Type of alcohol Percentage of alcohol

•Absolute alcohol 99.95%

•Denatured alcohol 95% alcohol +
or industrial spirit 5% wood naphtha
•Rectified spirit 90%
Products of alcohol Alcohol by volume
Rum 50-60%
Whisky 40-75%
Tequila 45-50.5%
Vodka 40-50%
Arrack (Liquor distilled from 40-50%
palm rice, sugar or jaggery)
Gin, Brandy 40-45%
Port, Sherry 16-20%
Wine 10-15%
Beers 4-8%
 20% through the empty stomach and 80% through the
small intestine
 From the blood, the alcohol goes to liver where it is

damaged by a specific enzyme at a constant rate.

• Absorption is slower in the stomach than intestine
• Absorp­tion is faster in empty stomach than when it con­
tains food
• Food affects the absorption by delaying the emptying
time of the stomach: (a) fatty foods, proteins and starch
delay the absorp­tion (b) milk has similar effect i.e., it
delays absorp­tion (c) food prevents 10-20% of the
ingested alcohol from being absorbed
• Diluted form of alcohol is absorbed slowly than the
concentrated form.
• Absorption of alcohol depends on habituation and tolerance
of the individual as habituated heavy drinkers tend to
absorb alcohol more rapidly
• Emotional state of the person affects the contraction of the
stomach resulting in rapid emptying time and the rate of
absorption
• Drugs like Benzedrine and atropine slows the absorption
and retards the emptying time
 The age of the person also has an effect on the absorption
as it occurs less rapidly in younger (< 35 years) individuals
 Individuals with gastrectomy have an increa­sed rate of

absorption
 Inhalation: Concentration in the blood is proportional to the

concentration in the inspired air

 Weight of the subject: The same amount when taken by

subjects of different weight has different blood levels

depending upon the amount of bone, fat and muscles.
 Alcohol is excreted 5% in urine, 5% in breath and very little
through the sweat, faeces and saliva. In hot climates, signi­
ficant amount is lost through the sweat.
• About 90% of the alcohol absorbed is oxidized in liver
and rest 10% is excreted. Alcohol is oxidized to
acetaldehyde by alcohol dehydro­genase (ADH) and
coenzyme nicotina­mide-adenine dinucleotide (NAD) in
the liver. This acetal­dehyde is converted into free
aceticacid (or acetyl coenzyme A). The acetate
undergoes oxidation to carbondioxide and water in the
citric acid (Krebs cycle). This acetate can form glyco­gen,
proteins and also fats and cholesterol.
• In case of a diabetic who is ketogenic will produce fat
from alcohol as he cannot use sugar.
• Alcohol from blood disappears at a rate of 10-15 ml/hour
(15 mg%/hour) and is not stored in the tissues. Due to an
increase in liver enzymes, chronic alco­holic can metabolise
alcohol faster at the rate of 40-50 mg%/hour.
• Of the metabolised alcohol 10% get deposited in the tissues
in the form of cholesterol and neutral fats.
 Alcohol being a central nervous system depressant causes
an irregularly descending type of depression.
 Higher centers are depressed first followed by the midbrain

and thalamus, spinal cord and finally the medulla.

