CNS DEPRESSANTS
CLASSIFICATION
ETHYL ALCOHOL
GENERAL ANAESTHETICS
OPIOID ANALGESICS
SEDATIVE HYPNOTICS
ALCOHOL
• INEBRIANT POISONS PRODUCE INTOXICATION
• THAT IS
Light headedness
Confusion
Disorientation
Drowsiness
• In most case there is recovery after prolonged
sleep, with some after-effects(hangover)
• Consisting of
Headache
Irritability
Lethargy
Nausea
Abdominal discomfort
Alcohol-Ethyl alcohol
•
•
•
•
•
Transparent
Colorless
Volatile liquid
Spirituous odor
Burning taste
• Absolute alcohol
contains 99.95%
• Rectified spirit -90%
• Denatured alcohol
Alcohol95%
Wood naphtha 5%
Ethanol
• sugar +yeast=ethanol by fermentation process
• Process stops when 15% alcohol is formed as
yeast is destroyed
Alcoholic beverages
• Are mixture of alcohol+water+small amount
of congeners which are produced in
fermentation
• Flavour is due to congeners
Propyl alcohol
Octyl alcohol
Glycerine
Aldehydes
Dimethyl and diethyl esters
Acids from acetic to linoleic,ketones,trimethyl
amine,allyl mercaptan etc.
Total content of congeners rarely exceeds
half%
• Odour may persist in tissues for several hours
after all alcohol is metabolised
Proof spirit-is one which at 10.5 degree celisus
weighs exactly 12/13 part of equal measure of
distilled water
Under proof –weaker spirits
Over proof – stronger spirits
• Proof is defined as twice the % of alcohol
content of the drink
• Expressed in units
• 1 unit=8g of alcohol
Alcohol content in beverages
• Vodka:60 to 65%
• Rum,liquors:50 to 60%
• Whisky.gin,brandy:40 to 45%
• port,sherry:20%
• Wine ,champagne:10 to 15%
• Beers:4 to 8%
Vodka:60 to 65%
Rum,liquors:50 to 60%
Brandy
40 to 45% of alcohol
Beers:4 to 8%
Whisky.gin,brandy:40 to 45%
Safe limit of drinking to avoid liver
damage
• Men=210g/per week
• Women=140g/per week
Arrack
• It is a liquor distilled from palm,rice,sugar or
jaggery,etc.
• 40 to 50% of alcohol
• For kick-is mixed with chloral hydrate and
potassium bromide.
Absorption
 Requires no digestion
prior to absorption
 Mouth & oesophagussmall amount
absorbed
 Stomach & small
intestine- immediately
20%
80%
• 10 to 20% is prevent absorption
by consumption of food with
alcohol.
• Warm alcoholic drinks- absorbed
fast as they dilated the gastric
capillaries.
• Achloryhydria or chronic gastritis
have slower absorption rates.
• 10 to 20% conc of alcohol
absorbed rapid
• Dil.alcohol- empty stomach -30 to 60mins 60%
• 90% in 60 to 90 mins
• Whisky and beer – in blood in just 2 to 3 mins
after few sips
• Max.conc in blood reached within 45 to 90
mins
• Majority in 1 hour
• Carbonated drinks hastens
absorption as the bubbles
greatly increases the
surface area carrying
alcohol.
• Food delays its absorption
• Fats and protein delay
more nearly for hours
• Mixed meal depress
max.conc in blood alcohol
by half hour
• Lower and higher concentration absorbed
quickly
• Beer takes longer absorption time than
stronger drinks .
Drinks containing more than 40% of alcohol
care absorbed more slowly
Due to
1.Pyloric spasm
2.Irritation of gastric mucosa and secretion of
mucosa
3.Reduced gastric motility.
• Habituated drinkers absorb alcohol more
rapidly than abstainers,probably due to more
rapid emptying time of the stomach and thus
the rate of absorption .
• Drugs like benzine and atropine may slow the
rate of absorption of alcohol by retarding the
emptying time of stomach.
• Alcohol is absorbed rapidly in gastrectomy.
• Conc of alcohol in air is high irritation and
breathing difficulty
• 60% of alcohol inhaled can be absorbed into
systemic circulation.
• Skin poor absorbent of alcohol
Distribution
• Some lost by diffusion into alveolar air as
arterial blood passes through the lungs.
• In arterial blood the alcohol concentration is
less due to passage through the capillary
network
• Adipose tissue –
ethanol is insoulble in
fat.
• Red cells contains less
alcohol then plasma.
