Drowsiness: From 1 Different Sources
A state of consciousness between full wakefulness and sleep or unconsciousness. Drowsiness is medically significant if a person fails to awaken after being shaken, pinched, and shouted at, or wakes but relapses into drowsiness.
Abnormal drowsiness may be the result of a head injury, high fever, meningitis, uraemia (excess urea in the blood due to kidney failure), or liver failure.
Alcohol or drugs may also produce this effect.
In a person with diabetes mellitus, drowsiness may be due to hypoglycaemia or to hyperglycaemia.
Abnormal drowsiness should be treated as a medical emergency.
A drug used for HYPERTENSION, MIGRAINE, GILLES DE LA TOURETTE’S SYNDROME, and menopausal ?ushing. It can cause drowsiness so caution is needed when driving or using machinery.... clonidine
A tranquilliser introduced as a hypnotic. It is long-acting and may produce drowsiness next day. Addiction can occur. (See TRANQUILLISERS; HYPNOTICS; BENZODIAZEPINES.)... nitrazepam
Nutritional Profile
Energy value (calories per serving): Low
Protein: Trace
Fat: Trace
Saturated fat: None Cholesterol: None Carbohydrates: Trace Fiber: Trace
Sodium: Low
Major vitamin contribution: None
Major mineral contribution: None
About the Nutrients in This Food
Coffee beans are roasted seeds from the fruit of the evergreen coffee tree. Like other nuts and seeds, they are high in proteins (11 percent), sucrose and other sugars (8 percent), oils (10 to 15 percent), assorted organic acids (6 percent), B vitamins, iron, and the central nervous system stimulant caffeine (1 to 2 percent). With the exceptions of caffeine, none of these nutrients is found in coffee.
Like spinach, rhubarb, and tea, coffee contains oxalic acid (which binds calcium ions into insoluble compounds your body cannot absorb), but this is of no nutritional consequence as long as your diet contains adequate amounts of calcium-rich foods.
Coffee’s best known constituent is the methylxanthine central ner- vous system stimulant caffeine. How much caffeine you get in a cup of coffee depends on how the coffee was processed and brewed. Caffeine is
Caffeine Content/Coffee Servings Brewed coffee 60 mg/five-ounce cup Brewed/decaffeinated 5 mg/five-ounce cup
Espresso 64 mg/one-ounce serving
Instant 47 mg/rounded teaspoon
The Most Nutritious Way to Serve This Food
In moderation, with high-calcium foods. Like spinach, rhubarb, and tea, coffee has oxalic acid, which binds calcium into insoluble compounds. This will have no important effect as long as you keep your consumption moderate (two to four cups of coffee a day) and your calcium consumption high.
Diets That May Restrict or Exclude This Food
Bland diet
Gout diet
Diet for people with heart disease (regular coffee)
Buying This Food
Look for: Ground coffee and coffee beans in tightly sealed, air- and moisture-proof containers.
Avoid: Bulk coffees or coffee beans stored in open bins. When coffee is exposed to air, the volatile molecules that give it its distinctive flavor and richness escape, leaving the coffee flavorless and/or bitter.
Storing This Food
Store unopened vacuum-packed cans of ground coffee or coffee beans in a cool, dark cabinet—where they will stay fresh for six months to a year. They will lose some flavor in storage, though, because it is impossible to can coffee without trapping some flavor- destroying air inside the can.
Once the can or paper sack has been opened, the coffee or beans should be sealed as tight as possible and stored in the refrigerator. Tightly wrapped, refrigerated ground coffee will hold its freshness and flavor for about a week, whole beans for about three weeks. For longer storage, freeze the coffee or beans in an air- and moistureproof container. ( You can brew coffee directly from frozen ground coffee and you can grind frozen beans without thawing them.)
Preparing This Food
If you make your coffee with tap water, let the water run for a while to add oxygen. Soft water makes “cleaner”-tasting coffee than mineral-rich hard water. Coffee made with chlorinated water will taste better if you refrigerate the water overnight in a glass (not plastic) bottle so that the chlorine evaporates.
Never make coffee with hot tap water or water that has been boiled. Both lack oxygen, which means that your coffee will taste flat.
Always brew coffee in a scrupulously clean pot. Each time you make coffee, oils are left on the inside of the pot. If you don’t scrub them off, they will turn rancid and the next pot of coffee you brew will taste bitter. To clean a coffee pot, wash it with detergent, rinse it with water in which you have dissolved a few teaspoons of baking soda, then rinse one more time with boiling water.
What Happens When You Cook This Food
In making coffee, your aim is to extract flavorful solids (including coffee oils and sucrose and other sugars) from the ground beans without pulling bitter, astringent tannins along with them. How long you brew the coffee determines how much solid material you extract and how the coffee tastes. The longer the brewing time, the greater the amount of solids extracted. If you brew the coffee long enough to extract more than 30 percent of its solids, you will get bitter compounds along with the flavorful ones. (These will also develop by let- ting coffee sit for a long time after brewing it.)
Ordinarily, drip coffee tastes less bitter than percolator coffee because the water in a drip coffeemaker goes through the coffee only once, while the water in the percolator pot is circulated through the coffee several times. To make strong but not bitter coffee, increase the amount of coffee—not the brewing time.
How Other Kinds of Processing Affect This Food
Drying. Soluble coffees (freeze-dried, instant) are made by dehydrating concentrated brewed coffee. These coffees are often lower in caffeine than regular ground coffees because caffeine, which dissolves in water, is lost when the coffee is dehydrated.
Decaffeinating. Decaffeinated coffee is made with beans from which the caffeine has been extracted, either with an organic solvent (methylene chloride) or with water. How the coffee is decaffeinated has no effect on its taste, but many people prefer water-processed decaf- feinated coffee because it is not a chemically treated food. (Methylene chloride is an animal carcinogen, but the amounts that remain in coffees decaffeinated with methylene chloride are so small that the FDA does not consider them hazardous. The carcinogenic organic sol- vent trichloroethylene [TCE], a chemical that causes liver cancer in laboratory animals, is no longer used to decaffeinate coffee.)
Medical Uses and/or Benefits
As a stimulant and mood elevator. Caffeine is a stimulant. It increases alertness and concentra- tion, intensifies muscle responses, quickens heartbeat, and elevates mood. Its effects derive
from the fact that its molecular structure is similar to that of adenosine, a natural chemical by-product of normal cell activity. Adenosine is a regular chemical that keeps nerve cell activ- ity within safe limits. When caffeine molecules hook up to sites in the brain when adenosine molecules normally dock, nerve cells continue to fire indiscriminately, producing the jangly feeling sometimes associated with drinking coffee, tea, and other caffeine products.
As a rule, it takes five to six hours to metabolize and excrete caffeine from the body. During that time, its effects may vary widely from person to person. Some find its stimu- lation pleasant, even relaxing; others experience restlessness, nervousness, hyperactivity, insomnia, flushing, and upset stomach after as little as one cup a day. It is possible to develop a tolerance for caffeine, so people who drink coffee every day are likely to find it less imme- diately stimulating than those who drink it only once in a while.
Changes in blood vessels. Caffeine’s effects on blood vessels depend on site: It dilates coronary and gastrointestinal vessels but constricts blood vessels in your head and may relieve headache, such as migraine, which symptoms include swollen cranial blood vessels. It may also increase pain-free exercise time in patients with angina. However, because it speeds up heartbeat, doc- tors often advise patients with heart disease to avoid caffeinated beverages entirely.
As a diuretic. Caffeine is a mild diuretic sometimes included in over-the-counter remedies for premenstrual tension or menstrual discomfort.
Adverse Effects Associated with This Food
Stimulation of acid secretion in the stomach. Both regular and decaffeinated coffees increase the secretion of stomach acid, which suggests that the culprit is the oil in coffee, not its caffeine.
Elevated blood levels of cholesterol and homocysteine. In the mid-1990s, several studies in the Netherlands and Norway suggested that drinking even moderate amounts of coffee (five cups a day or less) might raise blood levels of cholesterol and homocysteine (by-product of protein metabolism considered an independent risk factor for heart disease), thus increas- ing the risk of cardiovascular disease. Follow-up studies, however, showed the risk limited to drinking unfiltered coffees such as coffee made in a coffee press, or boiled coffees such as Greek, Turkish, or espresso coffee. The unfiltered coffees contain problematic amounts of cafestol and kahweol, two members of a chemical family called diterpenes, which are believed to affect cholesterol and homocysteine levels. Diterpenes are removed by filtering coffee, as in a drip-brew pot.
Possible increased risk of miscarriage. Two studies released in 2008 arrived at different conclusions regarding a link between coffee consumption and an increased risk of miscar- riage. The first, at Kaiser Permanente (California), found a higher risk of miscarriage among women consuming even two eight-ounce cups of coffee a day. The second, at Mt. Sinai School of Medicine (New York), found no such link. However, although the authors of the Kaiser Permanente study described it as a “prospective study” (a study in which the research- ers report results that occur after the study begins), in fact nearly two-thirds of the women who suffered a miscarriage miscarried before the study began, thus confusing the results.
