04 - Alcohol use disorders

Alcohol use disorders

© SPMM Course o During laxative induced diarrhoea, a large amount of bicarbonate may be lost in the stool. With normal kidneys, the lost bicarbonate is replaced effectively and a serious base deficit does not develop. When there is poor renal blood flow due to hypovolemia/starvation, base deficit and acidosis develop rapidly. o Acidosis also results from excessive production of lactic acid when patients have severe diarrhoea. Other abnormalities  Osteopenia and osteoporosis (with heightened fracture risk)  Enlarged cerebral ventricles and external cerebrospinal fluid spaces (pseudo atrophy)

Calculating BMI: BMI = Weight in kg / (height in meters)2. e.g. if weight = 50kg and height is 165cm, then BMI = 50 / (1.65) (1.65) = 50 / 2.7225 = 18.36. BMI categories: Underweight = <18.5; Normal weight = 18.5-24.9; Overweight = 25-29.9; Obesity = BMI of 30 or greater Alcohol use disorders No single lab test can dependably diagnose alcohol abuse. Of available tests such as GGT (a liver enzyme), Mean Corpuscular Volume, Breathalyzer and Carbohydrate Deficient Transferrin (CDT), the CDT is the single most specific and sensitive test for detecting heavy alcohol use over last 10 days. But due to a high degree of intersubject variability it is best to compare CDT levels with patient’s own baseline. In primary care, AUDIT is often considered to be the best screening tool. As alcohol abuse is associated with systemic complications, several other lab tests may be required when these complications are suspected. System involved Complications Neurological Seizures (intoxication or withdrawal), Wernicke's encephalopathy, Korsakoff's dementia, polyneuropathy, coma, amnesia, alcoholic dementia, cerebellar degeneration, damage to corpus callosum (Marchiafava syndrome) Gastrointestinal GI bleeds, peptic ulcer, malnutrition (esp. thiamine), Mallory-Weiss tears, esophageal strictures, fatty liver, hepatic cirrhosis, portal hypertension, pancreatitis and hypoglycaemia Cardiovascular Cardiomyopathy, hypertension, hyperlipidemia Hematologic Pancytopenia, folic acid and B12 deficiency resulting in MCV changes and anaemia, clotting disorders due to liver failure, immune compromise Respiratory Lung cancer, pneumonia due to aspiration under intoxication Musculoskeletal Muscle wasting, osteoporosis Renal Renal failure, hepatorenal syndrome, hyponatremia and other electrolyte imbalances Endocrine Testicular atrophy, sexual disorders, menstrual irregularities Pregnancy Low birth weight, foetal alcohol syndrome, developmental delays, neural tube