• Plasma level of
alcohol is high
• Serum level of alcohol
is high
• A given intake of
alcohol will prouce
high level of alcohol in
obese people then
lean of same weight
due to the aqueous
compartment is
smaller
• Ethanol passes
through blood
brain barrier and
baths neuron via
the cerebral
extracelluar
fluid.
• In females the
con is higher due
to small aqueous
compartment
Excretion
• 5% ingested alcohol
excreted via breath
• 5% in urine
• Negligible amount are
excreted in the
sweat,saliva,milk ,tears
and faeces.
• Odour is due to
excretion via skin
glands.
Metabolism
90% of alcohol absorbed in oxidised in liver
10% is excreted
liver
• Acetate is oxidised into co2 and water in krebs
cycle
• Diabetic who is ketogenic will produce fat
from alcohol , because he cannot use the
sugar.
• Enzymes can be increased by regulary use of
alcoholic beverages and alcohol decrease may
be doubled
OXIDATION
• Alcohol is not stored in tissues
• Disappears from blood fairly uniform rate of
about 10 to 15ml per hour
• This is equivalent of about 15mg 100ml
• Larger doses are lost faster.
• Chronic alcoholics are able to metabolise
alcohol faster -40 to 50 mg/100ml /hr
• BECAUSE DUE TO INCREASE IN LIVER ENZYME
• THUS THEY DEVELOP LIVER DAMAGE.
• Later due to liver damage alcohol metabolism
is depressed.
• Due to which the remain intoxicated for hours
after a few drinks.
• 10% of alcohol which is metabolised is
deposited in tissues as lipids in form of neytral
fat and cholesterol.
ACTION
• Traces of ethyl alcohol are found in all
persons.
• Endogenous alcohol
Normal metabolism
Bacterial activity in git
• Well –known stimulant
• Selective depressant especially
of higher nervous centres
which it inhibits.
• Ethanol depress reticular
activating system
• Frontal lobes –sensitive to low
concentration(mood changes)
• Followed by occipital lobe
(visual disturbances)
• Cerebellum – loss of
coordination
• Lower concentrationdepression of more specialised
and sensitive cells of cerebral
cortex(centres regulating
conduct,judgement,self
criticism)
• Increasing
concentration –
depresses more brain
function.
• Finally vital centres in
mid brain and
medulla are
depressed – death
from cardio –
respiratory failure.
• Causes generalised
vasodialation ,especially in
skin.
• Not true aphrodisiac
• Hynotic and diaphorectic
• Creates sensation of warmth
,but increases heat loss
• Low concentration –heart
rate increased
• More than 300mg % bradycardia
• Moderate –stimulates
appetite as it promotes
salivation and secretion of
gastric juice
• Stronger beverages the
reverse action
• Little brandy –carminative
action
• Diuresis occurs secondary to
inhibition of ADH
Release from posterior pituitary.
• Spiritous liquors on emptying
the stomach can cause severe
,even haemorrhagic gastritis.
• It has toxic effect on almost
every organ system.
• Due to effect of metabolite
acetaldehyde or to redox
potential of cells but the
mechanism is not known clearly
• All the neuro transmitter
system are affected ,no
specific receptors
• It has synergistic effect with other sedativehypnotic agents.
• 15 to 30g /day consumption increases the
concentration of hdl and decreases ldl.
• It has favourable effects on haemostatic
factors such plasma fibrinogen ,fibrinolytic
activity and platelet adhesiveness.
• MIXING OF DRINKS-greater intoxication
Than the amount consumed.
Due to presence or formation of substances
which affect the rate of emptying of
stomach,with more rapid absorption of
alcohol.
• Roman saying “IN VINO VERITAS” which
means “IN WINE THERE IS TRUTH”
• The real personality of individual often will be
revealed when he is intoxicated.
Cause of death
Direct depressive effects upon brain stem
mediated via the respiratory centre
Aspiration of vomit
Death due to acute overdoses not common
Chronic effects of alcohol are common.
3 phases
• There are three phases of intoxication
Stage of excitement
Stage of incoordination
Stage of coma
Stage of excitement
First a feeling of wellbeing and certain slight
excitation.
Actions ,speech and emotions are less
controlled due to lowering of inhibition
normally exercised by higher centre of the
brain
Increased confidence and lack of self control
constant feature of alcoholic poisoning.
• Mental concentration is poor and judgement
impaired.
• Attention is impaired
• Recall memory is often disturbed
• Disclose secrets.
• Good manners are forgotten
• The neat and orderly are careless in their
dress
• Blood alcohol concentration of 30mg%
impairment of cognitive function,motor
coordination and sensory perception occur
• 50 mg % slurring of speech,unsteadiness,drowsiness,impaired
reasoning and memory ,reduced perception and
decreased concentration occur.