Increased risk of heartburn /acid reflux. The natural oils in both regular and decaffeinated coffees loosen the lower esophageal sphincter (LES), a muscular valve between the esopha- gus and the stomach. When food is swallowed, the valve opens to let food into the stomach, then closes tightly to keep acidic stomach contents from refluxing (flowing backwards) into the esophagus. If the LES does not close efficiently, the stomach contents reflux and cause heartburn, a burning sensation. Repeated reflux is a risk factor for esophageal cancer.
Masking of sleep disorders. Sleep deprivation is a serious problem associated not only with automobile accidents but also with health conditions such as depression and high blood pres- sure. People who rely on the caffeine in a morning cup of coffee to compensate for lack of sleep may put themselves at risk for these disorders.
Withdrawal symptoms. Caffeine is a drug for which you develop a tolerance; the more often you use it, the more likely you are to require a larger dose to produce the same effects and the more likely you are to experience withdrawal symptoms (headache, irritation) if you stop using it. The symptoms of coffee-withdrawal can be relieved immediately by drinking a cup of coffee.
Food/Drug Interactions
Drugs that make it harder to metabolize caffeine. Some medical drugs slow the body’s metabolism of caffeine, thus increasing its stimulating effect. The list of such drugs includes cimetidine (Tagamet), disulfiram (Antabuse), estrogens, fluoroquinolone antibiotics (e.g., ciprofloxacin, enoxacin, norfloxacin), fluconazole (Diflucan), fluvoxamine (Luvox), mexi- letine (Mexitil), riluzole (R ilutek), terbinafine (Lamisil), and verapamil (Calan). If you are taking one of these medicines, check with your doctor regarding your consumption of caf- feinated beverages.
Drugs whose adverse effects increase due to consumption of large amounts of caffeine.
This list includes such drugs as metaproterenol (Alupent), clozapine (Clozaril), ephedrine, epinephrine, monoamine oxidase inhibitors, phenylpropanolamine, and theophylline. In addition, suddenly decreasing your caffeine intake may increase blood levels of lithium, a drug used to control mood swings. If you are taking one of these medicines, check with your doctor regarding your consumption of caffeinated beverages.
Allopurinol. Coffee and other beverages containing methylxanthine stimulants (caffeine, theophylline, and theobromine) reduce the effectiveness of the antigout drug allopurinol, which is designed to inhibit xanthines.
Analgesics. Caffeine strengthens over-the-counter painkillers (acetaminophen, aspirin, and other nonsteroidal anti-inflammatories [NSAIDS] such as ibuprofen and naproxen). But it also makes it more likely that NSAIDS will irritate your stomach lining.
Antibiotics. Coffee increases stomach acidity, which reduces the rate at which ampicillin, erythromycin, griseofulvin, penicillin, and tetracyclines are absorbed when they are taken by mouth. (There is no effect when the drugs are administered by injection.)
Antiulcer medication. Coffee increases stomach acidity and reduces the effectiveness of nor- mal doses of cimetidine and other antiulcer medication.
False-positive test for pheochromocytoma. Pheochromocytoma, a tumor of the adrenal glands, secretes adrenalin, which is converted to VM A (vanillylmandelic acid) by the body and excreted in the urine. Until recently, the test for this tumor measured the levels of VM A in the patient’s urine and coffee, which contains VM A, was eliminated from patients’ diets lest it elevate the level of VM A in the urine, producing a false-positive test result. Today, more finely drawn tests make this unnecessary.
Iron supplements. Caffeine binds with iron to form insoluble compounds your body cannot absorb. Ideally, iron supplements and coffee should be taken at least two hours apart.
Birth control pills. Using oral contraceptives appears to double the time it takes to eliminate caffeine from the body. Instead of five to six hours, the stimulation of one cup of coffee may last as long as 12 hours.
Monoamine oxidase (MAO) inhibitors. Monoamine oxidase inhibitors are drugs used to treat depression. They inactivate naturally occurring enzymes in your body that metabolize tyra- mine, a substance found in many fermented or aged foods. Tyramine constricts blood vessels and increases blood pressure. Caffeine is a substance similar to tyramine. If you consume excessive amounts of a caffeinated beverage such as coffee while you are taking an M AO inhibitor, the result may be a hypertensive crisis.
Nonprescription drugs containing caffeine. The caffeine in coffee may add to the stimulant effects of the caffeine in over-the-counter cold remedies, diuretics, pain relievers, stimulants, and weight-control products containing caffeine. Some cold pills contain 30 mg caffeine, some pain relievers 130 mg, and some weight-control products as much as 280 mg caffeine. There are 110 –150 mg caffeine in a five-ounce cup of drip-brewed coffee.
Sedatives. The caffeine in coffee may counteract the drowsiness caused by sedative drugs; this may be a boon to people who get sleepy when they take antihistamines. Coffee will not, however, “sober up” people who are experiencing the inebriating effects of alcoholic beverages.
Theophylline. Caffeine relaxes the smooth muscle of the bronchi and may intensif y the effects (and/or increase the risk of side effects) of this antiasthmatic drug.... coffee
A muscle-relaxing drug, indicated for chronic severe spasticity (see SPASTIC) of voluntary muscle such as may occur after a STROKE or in CEREBRAL PALSY and MULTIPLE SCLEROSIS (MS). Unlike most other relaxants, it acts directly on the muscle, thus producing fewer centralnervous-system side-effects. It is contraindicated if liver function is impaired, and is not recommended for children or for acute muscle spasm. It may cause drowsiness, resulting in impaired performance at skilled tasks and driving.... dantrolene
A drug used to prevent attacks of MIGRAINE. The drug requires hospital supervision, as it has to be used with care because of the toxic effects it sometimes produces – for example, nausea, drowsiness and retroperitoneal FIBROSIS.... methysergide
A chronic neurologic condition characterized by reoccurring and inexplicable drowsiness and sleep. There is no organic cause and no seeming changes in EEG readings.... narcolepsy
A benzodiazepine anxiolytic (see BENZODIAZEPINES; ANXIOLYTICS) derived from diazepam. To be used with care for short-term treatment of insomnia, generally associated with di?culty in falling asleep, frequent nocturnal awakening or early-morning awakening. Temazepam is a relatively quick-acting hypnotic of short duration, so – although there is little hangover the next morning compared with other hypnotics – there may still be some drowsiness and e?ect on skilled tasks such as driving. It should be avoided in elderly people who are at risk of becoming ataxic and so liable to falling and injuring themselves. Temazepam is often abused by drug addicts.... temazepam
An antihistamine drug, also known as trimeprazine, that is used mainly to relieve itching in allergic conditions such as urticaria and atopic eczema. Alimemazine often causes drowsiness.... alimemazine
A muscle-relaxant drug that is used to relieve muscle spasm and stiffness due to brain or spinal cord injury, stroke, or neurological disorders such as multiple sclerosis. Adverse effects of baclofen include drowsiness and muscle weakness; these side effects can be limited, however, by increasing the dose of the drug gradually.... baclofen
A drug used to suppress production of the hormone prolactin to treat conditions such as noncancerous pituitary tumours (see prolactinomas and acromegaly). Bromocriptine can be used to suppress lactation after childbirth. The drug may also be used as a treatment for Parkinson’s disease. Side effects of bromocriptine include nausea and vomiting. High doses may cause drowsiness and confusion.... bromocriptine
A benzodiazepine drug that is used mainly as an anticonvulsant drug to prevent and treat epileptic fits (see epilepsy). It also prevents petit mal attacks in children. Side effects include drowsiness, dizziness, fatigue, and irritability.... clonazepam
Encephalitis means in?ammation or infection of the brain, usually caused by a virus; it may also be the result of bacterial infection. It occurs throughout the world and affects all racial groups and ages. Rarely it occurs as a complication of common viral disease such as measles, mumps, glandular fever, or chickenpox. It may occur with no evidence of infection elsewhere, such as in HERPES SIMPLEX encephalitis, the most common form seen in Europe and America. RABIES is another form of viral encephalitis, and the HIV virus which causes AIDS invades the brain to cause another form of encephalitis (see AIDS/HIV). In some countries – North and South America, Japan and east Asia and Russia
– there may be epidemics spread by the bite of mosquitoes or ticks.
The clinical features begin with in?uenza-like symptoms – aches, temperature and wretchedness; then the patient develops a headache with drowsiness, confusion and neck sti?ness. Severely ill patients develop changes in behaviour, abnormalities of speech, and deterioration, sometimes with epileptic seizures. Some develop paralysis and memory loss. CT (see COMPUTED TOMOGRAPHY) and MRI brain scans show brain swelling, and damage to the temporal lobes if the herpes virus is involved. ELECTROENCEPHALOGRAPHY (EEG), which records the brainwaves, is abnormal. Diagnosis is possible by an examination of the blood or other body ?uids for antibody reaction to the virus, and modern laboratory techniques are very speci?c.
