Nontherapeutic Chemicals

EtOH in Adults

depressant. (i.e. depresses inhibition, ego control Þ Ý social)

Measured in alcohol equivalents (AE) 1 oz 80-proof liquor = 4 oz 10% wine = 12oz 3.3% beer

In 150 lb male, one AE Ý blood EtOH level by .02 g/dl. Legal imit = .10g/dl

Stages of intoxication

(1) 0.00 to 0.04 = sobriety – highest cerebral functions first impaired
(2) 0.05 to 0.14 = subclinical intoxication (legally drunk in Ohio)
(3) 0.15 to 0.24 = stimulation and excitement (obnoxious); behavior unpredictable; decreased inhibitions; slow reaction time
(4) 0.25 to 0.34 = confusion (slurred speech and staggering); diploplia (double vision)
(5) 0.35 to 0.39 = stupor (passed out but arousable)
(6) 0.40 and up = coma

Women have less EtOH dehydrogenase in their stomach, therefore metabolize it slower and reach a higher blood EtOH with the same amount consumed

Problems and signs of Chronic Alcoholism

Multiple contusions from frequent falling
Brain atrophy
Hemorrhagic diathesis from liver disease
Fatty liver

Jaundice due to poor metabolism of bilirubin
Ascites – fluid filled peritoneal cavity
Cardiomyopathy
Hemorrhagic pancreatitis
Wernicke encephalopathy (thiamin deficiency due to poor eating habits)
Reversible, but repeated injury leads to cirrhosis and formation of fibrous tissue

Cocaine

CNS stimulant Þ euphoria followed by dysphoria when drug wears off.

Increases confidence, energy, activity Acute psychosis, hallucinations

Dilated pupils, anorexia, tachycardia, insomnia

Hypertension, hyperpyrexia (high body temperature)

"Excited delirium" (a psychotic state that is dangerous due to uncontrollable behavior and can cause sudden death)

Effects the brain by blocking dopamine reuptake Þ euphoria and high temperature and blocking reuptake of systemic norepinephrine Þ tachycardia.

Powdered cocaine can Þ crystals called "crack," produces a rapid high. Alcohol + cocaine = cocaethylene which has additive toxic effects similar to cocaine

Amphetamines

CNS stimulant

Methamphetamine is a smokable form used today. (crossed blood-brain barrier better than regular amphetamine)

Other amphetamines include ephedrine found in many OTC cold medications and phenylpropanolamine found in cough syrups.

The effects of methamphetamine lasts longer than cocaine. "Ecstasy" (MDMA) is a new, popular form of methamphetamine

Opiates

CNS depressant / "downers" Include heroine, codeine, morphine, etc. Synthetic opiates include fentanyl and its derivatives

Cause constricted pupils, depression, coma

Chronic use of heroine leads to infection (due to the use of needles) , Endocarditis (septic vegetations on heart valves)

Fungus in brain and rest of body can cause infarction / vessel blockage, Accidental injection of a foreign body can lead to a granuloma

Carbon Monoxide / Asphyxiants

CO has 200 times greater affinity for hemoglobin, myoglobin, and cytochrome oxidase than O₂; Stops transport of O₂ to the tissues

% COHb = [3 x %CO in air x Min. of exposure]_rest or [ 8 x %CO_air x Min]_{light work} or [11 x %CO in air x Min]_{heavy work}Note: children and elderly worse

COHb of 50% Þ passing out and death. Therefore light work in a closed garage with the car on at 1% CO Þ 7 minutes before he passes out (8 x 1 x 7 = 56% COHb)

CO poisoning can be identified by coroner due to bright red / pinkish blood

A survivor of CO poisoning will typically have necrosis of part of the brain and some neurological dysfunction

Marijuana

Just a recreational drug and you really can’t overdose

May lead to lung injury like cigarettes

The problem with marijuana is that it is a lifestyle altering drug leading to risky behavior and fatalities

PCP ("Angel Dust")

May be mixed with marijuana and smoked

Ketamine is a form that is used as a legal anesthetic. Has a stimulatory effect (produces feelings of strength and power). "excited delirium" like cocaine

Heavy Metal Poison

Includes such metals like arsenic, mercury, thallium, lead, etc. Most often come from pesticides. Can cause acute gastritis. Chronic lead poisoning:

In children, can cause delay in bone growth and brain / learning problems

Found in old paint chips which taste sweet to children

One last comment by Dr. Raaf was that the foxglove plant is the source of digitalis. If the plant is put into water, it tastes sweet and can cause digitalis poisoning in children.