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PROF. DR. MD. IQBAL HOSSAIN
PROF & HEAD
DEPT OF FORENSIC MEDICINE
MH SAMORITA MEDICAL COLLEGE
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• Alcohol most commonly refers to:
• Alcohol (chemistry), an organic compound in
which a hydroxyl group is bound to a carbon
atom
• Alcohol (drug), an intoxicant found in alcoholic
drinks
• Alcohol may also refer to:
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• Chemicals
• Ethanol, one of several alcohols, commonly
known as alcohol in everyday life
– Alcoholic drink, sometimes referred to as "alcohol",
any drink containing ethanol
– Surrogate alcohol, any substance containing ethanol
that is intentionally consumed by humans but is not
meant for human consumption
• Alcohol fuel, a fuel containing alcohols
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• Alcohol powder, a powdered form of alcohol
• Fusel alcohol, a mixtures of several alcohols
(chiefly amyl alcohol) produced as a by-
product of alcoholic fermentation
• Alcohols (medicine), the use of alcohols in
medicine
• Rubbing alcohol, a solution of denatured or
isopropyl alcohol used in medicine
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• An alcoholic drink is a drink that contains
ethanol, a type of alcohol produced by
fermentation of grains, fruits, or other sources
of sugar that acts as a drug. The consumption
of alcoholic drinks, often referred to as
"drinking", plays an important social role in
many cultures
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Amount Per 100 grams • Sugar 0 g
Calories 43% • Protein 0.5 g 1%
• Daily Value • Vitamin C 0%
• Total Fat 0 g 0% • Calcium 0%
• Saturated fat 0 g 0% • Iron 0%
• Cholesterol 0 mg 0% • Vitamin D 0%
• Sodium 4 mg 0% • Vitamin B 60%
• Potassium 27 mg 0% • Cobalamin 0%
• Total Carbohydrate 3.6 g • Magnesium 1%
1%
• Dietary fiber 0 g 0%
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• Different type of Drinks –
• Soft drinks: Beers
• Moderate drinks: Wine, Champagne etc
• Hard drinks: Whisky, brandy, gin, rum etc
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• Percentage of Alcohol in different types of
Preparation-
Absolute alcohol – 99.95%
• Rectified spirit - 90%
• Vodka- 60-65%
• Rum, Liquors- 50-60%
• Whisky, Gin, Brandy- 40-45%
• Port, Sherry- 20%
• Wine, Champagne- 10-15%
• Beers- 4-8%
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• Hazard of Alcohol:-
•
1) Acute /Chronic health hazard of alcohol
• 2) Vehicular accident/RTA
• 3) Fall from height
• 4) Electrocution ‘
• 5) Drowning
• 6) Burning
• 7) Chocking
• 8) Saturday night palsy
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• Fatal Dose:-
• Ethyl alcohol/Ethanol:- 150-250 ml of absolute
alcohol consumed in 1 hour. (12-24 hours)
• Methyl alcohol/Methanol:- 60-140 ml (24-36
hours)
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• Stage of Alcohol intoxication:-
• A) 1st stage of mild or early intoxication / Stage of
excitement:
• -Feeling of wellbeing and certain slight excitement.
• -The actions, speech, and emotions are less
restrained.
• -Increased confidence & a lack of self-control.
• -The person may disclose secrets.
• -Normal good nature are forgotten.
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• -The neat and orderly persons are careless
about their dress.
• -Impairment of cognitive function motor
coordination and sensory perception
• -Slurring of speech, impaired reasoning and
memory, reduces perception.
• -Reduction of visual acuity.
• -Mental concentration is absent & judgment is
impaired.
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• B) Stage of stupor:
• -The sense perception and skill movements are
affected.
• -Alteration in the conduct of the individual. He
may be careless, Cheerful, excitable,
quarrelsome, sleepy and so on.
• -Certain clumsiness and in coordination in the
fine and more skilled movements, such as slight
alteration in speech in fine finger movement.
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• -Nausea and vomiting.
• -Alcoholic breath.
• -Flushing of face and rapid pulse.
• -Diminished sense of touch, taste, smell and
hearing.
• -Body temperature decrease.
• -Heart rate – Increase
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• C) Stage of Coma-
• -Speech: thick and slurred, uncoordinated
• -The patient may become giddy, stagger, and
possibly he may fall.
• -The person passes into a state of coma with
Sertorius breathing.
• -Rapid pulse
• - Mc Ewan’s Sign: Positive (Constricted pupils are
dilated on stimulation by pinching and slapping only
to constrict shortly again.
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• Mc Ewan’s Sign:-
• In acute alcohol poisoning (In the stage of
coma), pupils are constricted but stimulation of
the person. Eg-by pinching or slapping, pupils
become dilated. After a short period they
become constrict again. This phenomenon is
called Mc Ewan sign. This sign occurs at above
300% of blood level alcohol.