In general, drugs are not e?ective against viruses – antibiotics are of no use. Herpes encephalitis does respond to treatment with the antiviral agent, aciclovir. Treatment is supportive: patients should be given painkillers, and ?uid replacement drugs to reduce brain swelling and counter epilepsy if it occurs. Fortunately, most sufferers from encephalitis make a complete recovery, but some are left severely disabled with physical defects, personality and memory disturbance, and epileptic ?ts. Rabies is always fatal and the changes found in patients with AIDS are almost always progressive. Except in very speci?c circumstances, it is not possible to be immunised against encephalitis.
Encephalitis lethargica is one, now rare, variety that reached epidemic levels after World War I. It was characterised by drowsiness and headache leading on to COMA. The disease occasionally occurs as a complication after mumps and sometimes affected individuals subsequently develop postencephalitic PARKINSONISM.... encephalitis
An involuntary opening of the mouth, which is accompanied by marked dilatation of the pharynx, a characteristic distortion of the face and usually stretching of the limbs. The cause and function of yawning are quite obscure. It is classically regarded as a sign of drowsiness or boredom, but it it may be the result of raised concentrations of CARBON DIOXIDE (CO2) in the blood – the physiological aim being to cut the amount of CO2 and raise the level of oxygen in the blood.... yawning
A neuropsychiatric syndrome caused by disease of the LIVER, and occurring most often in patients with CIRRHOSIS – see also LIVER, DISEASES OF; it also occurs in acute form in acute failure of liver function. The disorder is believed to be the result of biochemical disturbance of brain function, because the condition is reversible and pathological changes in brain tissue are rarely found. The patient’s intellect, personality, emotions and consciousness are altered but neurological signs may or may not be identi?ed. Apathy, confusion, drowsiness, sometimes CONVULSIONS, speech disturbance and eventually COMA mark the progress of the condition. The principles of treatment are to remove the precipitating causes. These include: URAEMIA; sedative, antidepressant and hypnotic drugs; gastrointestinal bleeding; too much protein in the diet; infection; and trauma (including surgical operations).... hepatic encephalopathy
In?ammation affecting the membranes of the BRAIN or SPINAL CORD, or usually both. Meningitis may be caused by BACTERIA, viruses (see VIRUS), fungi, malignant cells or blood (after SUBARACHNOID HAEMORRHAGE). The term is, however, usually restricted to in?ammation due to a bacterium or virus. Viral meningitis is normally a mild, self-limiting infection of a few days’ duration; it is the most common cause of meningitis but usually results in complete recovery and requires no speci?c treatment. Usually a less serious infection than the bacterial variety, it does, however, rarely cause associated ENCEPHALITIS, which is a potentially dangerous illness. A range of viruses can cause meningitis, including: ENTEROVIRUSES; those causing MUMPS, INFLUENZA and HERPES SIMPLEX; and HIV.
Bacterial meningitis is life-threatening: in the United Kingdom, 5–10 per cent of children who contract the disease may die. Most cases of acute bacterial meningitis in the UK are caused by two bacteria: Neisseria meningitidis (meningococcus), and Streptococcus pneumoniae (pneumococcus); other bacteria include Haemophilus in?uenzae (a common cause until virtually wiped out by immunisation), Escherichia coli, Mycobacterium tuberculosis (see TUBERCULOSIS), Treponema pallidum (see SYPHILIS) and Staphylococci spp. Of the bacterial infections, meningococcal group B is the type that causes a large number of cases in the UK, while group A is less common.
Bacterial meningitis may occur by spread from nearby infected foci such as the nasopharynx, middle ear, mastoid and sinuses (see EAR, DISEASES OF). Direct infection may be the result of penetrating injuries of the skull from accidents or gunshot wounds. Meningitis may also be a complication of neurosurgery despite careful aseptic precautions. Immuno-compromised patients – those with AIDS or on CYTOTOXIC drugs – are vulnerable to infections.
Spread to contacts may occur in schools and similar communities. Many people harbour the meningococcus without developing meningitis. In recent years small clusters of cases, mainly in schoolchildren and young people at college, have occurred in Britain.
Symptoms include malaise accompanied by fever, severe headache, PHOTOPHOBIA, vomiting, irritability, rigors, drowsiness and neurological disturbances. Neck sti?ness and a positive KERNIG’S SIGN appearing within a few hours of infection are key diagnostic signs. Meningococcal and pneumococcal meningitis may co-exist with SEPTICAEMIA, a much more serious condition in terms of death rate or organ damage and which constitutes a grave emergency demanding rapid treatment.
Diagnosis and treatment are urgent and, if bacterial meningitis is suspected, antibiotic treatment should be started even before laboratory con?rmation of the infection. Analysis of the CEREBROSPINAL FLUID (CSF) by means of a LUMBAR PUNCTURE is an essential step in diagnosis, except in patients for whom the test would be dangerous as they have signs of raised intracranial pressure. The CSF is clear or turbid in viral meningitis, turbid or viscous in tuberculous infection and turbulent or purulent when meningococci or staphylococci are the infective agents. Cell counts and biochemical make-up of the CSF are other diagnostic pointers. Serological tests are done to identify possible syphilitic infection, which is now rare in Britain.
Patients with suspected meningitis should be admitted to hospital quickly. General pracitioners are encouraged to give a dose of intramuscular penicillin before sending the child to hospital. Treatment in hospital is usually with a cephalosporin, such as ceftazidime or ceftriaxone. Once the sensitivity of the organism is known as a result of laboratory studies on CSF and blood, this may be changed to penicillin or, in the case of H. in?uenzae, to amoxicillin. Local infections such as SINUSITIS or middle-ear infection require treatment, and appropriate surgery for skull fractures or meningeal tears should be carried out as necessary. Tuberculous meningitis is treated for at least nine months with anti-tuberculous drugs (see TUBERCULOSIS). If bacterial meningitis causes CONVULSIONS, these can be controlled with diazepam (see TRANQUILLISERS; BENZODIAZEPINES) and ANALGESICS will be required for the severe headache.
Coexisting septicaemia may require full intensive care with close attention to intravenous ?uid and electrolyte balance, control of blood clotting and blood pressure.
Treatment of close contacts such as family, school friends, medical and nursing sta? is recommended if the patient has H. in?uenzae or N. meningitidis: RIFAMPICIN provides e?ective prophylaxis. Contacts of patients with pneumococcal infection do not need preventive treatment. Vaccines for meningococcal meningitis may be given to family members in small epidemics and to any contacts who are especially at risk such as infants, the elderly and immuno-compromised individuals.
The outlook for a patient with bacterial meningitis depends upon age – the young and old are vulnerable; speed of onset – sudden onset worsens the prognosis; and how quickly treatment is started – hence the urgency of diagnosis and admission to hospital. Recent research has shown that children who suffer meningitis in their ?rst year of life are ten times more likely to develop moderate or severe disability by the age of ?ve than contemporaries who have not been infected. (See British Medical Journal, 8 September 2001, page 523.)
Prevention One type of bacterial meningitis, that caused by Haemophilus, has been largely controlled by IMMUNISATION; meningococcal C vaccine has largely prevented this type of the disease in the UK. So far, no vaccine against group B has been developed, but research continues. Information on meningitis can be obtained from the Meningitis Trust and the Meningitis Research Foundation.... meningitis
An antihypertensive drug. Adverse effects include drowsiness, depression, and nasal congestion.... methyldopa
An antidepressant drug used to treat severe depression, especially that accompanied by anxiety or insomnia. Mianserin usually takes several weeks to become fully effective. Possible adverse effects include dry mouth, blurred vision, constipation, dizziness, and drowsiness. Rarely, prolonged use may reduce blood cell production; regular blood counts are therefore carried out during treatment.... mianserin
An opioid analgesic drug derived from the opium poppy. Morphine is given to relieve severe pain caused by myocardial infarction, major surgery, serious injury, and cancer.Morphine blocks the transmission of pain signals at sites called opiate receptors in the brain and spinal cord. The drug also induces a sense of well-being or euphoria. Side effects include drowsiness, dizziness, constipation, nausea, vomiting, and confusion. Long-term use of morphine may lead to drug dependence, with severe flu-like symptoms when the drug is withdrawn (see withdrawal syndrome).... morphine
The clinical state which results from renal failure (see KIDNEYS, DISEASES OF). It may be due to disease of the KIDNEYS or it may be the result of pre-renal causes where a lack of circulating blood volume inadequately perfuses the kidneys. It may result from acute necrosis in the tubules of the kidney or it may result from obstruction to the out?ow of URINE.
