inhibitory period. During the euphoric period, the patient’s self-control decreases and behavior changes vary from person to person. Most people are cheerful, articulate and chattering, and can become sociable, brisk and generous, but their emotions are variable, crying, laughing, happy or sad. A few are less verbal, depressed, and even hostile and aggressive. As the inhibitory effect of alcohol deepens, the patient enters the inhibitory phase, which is characterized by staggering gait, confusion, drowsiness, vomiting, pale face, cold skin, deep inhalation with snoring, fast and thin pulse, and in severe cases, coma and decreased blood pressure, and death due to paralysis of the whistling muscles if the medulla oblongata is suppressed. After waking up after timely treatment, patients often have no memory of their experiences when drinking alcohol, called alcoholic fragmentary amnesia, which is a manifestation of impaired brain storage memory function. Chronic alcoholism Chronic alcoholism often refers to the process of drinking for a longer period of time, alcohol produces irreversible damage to important organs of the body, serious disturbances to metabolism, the impact on the central nervous system and some kind of dependence on it. Patients who drink alcohol for a long period of time tend to accelerate the process of atherosclerosis, induce increased blood pressure, blood sugar fluctuations, and disorders of lipid metabolism, which increase the incidence of cardiovascular and cerebrovascular events. Alcohol can also interfere with the activity of liver enzymes and increase the burden on the liver, easily causing the formation of fatty liver and alcoholic cirrhosis. The damage of chronic alcoholism to the nervous system is more obvious, which can cause different symptoms in the peripheral nerve, optic nerve, central nervous system and psychiatric system. Once alcohol consumption is stopped, a series of withdrawal symptoms including physical and psychological symptoms can also occur, which is clinically known as alcohol withdrawal syndrome. Common manifestations of chronic neurological intoxication include: 1. Alcoholic peripheral neuropathy: symmetrical numbness and pain in the distal extremities, with burning and pins and needles pain, which can be accompanied by weakness and muscle atrophy, nociceptive disorders in a “set distribution”, and joint position sensation is also involved, commonly in the lower extremities. 2.Alcoholic tremor: The tremor of the limbs is aggravated by generalized movement or stress, resulting in difficulty in standing, slurred speech, inability to eat, and difficulty in moving, often accompanied by emotional tension, palpitations, insomnia, impulsiveness, and hallucinations, lasting 10-15 days, with increased levels of catecholamines and their metabolites in blood and brain crest fluid. 3, alcoholic amblyopia: its occurrence may be related to the deficiency of one or more B vitamins and the direct toxicity of ethanol, often involving the macular fibers of the optic disc and the optic nerve, resulting in progressive loss of vision. 4, alcoholic encephalopathy, myopathy: often including Wernicke-Korsakoff syndrome, cerebellar degeneration, alcoholic dementia, alcoholic myopathy, etc.. Its appearance is related to long-term alcohol consumption interfering with the normal metabolism of neural tissues, structural damage to neuromuscular tissues and vitamin deficiency. These patients are prone to walking instability and ataxia; cognitive decline, disorientation, memory impairment, hallucinations, fictitious and delusional; muscle pain, weakness, atrophy, increased serum CK value and other symptoms. 5. Alcohol withdrawal syndrome: During the interruption of drinking, it often causes a series of symptoms and signs, partly due to sympathetic reflex excitation. Limb tremors appear at the earliest, and may be accompanied by sweating, flushing, palpitations, dilated pupils, agitation, abdominal pain, diarrhea, and in a few patients, mental confusion, mania, nightmares, high fever, seizures, etc. Serious or improper treatment may lead to death due to water-electrolyte disorders, asphyxia and heart failure caused by the above symptoms. The syndrome generally appears 6 to 12 hours after alcohol interruption, 24 hours is the most serious, and lasts 1 to 3 days. The mortality rate of alcohol withdrawal syndrome is generally about 15%. Diagnosis] Alcoholism is relatively easy to diagnose. Anyone who has a history of heavy drinking or long-term alcoholism and presents with the above clinical manifestations can be diagnosed, and it can also be diagnosed according to the four diagnostic criteria for alcoholism of DSM-III-R. However, careful differentiation is needed for those who have developed coma to exclude that it is caused by cardiac, pulmonary, hepatic, or nephrogenic diseases or other toxic or metabolic diseases. The odor of alcohol in the whistling breath and vomitus can help in the diagnosis. The diagnosis of alcohol withdrawal syndrome can be made by referring to the criteria proposed by WHO (1977): ① uncontrollable urge to drink, ② a pattern of regular daily drinking, ③ the need for drinking over all other activities, ④ increased tolerance to alcohol, ⑤ recurrent withdrawal symptoms, ⑥ only continued drinking can eliminate withdrawal symptoms, ⑦ old addiction can often be re-infected after withdrawal. (Auxiliary examination] The blood alcohol level in acute severe alcoholism is mostly above 65.1 mmol/L (3000 mg/L). In addition, morphological examination, EEG, EMG, and B-mode ultrasound can help in the differential diagnosis of damage related to chronic alcoholism. 【Treatment】 No special treatment is needed for general alcohol poisoning. After excessive alcohol consumption into intoxication, emetic or 1% NaHCO3 gastric lavage can be used within 30 minutes, while intravenous hypertonic glucose solution can be injected to accelerate excretion and intramuscular injection of vitamin B1, B6, B12, etc. If consciousness and whistling are affected, oxygen, appropriate amount of whistling stimulants, or whistling machine can be given; and naloxone 0.4-0.8 mg can be given intravenously. Pay attention to maintain electrolyte and acid-base balance, prevent the occurrence of cerebral edema and liver damage, and perform hemodialysis if necessary. The use of morphine, apomorphine, phenobarbital and other drugs is prohibited in such patients. Treatment of chronic alcoholism is mainly focused on abstinence from alcohol, liver protection and treatment of complications, which can be done in specialized drug treatment facilities.
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