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• Sign Symptoms of Methyl Alcohol (Methanol) poisoning:
-
•
-Nausea & Vomiting
• -Pain & cramps in the abdomen.
• -Headache, dizziness & vertigo.
• -Dyspnoea. Cyanosis
• -Muscular weakness.
• -Cardiac depression.
• -Blurring of vision
• -Pupil: Dilated & fixed
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• -Conjunctiva-congested
• -CNS: Unconsciousness
• -Raised: ICP
• -Restlessness, cyanosis, dehydration
• -Hypotension, tachycardia, - shock &
circulatory collapse
• -Convulsion, coma, respiratory failure
• -Death
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• Treatment of a case of acute alcohol poisoning:
• Evacuation of the stomach & bowel and gastric
lavage with an alkaline solution. Such as
NaHCO3.
• The Patient must be kept warm. He should be
covered with warm blanket.
• If there is congestion of the brain, ice bags
should be applied to the head.
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• 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.
• If there is difficulty in breathing, artificial
respiration should be given.
• Oxygen inhalation, if required.
• Haemodialysis or peritoneal dialysis.
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• Complication of Methyl alcohol (methanol)
poisoning –
• Visual disturbance & even blindness.
• Neurological & behavioural disturbance.
• Amnesia
• Scanty urination, urinary incontinence & even
total suppression of urine.
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• Hangover effects.
• Vertigo, dyspnoea
• Hypoglycaemia, gastritis, pancreatitis
• Toxic psychosis
• Holiday heart syndrome
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• Holiday Heart Syndrome: Patient may exhibit
holiday heart syndrome in which cardiac
dysarythmias (especially atrial fibrillation &
ventricular arrhythmias) are often observed after
a heavy drinking episode. This drinking episode
is often seen in weekend (holiday)
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• Cause of Death in acute alcohol poisoning/
methyl alcohol poisoning:
• Respiratory depression
• Circulatory failure
• Depression of cardio-respiratory center
• Dehydration
• Acute renal failure
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• Management of chronic Alcohol poisoning:
• Disulfiram is given in a single daily dose of 250
mg. The dosage is gradually reduced until an
adequate daily dosage of 0.125- 0.25gm is
reached.
• Citrate calcium carbimide, 50mg tablet once
daily can be used with fewer side effects.
• Chlorpromazine 25-50 mg (4-6 hourly)
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• Delirium tremens:
Cause-
• Sudden increase
• Sudden withdrawal.
• Injury or infection
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• Symptoms: -
Tremor
• Nightmares
• Insomnia
• Convulsion
• Agitated behaviour
• Loss of memory
• Disorientation
• Failure to recognized known things
• Hallucination of horror etc
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Drunkenness - It is a condition in which a person
intoxicated with alcohol loses control of his
faculties to such an extent , that he is unable to
execute safely the occupation in which he was
engaged at the particular time.
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• Medico-Legal Importance: -
• According to the section 85 BPC ‘An act done
by a person who is incapable of knowing the
nature of the act due to intoxication is not an
offence, if the thing which intoxicated him
without his knowledge or against his will.
• According to the section 86 BPC “An
intoxicated person is criminally responsible, if
he had the intention or knowledge of
committing a crime”.
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• Korsakoff Psychosis – It is a syndrome characterized
by hallucination, disorientation & multiple neurosis.
• Feature :
• Peripheral neuritis with perception derangement.
• Polyneuritis
• Muscular degeneration with weakness, muscle
wasting.
• Unsteady gait
• Disorientation, hallucination
• Retrograde amnesia with cortical degeneration etc.
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• Cause of Death in acute alcohol poisoning/
methyl alcohol poisoning:
• Respiratory depression
• Circulatory failure
• Depression of cardio-respiratory center
• Dehydration
• Acute renal failure
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• PM Findings –
1) Signs of malnutrition may be present.
2) Gastric mucous membrane is deep reddish
brown with patches of congestion.
3) Liver congested, enlarge shows fatty infiltration.
4) Cirrhosis present
5) Kidney shows granular degeneration.
6) Heart is dilated and shows fatty degeneration
and patchy fibrosis.
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Uses of Alcohol :-
• Antiseptic.
• Disinfectant, and
• Antidote.
• Alcohols applied to the skin are used to disinfect
skin before a needle stick and before surgery.
• They may be used both to disinfect the skin of
the person and the hands of the healthcare
providers.
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• Lab alcohol burner is used to produce an open
flame.
• Alcohol is a good preservative.
• As a solvent Ethanol, like water, is a good
solvent for many polar compounds.
• Solvent in medicines and cosmetics (cough
syrup and perfumes) and biofuel.
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• Alcohol molecules all contain the hydroxyl (-
OH) functional group. They are a homologous
series and have the general
formula CnH2n+1OH. Their names all end in -
ol.
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Thank You