The word uraemia means excess UREA in the blood; however, the symptoms of renal failure are not due to the abnormal amounts of urea circulating, but rather to the electrolyte disturbances (see ELECTROLYTES) and ACIDOSIS which are associated with impaired renal function. The acidosis results from a decreased ability to ?lter hydrogen ions from blood into the glomerular ?uid: the reduced production of ammonia and phosphate means fewer ions capable of combining with the hydrogen ions, so that the total acid elimination is diminished. The fall in glomerular ?ltration also leads to retention of SODIUM and water with resulting OEDEMA, and to retention of POTASSIUM resulting in HYPERKALAEMIA.
The most important causes of uraemia are the primary renal diseases of chronic glomerular nephritis (in?ammation) and chronic PYELONEPHRITIS. It may also result from MALIGNANT HYPERTENSION damaging the kidneys and amyloid disease destroying them. Analgesic abuse can cause tubular necrosis. DIABETES MELLITUS may cause a nephropathy and lead to uraemia, as may MYELOMATOSIS and SYSTEMIC LUPUS ERYTHEMATOSUS (SLE). Polycystic kidneys and renal tuberculosis account for a small proportion of cases.
Symptoms Uraemia is sometimes classed as acute – that is, those cases in which the symptoms develop in a few hours or days – and chronic, including cases in which the symptoms are less marked and last over weeks, months, or years. There is, however, no dividing line between the two, for in the chronic variety, which may be said to consist of the symptoms of chronic glomerulonephritis, an acute attack is liable to come on at any time.
Headache in the front or back of the head, accompanied often by insomnia and daytime drowsiness, is one of the most common symptoms. UNCONSCIOUSNESS of a profound type, which may be accompanied by CONVULSIONS resembling those of EPILEPSY, is the most outstanding feature of an acute attack and is a very dangerous condition.
Still another symptom, which often precedes an acute attack, is severe vomiting without apparent cause. The appetite is always poor, and the onset of diarrhoea is a serious sign.
Treatment The treatment of the chronic type of uraemia includes all the measures which should be taken by a person suffering from chronic glomerulonephritis (see under KIDNEYS, DISEASES OF). An increasing number of these patients, especially the younger ones, are treated with DIALYSIS and/or renal TRANSPLANTATION.... uraemia
Hypersensitiveness to a foreign protein which produces a violent reaction taking the form of asthma, hay fever, urticaria, eczema, migraine, catarrh, irritable bowel. Sensitivity covers a wide range of irritants including animal odours, pollens, insect bites. All kinds of food may be responsible: milk, eggs, pork, tomatoes, strawberries, coffee, tea, etc, also preservatives and artificial colourings.
Substances that cause allergic reactions are known as allergens. Their number are limitless. Against these, the body produces antibodies to fight off invaders. If we are allergic, such defence mechanisms over-react. The reaction has the effect of releasing various chemicals such as histamine which causes irritation and swelling of mucous membranes. Removal of dental amalgam fillings sometimes relieves.
Perhaps the most common allergy is hay fever. It is now known that most sufferers have a family
history of the complaint. Asthma is a serious form, but with the aid of certain herbs (Lobelia, etc) sufferers may lead normal lives.
Premature babies fed on cow’s milk are at risk of cow’s milk allergy with increased histamine release. (Dunn Nutrition Unit, Cambridge)
Food allergies from shell fish and cereal grain fungi are difficult to detect. A large body of opinion favours Garlic (corm, tablets or capsules), being observed that Garlic eaters seldom suffer allergies. Agrimony tea.
Skin reactions may be severe. Hives, dermatitis and blisters can be the result of allergies triggered off by insect stings or animal bites, drugs, food additives, colourings, monosodium glutamate, chocolate, wines, aspirin, penicillin and other drugs. Cytotoxic tests are made to discover foods to which a person may be allergic.
Heredity predisposes, but forms vary. A ‘nettle rash’ father may have a ‘hay fever’ son. Stress is an important factor. While allergy is not a psychosomatic disturbance, there is general agreement that emotional distress – fright, fury or fatigue – can be related. An allergy can also be due to a flaw in the immune system, the body over-reacting to an allergen. Some allergies are treated with the antihistamines of orthodox pharmacy but which may induce drowsiness.
Treatment. The phytotherapist’s primary agent is Ephedra.
Teas. Chamomile, Centuary, Elderflowers, Ground Ivy, Lime flowers, Nettles, Plantain, Red Sage. 1 heaped teaspoon to each cup boiling water; infuse 5-10 minutes. 1 cup 1 to 3 times daily.
Liquid Extract. Ephedra sinica BHP (1983): Dose – 1-3ml. Thrice daily.
Tincture. Ephedra sinica BHP (1983) 1:4 in 45 per cent alcohol. Dose: 6-8ml thrice daily.
A Vogel. Devil’s Claw, thrice daily.
J. Christopher. Burdock, Marshmallow root, Parsley root.
Valerian. Add to prescription in cases of nervous hyperactivity.
Diet. Low salt, low fat, high fibre. Eggs and dairy products are known to cause allergies. Raw salad once daily. Add more protein, cooked and raw vegetables. Rice is not known to cause any allergic reactions. Supplements. Daily. Vitamin A, B-complex, Vitamin C. Bromelain, Selenium, Zinc.
Note: No animals or birds in the house. ... allergy
A barbiturate drug used mainly as an anticonvulsant. It is often used with phenytoin to treat epilepsy. Possible side effects include drowsiness, clumsiness, dizziness, excitement, and confusion.... phenobarbital
An anthelmintic drug used to treat tapeworm infestation. Adverse effects may include dizziness, drowsiness, and abdominal pain.... praziquantel
A colourless liquid, also called ethanol or ethyl-alcohol, produced by the fermentation of carbohydrates by yeast. Medically, alcohol is used as a solvent and an antiseptic; recreationally it is a widely used drug, taken in alcoholic drinks to give a pleasant taste as well as to relax, reduce inhibitions, and increase sociability. Taken to excess, alcohol causes much mental and physical harm – not just to the individual imbibing it, but often to their family, friends, community and work colleagues.
Alcohol depresses the central nervous system and disturbs both mental and physical functioning. Even small doses of alcohol will slow a person’s re?exes and concentration; potentially dangerous effects when, for example, driving or operating machinery. Drunkenness causes slurred speech, muddled thinking, amnesia (memory loss), drowsiness, erectile IMPOTENCE, poor coordination and dulled reactions – thereby making driving or operating machinery especially dangerous. Disinhibition may lead to extreme euphoria, irritability, misery or aggression, depending on the underlying mood at the start of drinking. Severe intoxication may lead to COMA and respiratory failure.
Persistent alcohol misuse leads to physical, mental, social and occupational problems, as well as to a risk of DEPENDENCE (see also ALCOHOL DEPENDENCE). Misuse may follow several patterns: regular but controlled heavy intake, ‘binge’ drinking, and dependence (alcoholism). The ?rst pattern usually leads to mainly physical problems such as gastritis, peptic ulcer, liver disease, heart disease and impotence. The second is most common among young men and usually leads to mainly social and occupational problems – getting into ?ghts, jeopardising personal relationships, overspending on alcohol at weekends, and missing days o? work because of hangovers. The third pattern – alcohol dependence – is the most serious, and can severely disrupt health and social stability.
Many researchers consider alcohol dependence to be an illness that runs in families, with a genetic component which is probably passed on as a vulnerable personality. But it is hard to disentangle genetic, environmental and social factors in such families. In the UK there are estimated to be around a million people suffering from alcohol dependence and a similar number who have di?culty controlling their consumption (together about 1:30 of the population).
Alcohol causes tolerance and both physical and psychological dependence (see DEPENDENCE for de?nitions). Dependent drinkers classically drink early in the morning to relieve overnight withdrawal symptoms. These symptoms include anxiety, restlessness, nausea and vomiting, and tremor. Sudden withdrawal from regular heavy drinking can lead to life-threatening delirium tremens (DTs), with severe tremor, hallucinations (often visual – seeing spiders and monsters, rather than the pink elephants of romantic myth), and CONVULSIONS. This must be treated urgently with sedative drugs, preferably by intravenous drip. Similar symptoms, plus severe INCOORDINATION and double-vision, can occur in WERNICKE’S ENCEPHALOPATHY, a serious neurological condition due to lack of the B vitamin thiamine (whose absorption from the stomach is markedly reduced by alcohol). If not treated urgently with injections of thiamine and other vitamins, this can lead to an irreversible form of brain damage called Korsako?’s psychosis, with severe amnesia. Finally, prolonged alcohol misuse can cause a form of dementia.