 The recovery occurs in a reverse order.
1. State of excitement: This occurs at the blood alcohol
level of 50-150 mg%,
• there is feeling of well-being, slight excitement,
confidence is increased and a lack of self-control is there.
• The sexual desire is heightened but the perfor­mance is
reduced.
• The visual acuity is also redu­ced in the blood alcohol
concentration of 20 mg% in a nondrinker; 25-35 mg% in
a mode­­rate drinker and 40-70 mg% in a heavy drin­­ker.
• The time and space orientation is altered with feeling of
sleepiness. There is loss of critical judgment and the
mental concen­tration is retarded. The memory is
impaired.
• The symptoms of incoordination appear when the blood alcohol
level is 150-250 mg/100 ml.
• The sense percep­tion and skilled movements are affected.
Inhibition of higher centers is lost resulting in change in the
conduct of the individual.
• The person becomes irritable, quarrelsome and sleepy. There is
incoordination and clumsi­ness’ of fine and skilled movements.
The speech is also altered. There are fine move­ments of fingers
and tremors. Nausea and vomiting is common. Pulse is raised
and face is flushed. The sense of touch, smell and hearing is
diminished. Pupils are dilated and if light reflex is positive,
• To detect alcoholic intoxication, eyes should be examined for
nystagmus.
• Alcoholic gaze nystagmus appears at blood alcohol levels of 50-
100 mg%.
• Alcohol by acting on the vesti­bular system can cause positional
alcohol nystagmus (PAN). PAN is detected when the patient is
lying supine with head turned to either the left or right.
• Horizontal gaze nystagmus (HGN) results from inhibition of
the smooth pursuit system and the impaired ability to maintain
eccentric gaze brought about by alcohol’s effect on ocular
moments via neural mechanisms.
• Motor and sensory cells are deeply affected.
• Speech is slurred and the coordination is markedly affected. Gait
is staggered and the individual may fall.
• The patient is in a state of coma and there is Sertorius breathing.
• The pulse is rapid, temperature is subnormal and the pupils are
constricted.
• On painful stimuli the pupils are dilated which then return slowly
to the contracted stage called McEwan’s sign.
• The patient may die or may recover in 8-10 hours with acute
depression, nausea and headache. If coma is more than 5 hours,
the death may occur resulting from asphyxia due to respiratory
paralysis.
• Severe head injury
• Metabolic disorders such as diabetic or hypoglycemic coma
• Uraemic coma
• Intracranial tumours
• Epilepsy, Parkinsonism, Disseminated sclerosis (ataxia,
tremors and drowsiness simulating drunkenness is there)
• Cerebrovascular accidents
• Intake of drugs such as Insulin, barbiturates, atropine,
antihistaminics, hallucinogens or morphine
• Psychological disorders such as general paralysis of insane
and hypomania
• CO poisoning.
 The person concerned is so much under the influence of
alcohol to have lost control of his faculties to such an extent
as to render him unable to execute safely the occupation in
which he is engaged at the material time
 It is the unsoundness of mind resulting from long continued
action of alcohol on the brain.
 It occurs in chronic alcoholics due to: Sudden withdrawal of

alcohol, Shock after receiving injuries such as fracture of

bone ,Acute infections
• Coarse muscular tremors of the face, tongue and hands
• Hyperactivity of central nervous system
• Restlessness
• Loss of memory
• Uncontrollable tears
• Sweating
• Agitation and anxiety
• Tendency to commit sui­cide, homicide, violent assault or
to cause dam­age to the property
• Disorientation for time and place
• Hallucination of hearing, sight and tactile when one feels
that the insects are crawling under the skin.
• Convulsions
 Detoxification
 Detoxification is a process by which alcohol depen­­dent

persons recover from intoxication in a supervised manner

so that the withdrawal symp­toms are minimized. Delirium
tremens is a medical emergency and its treatment is of two
types:
 Non-medicated detoxification
 Medicated Detoxification
 Chloromethazole: It is a short acting sedative and
anticonvulsant
 Diazepam: It is a long acting drug given orally every two