• Alcohol reduces visual in conc as low as 20mg% in
abstainers
• 20 to 30mg% in moderate drinkers
• 40 to 70 mg %in heavy drinkers
• Affects the judgement and motor control
when BAC of 25 to 50mg%
• Strong light is needed for distinguish objects
• Dimly lighted object may not be distinguished
• It alters time and space preception.
• Pupils are dilated
• Between 50 to 100 mg% -loss of inhibition
,loquaciousness and laughter occurs.
• Slurred speech ,unsteadiness and nausea are
between 100 to 150mg%.
• When jerking movements is in the direction of
gaze and independent of position of the headit is known as alcohol gaze nystagmus and
appears at blood level of 40 to 100mg%
• Emotions are affected
• It increases the desire for sex but it impairs
the performance at 50 to 150mg% of blood
alcohol
Stage of incoordination
• At 150 to 250mg/100ml the sense of
perception and skilled movements are
affected.
• Loss of control over the higher centres causes
alteration in conduct .
• Carefree,cheerful,ill tempered
,irritable,excitable,quarrelsome,sleeply .
• Clumsiness and incoordination of movements
which are skilled ones
• Alteration in speech
• Nausea and vomiting
• Breath smells of alcohol
• Face – flused,pulse –rapid
• Sense of touch,taste,smell and hearing are
diminished.
• Temperature – subnormal
• Heart rate increased
Stage of coma
• Motor and sensory cells are deeply affected
• Speech –thick and slurring , coordination is
markedly affected
• Giddy,stagger and possibly fall
• Person passes into state of coma with
stertorous breathing.
• Pulse is rapid and temperature subnormal.
• Pupils are contracted but stimulation of the
person e,g by pincing or slapping ,cause them
to dilate with slow return Mc EWAN SIGN.
With recovery –coma lightens into deep sleep
Recovery -8 to 10hrs
Wake up –with depression,nausea ,abdominal
discomfort,irritability,lethargy and severe
headache.
Munich beer heart
In which cardiac dilation and hypertrophy is seen
due to excessive and prolonged beer drinking.
MICTURITION SYNCOPE
A condition which occurs usually after heavy
beer drinking .when the person rises from bed in
the middle of night to pass urine ,he loses
consciousness during the act of
urination,probably due to sudden upright posture
• If coma continues more than 5hrs condition is
going to worse
• Death –due to asphyxia,respiratory paralysis
,may occur in shock.
• Mostly death occurs not due to high blood
level but after it have damaged the vital
organs.
• Acute intoxication death –BAC of less than
400mg%
• In person with chronic diseases
Arteriosclerotic heart
Pulmonary emphysema
Chronic lung diseases
Hypoxia severe condition
• Prolonged coma leads to hypoxic brain
damage and death with BAC low.
• As the alcohol might be oxdised and excreted.
• Fatal dose -150 to 250ml of absolute
alcohol/one hr
• Fatal period -12 to 24hr
• Tolerance to alcohol
it is aquired and may be lost by those ‘out of
practice’
Consent of examination
• Consent of the detained person for medical
examination is necessary.
• If the person is unconscious or not fit for
consent ,the doctor called by police should
not disclose to police any information he has
obtained during examintion but should wait to
get the consent of the patient when he
regains consciousness,or in fit condition to be
asked
TREATMENT
Evacuation of stomach and gastric lavage with
an alkaline solution
Patient must be kept warm
Congestion of the brain –ice berg should be
applied to head.
One litre of normal saline with
10%glucose,100mg thiamine and 15 units of
insulin are useful.
If coma deepens ,nerve stimulants such as
caffeine and strychnine should be used and
artificial respiration,if there is difficulty in
breathing .
Inhalation of oxygen is of great use
Haemodialysis or peritoneal dialysis is very
useful.
POSTMORTEM APPEARANCES
• On opening the cavities of the body ,alcoholic
odour is frequently noted
• Acute inflammation of stomach with a coating
of mucus is commonly found.
• The brain ,liver and lungs are congested and
the smell of alcohol in the viscera may be
noted.
• Blood-fluid and dark
• Oedema and congestion of brain
• Meninges and cloudy swelling of
parenchymatous organs are seen
CHRONIC POISONING
• Alcohol addicts withdrawal symptoms,if they
do
• Results in impaired social or occupational
functioning
• Chronic alcoholics are those who have
reached a state of more or less irreversible
somatic or brain changes caused by alcohol.