In addition to these severe neurological disorders, the wide range of life-threatening problems caused by heavy drinking includes HEPATITIS, liver CIRRHOSIS, pancreatitis (see PANCREAS, DISEASES OF), gastrointestinal haemorrhage, suicide and FETAL ALCOHOL SYNDROME; pregnant women should not drink alcohol as this syndrome may occur with more than a glass of wine or half-pint of beer a day. The social effects of alcohol misuse – such as marital breakdown, family violence and severe debt – can be equally devastating.
Treatment of alcohol-related problems is only moderately successful. First, many of the physical problems are treated in the short term by doctors who fail to spot, or never ask about, heavy drinking. Second, attempts at treating alcohol dependence by detoxi?cation or ‘drying out’ (substituting a tranquillising drug for alcohol and withdrawing it gradually over about a week) are not always followed-up by adequate support at home, so that drinking starts again. Home support by community alcohol teams comprising doctors, nurses, social workers and, when appropriate, probation o?cers is a recent development that may have better results. Many drinkers ?nd the voluntary organisation Alcoholics Anonymous (AA) and its related groups for relatives (Al-Anon) and teenagers (Alateen) helpful because total abstinence from alcohol is encouraged by intensive psychological and social support from fellow ex-drinkers.
Useful contacts are: Alcoholics Anonymous; Al-Anon Family Groups UK and Eire (including Alateen); Alcohol Concern; Alcohol Focus Scotland; and Alcohol and Substance Misuse.
1 standard drink =1 unit
=••• pint of beer
=1 measure of spirits
=1 glass of sherry or vermouth
=1 glass of wine
Limits within which alcohol is believed not to cause long-term health risks:... alcohol
(Ale)
Nutritional Profile
Energy value (calories per serving): Low
Protein: Moderate
Fat: None
Saturated fat: None Cholesterol: None Carbohydrates: High Fiber: None
Sodium: Low
Major vitamin contribution:
B vitamins
Major mineral contribution: Phosphorus
About the Nutrients in This Food
Beer and ale are fermented beverages created by yeasts that convert the sugars in malted barley and grain to ethyl alcohol (a.k.a. “alcohol,” “drink- ing alcohol”).*
The USDA /Health and Human Services Dietary Guidelines for Americans defines one drink as 12 ounces of beer, five ounces of wine, or
1.25 ounces of distilled spirits. One 12-ounce glass of beer has 140 calo- ries, 86 of them (61 percent) from alcohol. But the beverage—sometimes nicknamed “liquid bread”—is more than empty calories. Like wine, beer retains small amounts of some nutrients present in the food from which it was made.
* Because yeasts cannot digest t he starches in grains, t he grains to be used in mak ing beer and ale are allowed to germinate ( “malt” ). When it is t ime to make t he beer or ale, t he malted grain is soaked in water, forming a mash in which t he starches are split into simple sugars t hat can be digested (fermented) by t he yeasts. If undisturbed, t he fermentat ion will cont inue unt il all t he sugars have been digested, but it can be halted at any t ime simply by raising or lowering t he temperature of t he liquid. Beer sold in bott les or cans is pasteurized to k ill t he yeasts and stop t he fermentat ion. Draft beer is not pasteurized and must be refrigerated unt il tapped so t hat it will not cont inue to ferment in t he container. The longer t he shipping t ime, t he more likely it is t hat draft beer will be exposed to temperature variat ions t hat may affect its qualit y—which is why draft beer almost always tastes best when consumed near t he place where it was brewed.
The Nutrients in Beer (12-ounce glass)
|
Nutrients |
Beer |
%R DA |
| Calcium |
17 mg |
1.7 |
| Magnesium |
28.51 mg |
7–9* |
| Phosphorus |
41.1 mg |
6 |
| Potassium |
85.7 mg |
(na) |
| Zinc |
0.06 mg |
0.5– 0.8* |
| Thiamin |
0.02 mg |
1.6 –1.8* |
| R iboflavin |
0.09 mg |
7– 8* |
| Niacin |
1.55 mg |
10 |
| Vitamin B6 |
0.17 mg |
13 |
| Folate |
20.57 mcg |
5 |
* t he first figure is t he %R DA for a man; t he second, for a woman
Source: USDA Nut rient Database: w w w.nal.usda.gov/fnic/cgi-bin /nut _search.pl.
Diets That May Restrict or Exclude This Food
Bland diet
Gluten-free diet
Low-purine (antigout) diet
Buying This Food
Look for: A popular brand that sells steadily and will be fresh when you buy it.
Avoid: Dusty or warm bottles and cans.
Storing This Food
Store beer in a cool place. Beer tastes best when consumed within two months of the day it is made. Since you cannot be certain how long it took to ship the beer to the store or how long it has been sitting on the grocery shelves, buy only as much beer as you plan to use within a week or two.
Protect bottled beer and open bottles or cans of beer from direct sunlight, which can change sulfur compounds in beer into isopentyl mercaptan, the smelly chemical that gives stale beer its characteristic unpleasant odor.
When You Are Ready to Serve This Food
Serve beer only in absolutely clean glasses or mugs. Even the slightest bit of grease on the side of the glass will kill the foam immediately. Wash beer glasses with detergent, not soap, and let them drain dry rather than drying them with a towel that might carry grease from your hands to the glass. If you like a long-lasting head on your beer, serve the brew in tall, tapering glasses to let the foam spread out and stabilize.
For full flavor, serve beer and ales cool but not ice-cold. Very low temperatures immo- bilize the molecules that give beer and ale their flavor and aroma.
What Happens When You Cook This Food
When beer is heated (in a stew or as a basting liquid), the alcohol evaporates but the flavor- ing agents remain intact. Alcohol, an acid, reacts with metal ions from an aluminum or iron pot to form dark compounds that discolor the pot or the dish you are cooking in. To prevent this, prepare dishes made with beer in glass or enameled pots.
Medical Uses and/or Benefits
Reduced risk of heart attack. Data from the American Cancer Society’s Cancer Prevention Study 1, a 12-year survey of more than 1 million Americans in 25 states, shows that men who take one drink a day have a 21 percent lower risk of heart attack and a 22 percent lower risk of stroke than men who do not drink at all. Women who have up to one drink a day also reduce their risk of heart attack. Numerous later studies have confirmed these findings.
Lower risk of stroke. In January 1999, the results of a 677-person study published by researchers at New York Presbyterian Hospital-Columbia University showed that moder- ate alcohol consumption reduces the risk of stroke due to a blood clot in the brain among older people (average age: 70). How the alcohol prevents stroke is still unknown, but it is clear that moderate use of alcohol is a key. Heavy drinkers (those who consume more than seven drinks a day) have a higher risk of stroke. People who once drank heavily, but cut their consumption to moderate levels, can also reduce their risk of stroke. Numerous later studies have confirmed these findings.
Lower cholesterol levels. Beverage alcohol decreases the body’s production and storage of low-density lipoproteins (LDLs), the protein and fat particles that carr y cholesterol into your arteries. As a result, people who drink moderately tend to have lower cholesterol levels and higher levels of high density lipoproteins (HDLs), the fat and protein particles that carr y cholesterol out of the body. The USDA /Health and Human Services Dietar y Guidelines for Americans defines moderation as two drinks a day for a man, one drink a day for a woman.
Stimulating the appetite. Alcoholic beverages stimulate the production of saliva and the gastric acids that cause the stomach contractions we call hunger pangs. Moderate amounts of alcoholic beverages, which may help stimulate appetite, are often prescribed for geriatric
patients, convalescents, and people who do not have ulcers or other chronic gastric problems that might be exacerbated by the alcohol.
Dilation of blood vessels. Alcohol dilates the capillaries (the tiny blood vessels just under the skin), and moderate amounts of alcoholic beverages produce a pleasant flush that temporar- ily warms the drinker. But drinking is not an effective way to warm up in cold weather since the warm blood that flows up to the capillaries will cool down on the surface of your skin and make you even colder when it circulates back into the center of your body. Then an alco- hol flush will make you perspire, so that you lose more heat. Excessive amounts of beverage alcohol may depress the mechanism that regulates body temperature.
Adverse Effects Associated with This Food
Increased risk of breast cancer. In 2008, scientists at the National Cancer Institute released data from a seven-year survey of more than 100,000 postmenopausal women showing that even moderate drinking (one to two drinks a day) may increase by 32 percent a woman’s risk of developing estrogen-receptor positive (ER+) and progesterone-receptor positive (PR+) breast cancer, tumors whose growth is stimulated by hormones. No such link was found between consuming alcohol and the risk of developing ER-/PR- tumors (not fueled by hor- mones). The finding applies to all types of alcohol: beer, wine, and spirits.
Increased risk of oral cancer (cancer of the mouth and throat). Numerous studies confirm the American Cancer Society’s warning that men and women who consume more than two drinks a day are at higher risk of oral cancer than are nondrinkers or people who drink less. Note: The Dietary Guidelines for Americans describes one drink as 12 ounces of beer, five ounces of wine, or 1.5 ounces of distilled spirits.