hours until sedation is achieved; maximum 120 mg can be

given
 Clonidine: It is a major tranquilizer and antipsychotic drug

that is given when the above drug fails

 Thiamine is administered intravenously
 Electrolyte and acid base balance is corrected.
 Disulfiram (Antabuse): It was introduced about 40 years
ago. It acts by inhibiting hepatic enzyme aldehyde dehy­dro­
genase whenever alcohol is ingested. It produces symptoms
such as flushing of face, upper trunk causes vomiting,
dizziness and head­­ache. (Temposil 50 mg/day)
 S.23, BNS: Nothing is an offence which is done by a person
who at the time of doing it, is by reason of intoxication
incapable of knowing the nature of the act, or that he is
doing what is either wrong or contrary to law; provided that
the thing which intoxicated him was administered to him
without his knowledge or against his will
 S.24 BNS: In cases where an act is done is not an offence
unless done with a particular knowledge or intent, a person
who does the act in a state of intoxication shall be liable to
be dealt with as if he had the same knowledge as he would
have had if he had not been intoxicated, unless the thing
which intoxicated him was administered to him without his
knowledge or against his will. Under S.86 a person who gets
in to a state of intoxication voluntarily presumed to have
the same knowledge as he would have had he not been
intoxicated.
 S. 355 BNS. Whoever, in a state of intoxication, appears in
any public place, or in any place which it is a trespass in
him to enter, and there conducts himself in such a manner
as to cause annoyance to any person, shall be punished
with simple imprisonment for a term which may extend to
twenty-four hours, or with fine which may extend to one
thousand rupees, or with both or with community service
 In India S. 185 Motor Vehicle Act 1988 states that
statutory limit of blood alcohol is 30 mg% and for
contravention the punishment involves fine up to Rs 2000
or 6 months imprisonment or both for the first offence. For
subsequent offence, the fine is upto Rs 3000 or
imprisonment upto 2 years or both.
 Methyl alcohol is prepared by destructive distil­la­tion of
wood or molasses.
 When pure it is colour­less, tasteless and odourless. It burns

with pale blue non-luminous flame and its vapour produces

explosive mixture in presence of oxygen or air.
 As a solvent for gums, fats and varnishes for cinematograph
films and as an antifreeze
 For denaturation of ethyl alcohol : Industrial methylated

spirit contains 95% by volume of ethyl alcohol, 5% by

volume of wood naptha and 0.5% of crude pyridine. Methyl
violet is added for colouring. It has disagreeable odour that
is used for fouling rectified spirit, rendering it unfit for
drinking. (v)
 Surgical spirit contains industrial methylated spirit with

methyl salicylate or mineral naptha and ethyl phthalate.

 Fatal dose: 100–125mL, is quite vari­able as recovery has
even occurred with large doses.
 Fatal period: 24-36 hours.
 Headache, dizziness and vertigo
 Nausea, vomiting and severe epigastric pain
 Rise of serum amylase may result in acute abdominal pain

due to pancreatitis
 Cardiac functions are depressed
 Muscular weakness, dyspnoea and cyanosis
 Visual disturbances: (a) concentric diminution of visual field

for colour (b) photophobia (c) blurred vision (d) optic

neuritis resulting in partial blindness.
 Cold sweating and convulsions
 Subnormal temperature
 Delirium and coma may last for 2-3 days
 Bradycardia and Kussmaul breathing
 Urine is strongly acid and contains albumen, acetone and

formic acid
 Coma follows unconsciousness and coma induced is longer

in onset and lasts longer compared to ethyl alcohol

drunkenness
 Death occurs from cardiac failure.
 Gastric lavage using 4% soda bicarbonate solution in warm
water and 500 ml of this solution is left in the stomach
 5% dextrose saline i.v and molar sodium lac­tate solution

are helpful in causing diuresis

 To control acidosis, sodium bicarbonate solution 1.2 gms

orally every 15 minutes or through stomach tube if patient

is unconscious. This can be repea­ted till the plasma
bicarbonate level does not exceed 20 meq/L or
hypokalemia is not induced
 Renal dialysis or hemodialysis is induced
 Stimulants and steroids are given
 Oxygen inhalation and artificial respiration
 Ethyl alcohol (50%) 60 ml initially and 10-15 ml per hour

subsequently orally is given for 4-6 days because ethyl

alcohol helps to reduce metabolism of methyl alcohol to
formal­dehyde and formic acid
 Barbiturates are given to treat convul­sions