Patient suffers from
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Nausea
Vomiting
Anorexia
Diarrhoea
Jaundice
Tremors of tongue and hands
Insomnia
Loss of memory
Impaired power of judgement
Hypoproteinaemia
General anasarca
Symptoms of peripheral neuritis and dementia occur in last stage
Suddenly they die from coma
Postmortem appearances
• Signs of malnutrition
may be present
• Gastric mucous
membrane is deep
reddish-brown with
patches of congestion
or effusion and is
hypertropied.
• Liver is congested,fatty
infiltration,enlarged and
weight may exceed 2kg
• Cirrhosis occurs
• Kidneys show granular degeneration
• Heart is dilated and shows fatty degeneration
,patchy fibrosis.
Treatment
• Disulfiram-single dose daily 250mg
It is reduced gradually untill 0.125 to 0.25g is
reached which should be continued untill the
patient has been conditioned to accept
adequate follow-up therapy.
Antabuse inhibits the biotransformation of
ethanol beyond the acetaldehyde stage.
• Ethyl alcohol is metabolised by the liver as two
step process
Antabuse partially blocks reaction 2,leading
to acculumation of acetaldehyde in blood and
tissues and causes unpleasant symptoms
Flushing
,palpitation,anxiety,sweating,headache,abdo
minal cramps,nausea and vomiting due to
which the patient dislikes alcohol.
Citrated calcium carbimide 50mg.tablet once a
day can be used with less side effects.
Chlorpromazine 25 to 50mg every 4 to 6 hours
is also useful
Clonidine 60 to 180mg/hr i.v
chlormethiazole
Conditioned reflex treatment
It consists of giving alcoholic beverages to the
patient in surroundings that affect his visual
and olfactory senses.
With a backdrop of bottles of various alcoholic
beverages the patient is given various types of
liquor ,togather with drugs that will cause
immediate and acute nausea and vomiting .
• After 5 to 8 daily treatments,symptoms are
brought on simply by sight of a bottle and the
patient begins mentally to associate his
painful sickness with alcohol.
• Hypnosis and psychotherapy also useful
Alcoholics anonymous
• International organisation which has
branches throughout india.
• The addicts who are desirous to give up
alcohol narrate their bad experiences to other
alcoholics through group
meetings,letters,press and other media.
• The organisation functions on self-supporting
basis through contribution from the
membranes.
Drunkenness
• Drunkenness is a condition produced in a
person who has taken alcohol in a quantity
sufficient to cause him to lose control of
faculties to such an extent ,that he is unable to
execute safely ,in the occupation in which he
was engaged at particular time
Clinical diagnosis
• Same amount-different person-different
effects-same circumstances.
• Mentally unstable ,epileptics and those who
have suffered cerebral trauma show excessive
reaction for small amounts.
Model scheme of medical examination
• The scheme of examination of an alleged
alcoholic has been suggested by special
committee of british medical association “THE
DRINKING DRIVER”1965
Medical examiner’s record should note the
DATEand TIME at beginning and at the end of
the examination.
• (1) Exclusion of Injuries and Pathological States:
• The following conditions which simulate alcoholic intoxication
should be excluded :
• (a)Severe head injuries,
• (b) Metabolic disorders, e.g.hypoglycemia,diabetic pre-coma,
uremia,hyperthyroidism.
• (c) Neurological conditions,e.g. disseminated sclerosis,intracranial
tumors,Parkinson's disease, epilepsy, acute aural vertigo,
• (d) Drugs: Insulin, barbiturates, antihistamines,morphine, atropine,
hyoscine..Drugs capable of producing sedation or depression of the
nervous system (antihistaminic, tranquillizers), will simulate or
enhance the effects of alcohol,
• (e) Certain preexisting psychological disorders, e.g.
hypomania,general paresis,
• (f) High fever,
• (g) Exposure to CO.
(2) History:
Enquire whether he suffers
from any disease or disability and whether he is under
medical treatment.
(3) General Behavior:
(a) General manners and behavior,(b) State of dress: Presence of
slobber on mouth or clothing; presence, character and color
of any vomit, soiling of clothes by excretions,
(c) Speech: Note the type, e.g.is it thick, slurred or over-precise?
Slight blurring of certain consonants is one of the earliest
signs of in coordination of the muscles of the tongue and
lips. Certain test phrases may be used to bring out this
difficulty in speech, such as 'British Constitution', West
Register Street,Truly Rural',etc.A sober person will say that he
is not good at such phrases; the semi-intoxicated person will
often insist on getting them correctly,
(d) Self-control.: Note whether he is able to control himself in
response to the demands made on him by the examiner.