Increased risk of cancer of the colon and rectum. In the mid-1990s, studies at the University of Oklahoma suggested that men who drink more than five beers a day are at increased risk of rectal cancer. Later studies suggested that men and women who are heavy beer or spirits drinkers (but not those who are heavy wine drinkers) have a higher risk of colorectal cancers. Further studies are required to confirm these findings.
Fetal alcohol syndrome. Fetal alcohol syndrome is a specific pattern of birth defects—low birth weight, heart defects, facial malformations, and mental retardation—first recognized in a study of babies born to alcoholic women who consumed more than six drinks a day while pregnant. Subsequent research has found a consistent pattern of milder defects in babies born to women who consume three to four drinks a day or five drinks on any one occasion while pregnant. To date, there is no evidence of a consistent pattern of birth defects in babies born to women who consume less than one drink a day while pregnant, but two studies at Columbia University have suggested that as few as two drinks a week while preg- nant may raise a woman’s risk of miscarriage. (“One drink” means 12 ounces of beer, five ounces of wine, or 1.25 ounces of distilled spirits.)
Alcoholism. Alcoholism is an addiction disease, the inability to control one’s alcohol consumption. It is a potentially life-threatening condition, with a higher risk of death by accident, suicide, malnutrition, or acute alcohol poisoning, a toxic reaction that kills by para- lyzing body organs, including the heart.
Malnutrition. While moderate alcohol consumption stimulates appetite, alcohol abuse depresses it. In addition, an alcoholic may drink instead of eating. When an alcoholic does eat, excess alcohol in his/her body prevents absorption of nutrients and reduces the ability to synthesize new tissue.
Hangover. Alcohol is absorbed from the stomach and small intestine and carried by the bloodstream to the liver, where it is oxidized to acetaldehyde by alcohol dehydrogenase (ADH), the enzyme our bodies use to metabolize the alcohol we produce when we digest carbohydrates. The acetaldehyde is converted to acetyl coenzyme A and either eliminated from the body or used in the synthesis of cholesterol, fatty acids, and body tissues. Although individuals vary widely in their capacity to metabolize alcohol, on average, normal healthy adults can metabolize the alcohol in one quart of beer in approximately five to six hours. If they drink more than that, they will have more alcohol than the body’s natural supply of ADH can handle. The unmetabolized alcohol will pile up in the bloodstream, interfering with the liver’s metabolic functions. Since alcohol decreases the reabsorption of water from the kidneys and may inhibit the secretion of an antidiuretic hormone, they will begin to urinate copiously, losing magnesium, calcium, and zinc but retaining more irritating uric acid. The level of lactic acid in the body will increase, making them feel tired and out of sorts; their acid-base balance will be out of kilter; the blood vessels in their heads will swell and throb; and their stomachs, with linings irritated by the alcohol, will ache. The ultimate result is a “hangover” whose symptoms will disappear only when enough time has passed to allow their bodies to marshal the ADH needed to metabolize the extra alcohol in their blood.
Changes in body temperature. Alcohol dilates capillaries, tiny blood vessels just under the skin, producing a “flush” that temporarily warms the drinker. But drinking is not an effective way to stay warm in cold weather. Warm blood flowing up from the body core to the surface capillaries is quickly chilled, making you even colder when it circulates back into your organs. In addition, an alcohol flush triggers perspiration, further cooling your skin. Finally, very large amounts of alcohol may actually depress the mechanism that regulates body temperature.
Impotence. Excessive drinking decreases libido (sexual desire) and interferes with the ability to achieve or sustain an erection.
“Beer belly.” Data from a 1995, 12,000 person study at the University of North Carolina in Chapel Hill show that people who consume at least six beers a week have more rounded abdomens than people who do not drink beer. The question left to be answered is which came first: the tummy or the drinking.
Food/Drug Interactions
Acetaminophen (Tylenol, etc.). The FDA recommends that people who regularly have three or more drinks a day consult a doctor before using acetaminophen. The alcohol/acetamino- phen combination may cause liver failure.
Disulfiram (Antabuse). Taken with alcohol, disulfiram causes flushing, nausea, low blood pressure, faintness, respiratory problems, and confusion. The severity of the reaction gener- ally depends on how much alcohol you drink, how much disulfiram is in your body, and how long ago you took it. Disulfiram is used to help recovering alcoholics avoid alcohol. (If taken with alcohol, metronidazole [Flagyl], procarbazine [Matulane], quinacrine [Atabrine], chlorpropamide (Diabinase), and some species of mushrooms may produce a mild disulfi- ramlike reaction.)
Anticoagulants. Alcohol slows the body’s metabolism of anticoagulants (blood thinners) such as warfarin (Coumadin), intensif ying the effect of the drugs and increasing the risk of side effects such as spontaneous nosebleeds.
Antidepressants. Alcohol may increase the sedative effects of antidepressants. Drinking alcohol while you are taking a monoamine oxidase (M AO) inhibitor is especially hazard- ous. M AO inhibitors inactivate naturally occurring enzymes in your body that metabolize tyramine, a substance found in many fermented or aged foods. Tyramine constricts blood vessels and increases blood pressure. If you eat a food containing tyramine while you are taking an M AO inhibitor, you cannot effectively eliminate the tyramine from your body. The result may be a hypertensive crisis. Ordinarily, fermentation of beer and ale does not produce tyramine, but some patients have reported tyramine reactions after drinking some imported beers. Beer and ale are usually prohibited to those using M AO inhibitors.
Aspirin, ibuprofen, ketoprofen, naproxen, and nonsteroidal anti-inflammatory drugs. Like alcohol, these analgesics irritate the lining of the stomach and may cause gastric bleeding. Combining the two intensifies the effect.
Insulin and oral hypoglycemics. Alcohol lowers blood sugar and interferes with the metabo- lism of oral antidiabetics; the combination may cause severe hypoglycemia.
Sedatives and other central nervous system depressants (tranquilizers, sleeping pills, antidepres- sants, sinus and cold remedies, analgesics, and medication for motion sickness). Alcohol inten- sifies sedation and, depending on the dose, may cause drowsiness, respiratory depression, coma, or death.... beer
Physical or psychological reliance on a substance or an individual. A baby is naturally dependent on its parents, but as the child develops, this dependence lessens. Some adults, however, remain partly dependent, making abnormal demands for admiration, love and help from parents, relatives and others.
The dependence that most concerns modern society is one in which individuals become dependent on or addicted to certain substances such as alcohol, drugs, tobacco (nicotine), caffeine and solvents. This is often called substance abuse. Some people become addicted to certain foods or activities: examples of the latter include gambling, computer games and use of the Internet.
The 28th report of the World Health Organisation Expert Committee on Drug Dependence in 1993 de?ned drug dependence as: ‘A cluster of physiological, behavioural and cognitive phenomena of variable intensity, in which the use of a psychoactive drug (or drugs) takes on a high priority. The necessary descriptive characteristics are preoccupation with a desire to obtain and take the drug and persistent drug-seeking behaviour. Psychological dependence occurs when the substance abuser craves the drug’s desirable effects. Physical dependence occurs when the user has to continue taking the drug to avoid distressing withdrawal or abstinence symptoms. Thus, determinants and the problematic consequences of drug dependence may be biological, psychological or social and usually interact.’
Di?erent drugs cause di?erent rates of dependence: TOBACCO is the most common substance of addiction; HEROIN and COCAINE cause high rates of addiction; whereas ALCOHOL is much lower, and CANNABIS lower again. Smoking in the western world reached a peak after World War II with almost 80 per cent of the male population smoking. The reports on the link between smoking and cancer in the early 1960s resulted in a decline that has continued so that only around a quarter of the adult populations of the UK and USA smokes. Globally, tobacco consumption continues to grow, particularly in the developing world with multinational tobacco companies marketing their products aggressively.
Accurate ?gures for illegal drug-taking are hard to obtain, but probably approximately 4 per cent of the population is dependent on alcohol and 2 per cent on other drugs, both legal and illegal, at any one time in western countries.
How does dependence occur? More than 40 distinct theories or models of drug misuse have been put forward. One is that the individual consumes drugs to cope with personal problems or diffculties in relations with others. The other main model emphasises environmental in?uences such as drug availability, environmental pressures to consume drugs, and sociocultural in?uences such as peer pressure.
By contrast to these models of why people misuse drugs, models of compulsive drug use – where individuals have a compulsive addiction
– have been amenable to testing in the laboratory. Studies at cellular and nerve-receptor levels are attempting to identify mechanisms of tolerance and dependence for several substances. Classical behaviour theory is a key model for understanding drug dependence. This and current laboratory studies are being used to explain the reinforcing nature of dependent substances and are helping to provide an explanatory framework for dependence. Drug consumption is a learned form of behaviour. Numerous investigators have used conditioning theories to study why people misuse drugs. Laboratory studies are now locating the ‘reward pathways’ in the brain for opiates and stimulants where positive reinforcing mechanisms involve particular sectors of the brain. There is a consensus among experts in addiction that addictive behaviour is amenable to e?ective treatment, and that the extent to which an addict complies with treatment makes it possible to predict a positive outcome. But there is a long way to go before the mechanisms of drug addiction are properly understood or ways of treating it generally agreed.
