Medical Consequences of Alcohol Abuse

Gastritis and the Digestive System

Alcohol acts as a direct irritant to the tissues of the digestive system. It can damage the protective lining of the stomach, a condition known as gastritis. This inflammation can lead to pain, nausea, and in severe cases, gastrointestinal bleeding.

Liver Disease and Metabolic Dysfunction

The liver is the primary organ responsible for metabolizing alcohol, which places it at extreme risk for various complications:

1. Cirrhosis: Chronic inflammation and cell death can lead to cirrhosis, where healthy liver tissue is replaced by permanent scar tissue.
2. Hypoglycemia: Alcohol can interfere with the liver's ability to release glucose into the bloodstream, leading to dangerously low blood sugar levels.
3. Coagulopathies: Because the liver produces essential clotting factors, alcohol-induced liver damage often results in coagulopathies—conditions where the blood cannot clot effectively.

Systemic Risks and Chronic Illnesses

Beyond the immediate organs of ingestion and metabolism, chronic alcohol abuse increases the risk of several life-threatening systemic conditions:

• Acute Pancreatitis: Inflammation of the pancreas can occur suddenly and requires urgent medical intervention.
• Pneumonia: Alcohol-related immunosuppression and potential aspiration risks increase the vulnerability to lung infections.
• Cardiomyopathy: The heart muscle can become weakened and enlarged, reducing its ability to pump blood efficiently.

Alcohol-Related Emergencies

In acute settings, alcohol abuse can transition from a chronic health issue to a life-threatening emergency.

Acute Alcohol Intoxication

Severe intoxication is medically classified as a form of poisoning. Death can occur when blood alcohol levels reach approximately $87 \text{ mmol/l}$. The most immediate threats to life in an intoxicated patient are:

• Respiratory Depression: The CNS becomes so depressed that the drive to breathe is diminished.
• Aspiration: The loss of protective airway reflexes can lead to vomit entering the lungs.

Alcohol Withdrawal Syndrome

When a person with physical dependence suddenly ceases consumption, they enter a withdrawal state. This can manifest as alcohol withdrawal seizures, which typically occur within 12 to 48 hours after the last drink. Medical professionals often manage these symptoms using benzodiazepines under direct medical control.

Delirium Tremens (DTs)

Delirium Tremens is perhaps the most severe and potentially lethal complication of withdrawal. It typically manifests 48 to 72 hours after the last alcohol intake. Clinical signs include:

• Mental Status Changes: Confusion, restlessness, and hallucinations.
• Autonomic Instability: Fever, diaphoresis (excessive sweating), and hypotension (low blood pressure).
• Physical Signs: Visible tremors.

Clinical Note: In the prehospital setting, if a patient is unresponsive due to suspected overdose, priorities include maintaining the airway, ensuring adequate breathing, and managing circulation.