(4) Memory and Mental Alertness:
The memory of the person for recent events, and his appreciation of time can be judged by
asking suitable questions about his movements during the preceding few hours, and the details
of his accident if any. A few very simple sums of addition or subtraction may be asked.
(5)Handwriting:
The examinees should be asked to copy a few lines from a newspaper or book. A note should be
made of:
(a) The time taken,
(b) Repetition or omission of words,letters, or lines,
(c) Ability to read his own writing. Both the original and the copy should be retained. The
examinees should be asked to sign his name.The signature can be compared with that on his
driving license if any.
(6) Pulse:
The resting pulse should be taken at the beginning and at the end of the examination.The pulse
is rapid and is usually full and bounding. A slight increase in B.P. may occur, often in the systolic
level.
(7) Temperature:
The surface temperature is usually raised.
(8) Skin:
Note whether skin is dry, moist,flushed or pale.
Skin is warm, dry and flushed in drunkenness.
(9) Mouth:
(a) Record the general state of mouth, teeth and tongue, noting whether the
tongue is dry, furred or bitten,
(b) The smell of the breath should be recorded
(10) Eyes:
(a) General appearance :
(1) Whether the lids are swollen or red, and whether the
conjunctiva are congested.
(2) The color of the eyes, and abnormalities.
(b) Visual acuity: Any gross defect should be noted.
(c) Intrinsic muscles:
(1) Pupils: Equal or unequal, dilated or contracted or
abnormal in any way(usually dilated in early stages, but
may be
contracted in later stages or coma).
(2) Reaction to light : Note whether the action is brisk,
slow or absent. They may become unequal, equalizing
again
in response to light, and dilate again slowly even if the
light continues to be directed into the eyes.
(d) Extrinsic muscles:
(1) Convergence: Test the degree of
ability to follow a finger in all
normal directions and to converge
the eyes normally
on a near object.
(2) Strabismus : Note whether it is
present.
(3) Nystagmus : The presence of fine
lateral nystagmus may indicate
alcoholic intoxication. Nystagmus may
be produced by fatigue, emotion or
postural hypotension.
(11) Ears:
Examine for (a) Gross impairment of hearing, (b) Abnormality of the drums.
(12) Gait:
The integrity of the nervous and muscular system is tested for the coordination of
fine and gross movements, e.g. balance, gait and speech. The examinees should be
asked to walk across the room and note:
(a) Manner of walking: Is it straight, irregular, over precise, unsteady, or with feet
wide apart?
(b) Reaction time to a direction to turn: Does the examinees turn at once or
continue for one or two steps before obeying?
(c) Manner of turning : Does the examinees keep his balance, lurch forward, or reel
to one side? Does he correct any mistake in a normal or exaggerated way? It is
undesirable to ask the examinees to walk along a straight line drawn on the floor.
(13)Stance :Note whether the examinees can stand with his eyes closed and
heels together without swaying.
(14) Muscular Coordination :
Ask the examinees to perform the following tests:
(a) Placing finger to nose,
(b) Placing finger to finger,
(c) Picking up medium-sized objects from the floor,
(d) Lighting a cigarette with a match,
(e) Unbuttoning and rebuttoning coat.
(f) Lifting two objects, such as tumblers from the table, and replacing them
side by side on the table.
The examiner should not ask the examinees to perform any act which he could
not perform easily himself. He should also appreciate the difficulty involved for
some people in apparently simple movements, such as picking up small objects
from the floor. A chronic alcoholic when sober may not be able to perform
tests for coordination as well as when he has actually consumed alcohol.
(15) Reflexes :
Knee and ankle reflexes should be tested which are delayed or
sluggish.Plantar reflex may be extensor or flexor.
(16)Pulmonary, Cardiovascular and Alimentary Systems:
The heart, lungs and abdomen should be examined, and the blood
pressure taken to establish the presence or absence of disease.
(17) Tests:
Some of the following objective tests are useful; flicker fusion test,
measurements of tremor during standing, oscillations during forced
imbalance, pupillary reflex time, speed of spinal reflexes, presence of
random ocular movements with closed eye, nerve conduction speed,
complex reaction time, delayed auditory feedback, positional nystagmus,
glare recovery test, color difference threshold, etc.
(18) Laboratory Investigations:
The degree of intoxication can be estimated by the
concentration of alcohol in the blood, urine, breath, or saliva.
In fatal accidents with partial body destruction, muscle or the
fluid in the eye can be analyzed. Vitreous humour and urine
are protected from putrefactive processes for a longer period
of time and do not contain much glucose. Blood is the most
suitable and the most direct evidence of the concentration of
alcohol in the brain.