Effects of drugs Cannabis, derived from the plant Cannabis sativa, is a widely used recreational drug. Its two main forms are marijuana, which comes from the dried leaves, and hashish which comes from the resin. Cannabis may be used in food and drink but is usually smoked in cigarettes to induce relaxation and a feeling of well-being. Heavy use can cause apathy and vagueness and may even cause psychosis. Whether or not cannabis leads people to using harder drugs is arguable, and a national debate is underway on whether its use should be legalised for medicinal use. Cannabis may alleviate the symptoms of some disorders – for example, MULTIPLE SCLEROSIS (MS) – and there are calls to allow the substance to be classi?ed as a prescribable drug.
About one in ten of Britain’s teenagers misuses volatile substances such as toluene at some time, but only about one in 40 does so regularly. These substances are given o? by certain glues, solvents, varnishes, and liquid fuels, all of which can be bought cheaply in shops, although their sale to children under 16 is illegal. They are often inhaled from plastic bags held over the nose and mouth. Central-nervous-system excitation, with euphoria and disinhibition, is followed by depression and lethargy. Unpleasant effects include facial rash, nausea and vomiting, tremor, dizziness, and clumsiness. Death from COMA and acute cardiac toxicity is a serious risk. Chronic heavy use can cause peripheral neuropathy and irreversible cerebellar damage. (See SOLVENT ABUSE (MISUSE).)
The hallucinogenic or psychedelic drugs include LYSERGIC ACID DIETHYLAMIDE (LSD) or acid, magic mushrooms, ecstasy (MDMA), and phencyclidine (PCP or ‘angel’ dust, mainly used in the USA). These drugs have no medicinal uses. Taken by mouth, they produce vivid ‘trips’, with heightened emotions and perceptions and sometimes with hallucinations. They are not physically addictive but can cause nightmarish bad trips during use and ?ashbacks (vivid reruns of trips) after use, and can probably trigger psychosis and even death, especially if drugs are mixed or taken with alcohol.
Stimulant drugs such as amphetamine and cocaine act like adrenaline and speed up the central nervous system, making the user feel con?dent, energetic, and powerful for several hours. They can also cause severe insomnia, anxiety, paranoia, psychosis, and even sudden death due to convulsions or tachycardia. Depression may occur on withdrawal of these drugs, and in some users this is su?ciently deterrent to cause psychological dependence. Amphetamine (‘speed’) is mainly synthesised illegally and may be eaten, sni?ed, or injected. Related drugs, such as dexamphetamine sulphate (Dexedrine), are prescribed pills that enter the black market. ECSTASY is another amphetamine derivative that has become a popular recreational drug; it may have fatal allergic effects. Cocaine and related drugs are used in medicine as local anaesthetics. Illegal supplies of cocaine (‘snow’ or ‘ice’) and its derivative, ‘crack’, come mainly from South America, where they are made from the plant Erythroxylon coca. Cocaine is usually sni?ed (‘snorted’) or rubbed into the gums; crack is burnt and inhaled.
Opiate drugs are derived from the opium poppy, Papaver somniferum. They are described as narcotic because they induce sleep. Their main medical use is as potent oral or injectable analgesics such as MORPHINE, DIAMORPHINE, PETHIDINE HYDROCHLORIDE, and CODEINE. The commonest illegal opiate is heroin, a powdered form of diamorphine that may be smoked, sni?ed, or injected to induce euphoria and drowsiness. Regular opiate misuse leads to tolerance (the need to take ever larger doses to achieve the same e?ect) and marked dependence. A less addictive oral opiate, METHADONE HYDROCHLORIDE, can be prescribed as a substitute that is easier to withdraw.
Some 75,000–150,000 Britons now misuse opiates and other drugs intravenously, and pose a huge public-health problem because injections with shared dirty needles can carry the blood-borne viruses that cause AIDS/HIV and HEPATITIS B. Many clinics now operate schemes to exchange old needles for clean ones, free of charge. Many addicts are often socially disruptive.
For help and advice see APPENDIX 2: ADDRESSES: SOURCES OF INFORMATION, ADVICE, SUPPORT AND SELF-HELP – National Dugs Helpline.
(See ALCOHOL and TOBACCO for detailed entries on those subjects.)... dependence
(Brandy, gin, rum, tequila, whiskey, vodka)
Nutritional Profile
Energy value (calories per serving): Moderate to high
Protein: None
Fat: None
Saturated fat: None
Cholesterol: None
Carbohydrates: None (except for cordials which contain added sugar)
Fiber: None
Sodium: Low
Major vitamin contribution: None
Major mineral contribution: Phosphorus
About the Nutrients in This Food
Spirits are the clear liquids produced by distilling the fermented sugars of grains, fruit, or vegetables. The yeasts that metabolize these sugars and convert them into alcohol stop growing when the concentration of alcohol rises above 12–15 percent. In the United States, the proof of an alcoholic beverage is defined as twice its alcohol content by volume: a beverage with
20 percent alcohol by volume is 40 proof.
This is high enough for most wines, but not high enough for most whiskies, gins, vodkas, rums, brandies, and tequilas. To reach the concentra- tion of alcohol required in these beverages, the fermented sugars are heated and distilled. Ethyl alcohol (the alcohol in beer, wine, and spirits) boils at a lower temperature than water. When the fermented sugars are heated, the ethyl alcohol escapes from the distillation vat and condenses in tubes leading from the vat to a collection vessel. The clear liquid that collects in this vessel is called distilled spirits or, more technically, grain neutral spirits.
Gins, whiskies, cordials, and many vodkas are made with spirits
American whiskeys (which include bourbon, rye, and distilled from grains.
blended whiskeys) and Canadian, Irish, and Scotch whiskies are all made from spirits aged in wood barrels. They get their flavor from the grains and their color from the barrels. (Some whiskies are also colored with caramel.)
Vodka is made from spirits distilled and filtered to remove all flavor. By law, vodkas made in America must be made with spirits distilled from grains. Imported vodkas may be made with spirits distilled either from grains or potatoes and may contain additional flavoring agents such as citric acid or pepper. Aquavit, for example, is essentially vodka flavored with caraway seeds. Gin is a clear spirit flavored with an infusion of juniper berries and other herbs (botanicals). Cordials (also called liqueurs) and schnapps are flavored spirits; most are sweetened with added sugar. Some cordials contain cream.
Rum is made with spirits distilled from sugar cane (molasses). Tequila is made with spirits distilled from the blue agave plant. Brandies are made with spirits distilled from fruit. (Arma- gnac and cognac are distilled from fermented grapes, calvados and applejack from fermented apples, kirsch from fermented cherries, slivovitz from fermented plums.)
Unless they contain added sugar or cream, spirits have no nutrients other than alcohol. Unlike food, which has to be metabolized before your body can use it for energy, alcohol can be absorbed into the blood-stream directly from the gastrointestinal tract. Ethyl alcohol provides 7 calories per gram.
The Most Nutritious Way to Serve This Food
The USDA /Health and Human Services Dietary Guidelines for Americans defines one drink as 12 ounces of beer, five ounces of wine, or 1.25 ounces of distilled spirits, and “moderate drinking” as two drinks a day for a man, one drink a day for a woman.
Diets That May Restrict or Exclude This Food
Bland diet
Lactose-free diet (cream cordials made with cream or milk) Low-purine (antigout) diet
Buying This Food
Look for: Tightly sealed bottles stored out of direct sunlight, whose energy might disrupt the structure of molecules in the beverage and alter its flavor.
Choose spirits sold only by licensed dealers. Products sold in these stores are manufac- tured under the strict supervision of the federal government.
Storing This Food
Store sealed or opened bottles of spirits in a cool, dark cabinet.
Preparing This Food
All spirits except unflavored vodkas contain volatile molecules that give the beverage its characteristic taste and smell. Warming the liquid excites these molecules and intensifies the flavor and aroma, which is the reason we serve brandy in a round glass with a narrower top that captures the aromatic molecules as they rise toward the air when we warm the glass by holding it in our hands. Whiskies, too, though traditionally served with ice in America, will have a more intense flavor and aroma if served at room temperature.
What Happens When You Cook This Food
The heat of cooking evaporates the alcohol in spirits but leaves the flavoring intact. Like other alcoholic beverages, spirits should be added to a recipe near the end of the cooking time to preserve the flavor while cooking away any alcohol bite.