The disadvantages are: (1) it may be difficult to collect from an
uncooperative person, (2) consent of the person is necessary,
(3) substances like acetone, ether, paraldehyde, etc. when
present in the blood are estimated as alcohol.
URINE : Urine has about 25% more water than an equal
volume of blood,
•so its concentration of alcohol would be about 25%
higher than in blood collected at the same time.
• As the urine is secreted, its water will have essentially
the same alcohol concentration as the water of the
blood passing through the kidney.
•If the bladder contains urine before drinking began,
urine secreted during or after the period will be diluted
with the alcohol-free urine.
• If the bladder was empty when drinking began, urine
secreted after some time will reflect the blood
concentration of alcohol at that time. In order to
compare the urine and blood, a ratio of 1.3:1.0 is
usually accepted when urine and blood are in
Analysis of two urine samples are required. The first
sample should be taken as soon as possible following
the incident, the bladder being completely emptied.
The second sample should be taken 25 to 30 minutes
later. The concentration of alcohol in the second
specimen reflects the blood alcohol level during the
inter-specimen interval. The difference in the alcohol
concentrations in the two samples indicates whether
the subject was in the absorptive phase, at its peak,
or, in the elimination phase. Multiplication of alcohol
concentration in the second urine specimen by 0.75
(based on a bio urine alcohol ratio of 1:1.35) gives an
approximate value of the blood alcohol level, during
The disadvantages of urine examination are: (1) A time
lag before equilibrium between blood and urine is
reached; the maximum concentration is reached about
twenty to twenty-five minutes later than in blood.
(2) The urine alcohol concentration at any given time
after the maximum concentration in blood has been
reached will be higher by twenty to thirty percent than in
the blood, because the specimen of urine examined will
have been secreted from the blood at some earlier
period.
(3) Alcohol may pass through the lining of the bladder in
either direction both in life and after death, depending
on the relative concentration of alcohol in blood and
urine.
Collection of Blood:
Spirit must not be used for cleaning the skin, and
the syringe must be free from any trace of alcohol.
The skin is cleaned with a solution of 1:1000
mercuric chloride or washed with soap and water.
Blood samples should be preserved by the
addition of hundred mg. of sodium fluoride for
ten ml., followed by thorough shaking. This
prevents loss of alcohol by glycolysis and bacterial
action. Such samples will maintain alcohol
concentration for several weeks ,even at room
temperature. Hundred mg. of phenyl mercuric
nitrate or sodium azide can also be used, as a
preservative for 10 ml of blood or urine.
Precautions
Screw capped glass bottle of universal size is used
Container should be tightly clamped
Sealed to prevent loss of alcohol by evaporation and labelled with name and date ,time of
taking the specimens
Rubber stopper should be avoided ,because they may contaminate the sample with oxidisable
substances.
It must be refrigerated if not sent to lab but not froze it
Which will cause cells to lyse
When blood is kept in a refrigerator ,formation of oxidisible substances is not significant.
Analysis is best made within a week
Serum or plasma alcohol concentration is 12 to 20% higher than that of whole blood.
COLLECTION OF POSTMORTEM SAMPLES
TEMPERATE CLIMATESpostmortem blood alcohol determinations are
completely valid for 36hrs after death.
Blood –best place to be obtained is from femoral or
iliac veins or from axillary veins.
Jugular vein is not suitable as it may be
contaminated by reflux from the upper thorax
If the concentration of alcohol is same in all these
samples the exposure is extraneous ,because
bacterial and chemical decomposition does not occur
at exactly the same rate all over the body.
Free blood in the pleural or pericardial cavities
should not be used as false high results may be
obtained due to gastric alcohol diffusion after death.
Embalmed bodies alcohol can be estimated either
in vitreous or muscle.
Erroneous result can be obtained due to
haemolysis ,clot formation ,postmortem diffusion
from other body fluids and tissues ,not properly
preserved sample ,and putrefaction
False blood alcohol levels in excess of 0.1 mg% may
be produced if autopsy blood samples are stored at
room temperature for more than a week
Widmark formula for blood
Size,sex,type of alcohol consumed .
formula
A=PRC
A-WEIGHT OF ALCOHOL IN g in the body
P- is the body weight in kg
C-is the concentration of alcohol in blood in mg per kg
R- is a constant
0.6-men 0.5 –women
For urine analysis
A=3/4 PRQ
Q-ALCOHOL CONCENTRATION IN mg per kg
Methods used for determining blood alcohol
Basic principal: reduction of potassium bichromate by test
substance
1.Kozelka and hine test is a macro-method.
2.Cavett test is a micro-method.
Many procedures are there but gas chromatography in a specificity
can be ascertained
Test:in a test tube place
one ml of unknown solution +one ml of acetic acid+one drop of
sulphuric acid and heat gently for one minute .=strong fruity odour
is positive.
BREATH : breath analysis machine operte
on the principle that alcohol absorbs
radiation in the infrared light absorbed
by a vapour is proportional to the
concentration of the alcohol in that
vapour.
•60 to 100 ml of breath is received into
dry ballon and analysed by drunkotester,
drunkometer, intoximeter, alcometer,
alcotest or breathalyser
•The end portion of prolonged forced
expiration gives correct results .
•The concentration of alcohol in deep
lung air is dependant on conc in arterial
blood.
•2100 to 2300ml of alveolar air contains
the same amount of alcohol as one ml of
blood.
Factors that can upset the breath test
Sternuous hyperventilation
Violent physical exercise
Emesis
Regurgitation of stomach contents
Eructation or belching and drinking of liquor
within few minutes of the time of the
performance of the test .
False value is obtained in these conditions
Saliva-mouth should be thoroughly washed with water and about 5ml of saliva
collected in test tube containing 10mg of sodium fluoride
Vitreous- at equilibrium for every unit of alcohol in blood ,there are 1.2 units of
alcohol in vitreous ,as it has a high water content .
During the absorptive phase of alcohol ,vitreous alcohol levels are lower than the
blood.
Vitreous alcohol lags behind blood alcohol by 1 to 2 hours
It does not change after death due to putrefaction.
Henry ‘s law
when volatile chemical is dissolved in a liquid and is brought to equilibrium with air
,there is a fixed ratio between the concentration of volatile compound in air and its
concentration in the liquid and the ratio is constant at given temperature.
Temperature is 37⁰c that is exhaled air temperature
DiagnosisExtreme cases –no problem
Marginal cases – problem
usual Signs of drunkenness
Strong odour
Loss of selfcontrol
Unsteady gait
Vacant look
Congested eyes
Dilated pupils
Dry lips
In creased pulse rate
Unsteady and thick voice
Talks at random
Lack of perception of passage of time.
DETERMINATION OF BLOOD ALCOHOL HELPS:
 the concentration of alcohol circulating in the
body
This can be attempted only after equilibrium
between the blood and tissues has been attained
which helps the court in testing reliabity of
statement of accused
To assits in conforming
Enable to accept clinical diagnosis
Helps to judge the non medical witness
Medical terminology
• Under the influence means that due to
drinking alcohol,a person has lost his clearness
of mind and self control.
• Loss of judgement
• 140mg%- intoxicated to the point where they
cannot deal with unusual ,emergency or
noncustomary problems
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Below 10mg:sober
20 to 70mg%:drinking
80 to 100mg%:under the influence
150 to 300mg%:drunk or intoxicated
400mg% and above :coma and death
Under the influence
Drunk
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Symptoms
Flushed face
Dilated and sluggish pupils
Euphoria
Loss of restraint
Thickness of speech
Carelessness and recklessness
Incoordination
Stagger on sudden
Flushed face
Dilated and inactive pupils
Rapid movement of eyes
Unstable mood
Loss of restraint
Clouding of intellect
Thickness of speech
Incoordination
Staggering gait with reeling
and lurching when asked to
make sudden turns
Very drunk
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Mental confusion
Gross incoordination
Slurred speech
Staggering
Reeling gait
Tendency to lurch and fall
Vomiting
Coma
 Rapid pulse
 Subnormal temperature
 stertorous breathing
 Contracted pupils
Hazards of alcohol
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Child abuse,domestic violence,suicide
Personal risk
Death
Pneumonia
Vomit
Choking
Lowers resistances effect on hypoxia
May fall down
Head injury
Drowned
Electrical shock
Poisoned
Accidents
Saturaday night paralysis
Alcoholic palimpsests or blackout
• Loss of memory of a period during a drinking
spell or in some cases ,inability to recall what
happened over period of days.
• The person may cause a criminal act and may
not remember it when they recover
Alcohol and traffic accidents
• Driving ability 1/α conc of
alcohol in blood
• Increases reaction time
• Increases false confidence
• Impairs concentration
• Dulls judgement
• Degrades muscular
coordination
• Decreases visual and
auditory acuity
• Below 50%- no risk in driving
• At 50%- control of speed
,sensorimotor coordination
,braking is impaired.
• Boldness increases and
impulses also
• At60%-risk of accident is
higher
• As mg% increases risk also
increases
In india the limit of bac
• 30mg%-first offence Rs.2000 or 6 months
imprisonment or both
• Second or subsequent offence-Rs3000 or
imprisonment up to 2 years or both
Alcohol withdrawl
• Symptoms appear 12 to 48hrs after reduction in
alcohol intake
• Tremors of hands,tongue and eyelids
• Nausea and vomiting
• Malaise and weakness
• Hypertension
• Tachycardia,sweating
• Anxiety,depressed mood ,irritability
• Transient hallucinations and illusions
• Headache and insomnia
• Delirium tremens
Treatment
• 20 mg of CHLORDIAZEPOXIDE or 100mg of
diazepam are given 4times a day
PATHOLOGY
1.DELIRIUM TREMENS –72 to 96 hrs after the last
drink
TEMPORARY EXCESS
SUDDEN WITHDRAWL
SHOCK AFTER INJURY ,FRACTURE
ACUTE INFECTIONPNEUMONIA,INFLUENZA,ERYSIPELAS
Alcoholic polyneuritis
Weakness
Pain in extremities
Wrist and foot drop
Unsteady gait
Loss of deep reflexes and tenderness of
muscles of arm and leg
• Alcoholic paranoia
Fixed delusions no hallucinations
Deeply suspicious of the motives and action of
their family members
• Acute alcoholic hallucinosis
Persistent hallucination develop within 48hr
after cessation
Hallucination by be visual or audio
Content will be unpleasant and disturbing
Lasts for several weeks and months
• Alcoholic epilepsy
Seizures occur a day or more after termination
of drinking session
Sometimes during drinking itself it may occur
• WERNICKE’S EPILEPSY
LESIONS IN
HYPOTHALAMUS,MIDBRAIN,CEREBELLUM
VIT B1 DEFICIENCY
• WERNICKE’S ENCEPHALOPATHY
SYMPTOMS
Disturbances of consciousness, drowsiness,
amnesia, peripheral neuropathy, nystagmus,
ataxia, delirium and stupor.
If untreated 80% of cases progress to next
chronic stage KORSAKOFF PSYCHOSIS
KORSAKOFF PSYCHOSIS
IMPAIRMENT OF anterogade and retrograde
memory
Disorientation in time
Inability to learn new information and
confabulation
• Cardiac dysrhythmias
Tachyrhythmias due to high adrenergic
nervous system activity which may cause
sudden death.
• MARCHIAFAVA’S SYNDROME
 Degeneration of corpus
callosum
• Mallory –weiss syndrome
 Rupture of oesophagus with
mediastinitis
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Malnurition
Gastric and peptic ulcer
Cirrhosis
Myocarditis
Pancreatitis
Mental illness
Alcoholic and Criminal behaviour
• it is not due to infulence but due to the
repression of inhibitory influences that
prevents in sober person to commited a crime
• due excitement and stimulation of the brain at
high peak
• suppressed feelings of aggression and hostility
are released,the drinker goes into the state of
artificial display of bravery
• suicides and homicides
• slows the reaction of the victim
• not able to protect himself
• causes dilation small injury may lead
congestion of blood vessels dur to prolonged
bleeding
• CHRONIC LIVER DISEASES –IMPAIRS CLOTTING
• DIE FROM INHALATION OF VOMIT OR BLOOD
DUE TO INJURY
• SECTION 510 IPC-MISCONDUCT IN PUBLICIMPRISONMENT FOR 24HRS
ALCOHOL AND SUDDEN DEATH
• EFFECT ON MYOCARDIUM AND PRODUCES
ARRHYTHMIAS
• Cardiopulmonary arrest- intoxicated –struggledies.no anatomical causes for death
• Catecholamines+alcohol=cardiac
arrhythmia=death
• “Cardiopulmonary arrest contributed by alcohol
during violent struggle”
• Intoxicated person beaten in face=death –cns
depression and diffuse axonal injury from beating
Alcohol after death
• Diffuses through the stomach wall into pleural
fluid,pericardinal fluid,blood and tissues
• Higher level means it was the level during living
• Trauma – subdural clots and blood level of
concentration will be same in case of fatal injury
• Severe internal injury –gastric contents may collect in
thoracic cavity so diffusion possibity is high
• No loss occurs by evapouration
• Putrefaction-alcohol level is destroyed .analysis of
brain gives best results.
• Endogenous alcohol due to bacterial activity
occurs by fermentation of carbohydrates and
proteins .e.coil.
• Longer interval after death .higher temperture
α more production of alcohol
• 0.2% -putrefaction alcohol
• 0.2% above –alcohol consumption
• Blood,organs but not in urine and vitreous
humour it is not due to putrefaction.