Alcohol is an acid. If you cook it in an aluminum or iron pot, it will combine with metal ions to form dark compounds that discolor the pot and the food you are cooking. Any recipe made with spirits should be prepared in an enameled, glass, or stainless-steel pot.
Medical Uses and/or Benefits
Reduced risk of heart attack. Data from the American Cancer Society’s Cancer Prevention Study 1, a 12-year survey of more than 1 million Americans in 25 states, shows that men who take one drink a day have a 21 percent lower risk of heart attack and a 22 percent lower risk of stroke than men who do not drink at all. Women who have up to one drink a day also reduce their risk of heart attack. Numerous later studies have confirmed these findings.
Lower cholesterol levels. Beverage alcohol decreases the body’s production and storage of low density lipoproteins (LDLs), the protein and fat particles that carry cholesterol into your arteries. As a result, people who drink moderately tend to have lower cholesterol levels and higher levels of high density lipoproteins (HDLs), the fat and protein particles that carry cholesterol out of the body. Numerous later studies have confirmed these findings.
Lower risk of stroke. In January 1999, the results of a 677-person study published by researchers at New York Presbyterian Hospital-Columbia University showed that moderate alcohol consumption reduces the risk of stroke due to a blood clot in the brain among older people (average age: 70). How alcohol prevents stroke is still unknown, but it is clear that moderate use is a key. Heavy drinkers (those who consume more than seven drinks a day) have a higher risk of stroke. People who once drank heavily, but cut their consumption to moderate levels, reduce their risk of stroke.
Stimulating the appetite. Alcoholic beverages stimulate the production of saliva and the gastric acids that cause the stomach contractions we call hunger pangs. Moderate amounts of alcoholic beverages, which may help stimulate appetite, are often prescribed for geriatric patients, convalescents, and people who do not have ulcers or other chronic gastric problems that might be exacerbated by the alcohol.
Dilation of blood vessels. Alcoholic beverages dilate the tiny blood vessels just under the skin, bringing blood up to the surface. That’s why moderate amounts of alcoholic beverages (0.2–1 gram per kilogram of body weight, or two ounces of whiskey for a 150-pound adult) temporarily warm the drinker. But the warm blood that flows up to the surface of the skin will cool down there, making you even colder when it circulates back into the center of your body. Then an alcohol flush will make you perspire, so you lose more heat. Excessive amounts of beverage alcohol may depress the mechanism that regulates body temperature.
Adverse Effects Associated with This Food
Alcoholism. Alcoholism is an addiction disease, the inability to control one’s alcohol consumption. It is a potentially life-threatening condition, with a higher risk of death by accident, suicide, malnutrition, or acute alcohol poisoning, a toxic reaction that kills by para- lyzing body organs, including the heart.
Fetal alcohol syndrome. Fetal alcohol syndrome is a specific pattern of birth defects—low birth weight, heart defects, facial malformations, learning disabilities, and mental retarda- tion—first recognized in a study of babies born to alcoholic women who consumed more than six drinks a day while pregnant. Subsequent research has found a consistent pattern of milder defects in babies born to women who drink three to four drinks a day or five drinks on any one occasion while pregnant. To date there is no evidence of a consistent pattern of birth defects in babies born to women who consume less than one drink a day while preg- nant, but two studies at Columbia University have suggested that as few as two drinks a week while pregnant may raise a woman’s risk of miscarriage. (One drink is 12 ounces of beer, five ounces of wine, or 1.25 ounces of distilled spirits.)
Increased risk of breast cancer. In 2008, scientists at the National Cancer Institute released data from a seven-year survey of more than 100,000 postmenopausal women showing that even moderate drinking (one to two drinks a day) may increase by 32 percent a woman’s risk of developing estrogen-receptor positive (ER+) and progesterone-receptor positive (PR+) breast cancer, tumors whose growth is stimulated by hormones. No such link was found between consuming alcohol and the risk of developing ER-/PR- tumors (not fueled by hor- mones). The finding applies to all types of alcohol: beer, wine, and distilled spirits.
Increased risk of oral cancer (cancer of the mouth and throat). Numerous studies confirm the A merican Cancer Societ y’s warn ing that men and women who consume more than t wo drinks a day are at higher risk of oral cancer than are nondrinkers or people who drink less.
Increased risk of cancer of the colon and rectum. In the mid-1990s, studies at the University of Oklahoma suggested that men who drink more than five beers a day are at increased risk of rectal cancer. Later studies suggested that men and women who are heavy beer or spirits drinkers (but not those who are heavy wine drinkers) have a higher risk of colorectal cancers. Further studies are required to confirm these findings.
Malnutrition. While moderate alcohol consumption stimulates appetite, alcohol abuses depresses it. In addition, an alcoholic may drink instead of eating. When an alcoholic does eat, excess alcohol in his/her body prevents absorption of nutrients and reduces the ability to synthesize new tissue.
Hangover. Alcohol is absorbed from the stomach and small intestine and carried by the bloodstream to the liver, where it is oxidized to acetaldehyde by alcohol dehydrogenase (ADH), the enzyme our bodies use every day to metabolize the alcohol we produce when we digest carbohydrates. The acetaldehyde is converted to acetyl coenzyme A and either eliminated from the body or used in the synthesis of cholesterol, fatty acids, and body tis- sues. Although individuals vary widely in their capacity to metabolize alcohol, an adult of average size can metabolize the alcohol in four ounces (120 ml) whiskey in approximately five to six hours. If he or she drinks more than that, the amount of alcohol in the body will exceed the available supply of ADH. The surplus, unmetabolized alcohol will pile up in the bloodstream, interfering with the liver’s metabolic functions. Since alcohol decreases the reabsorption of water from the kidneys and may inhibit the secretion of an antidiuretic hormone, the drinker will begin to urinate copiously, losing magnesium, calcium, and zinc but retaining uric acid, which is irritating. The level of lactic acid in the body will increase, making him or her feel tired and out of sorts; the acid-base balance will be out of kilter; the blood vessels in the head will swell and throb; and the stomach, its lining irritated by the alcohol, will ache. The ultimate result is a hangover whose symptoms will disappear only when enough time has passed to allow the body to marshal the ADH needed to metabolize the extra alcohol in the person’s blood.
Changes in body temperature. Alcohol dilates capillaries, tiny blood vessels just under the skin, producing a “flush” that temporarily warms the drinker. But drinking is not an effective way to stay warm in cold weather. Warm blood flowing up from the body core to the surface capillaries is quickly chilled, making you even colder when it circulates back into your organs. In addition, an alcohol flush triggers perspiration, further cooling your skin. Finally, very large amounts of alcohol may actually depress the mechanism that regulates body temperature.
Impotence. Excessive drinking decreases libido (sexual desire) and interferes with the ability to achieve or sustain an erection.
Migraine headache. Some alcoholic beverages contain chemicals that inhibit PST, an enzyme that breaks down certain alcohols in spirits so that they can be eliminated from the body. If they are not broken down by PST, these alcohols will build up in the bloodstream and may trigger a migraine headache. Gin and vodka appear to be the distilled spirits least likely to trigger headaches, brandy the most likely.
Food/Drug Interactions
Acetaminophen (Tylenol, etc.). FDA recommends that people who regularly have three or more drinks a day consult a doctor before using acetaminophen. The alcohol/acetaminophen combination may cause liver failure.
Anti-alcohol abuse drugs (disulfiram [Antabuse]). Taken concurrently with alcohol, the anti- alcoholism drug disulfiram can cause flushing, nausea, a drop in blood pressure, breathing difficulty, and confusion. The severity of the symptoms, which may var y among individu- als, generally depends on the amount of alcohol consumed and the amount of disulfiram in the body.
Anticoagulants. Alcohol slows the body’s metabolism of anticoagulants (blood thinners), intensif ying the effect of the drugs and increasing the risk of side effects such as spontane- ous nosebleeds.
Antidepressants. Alcohol may strengthen the sedative effects of antidepressants.
Aspirin, ibuprofen, ketoprofen, naproxen and nonsteroidal anti-inflammatory drugs. Like alco- hol, these analgesics irritate the lining of the stomach and may cause gastric bleeding. Com- bining the two intensifies the effect.
Insulin and oral hypoglycemics. Alcohol lowers blood sugar and interferes with the metabo- lism of oral antidiabetics; the combination may cause severe hypoglycemia.
Sedatives and other central nervous system depressants (tranquilizers, sleeping pills, antide- pressants, sinus and cold remedies, analgesics, and medication for motion sickness). Alcohol intensifies the sedative effects of these medications and, depending on the dose, may cause drowsiness, sedation, respiratory depression, coma, or death.
MAO inhibitors. Monoamine oxidase (M AO) inhibitors are drugs used as antidepressants or antihypertensives. They inhibit the action of natural enzymes that break down tyramine, a substance formed naturally when proteins are metabolized. Tyramine is a pressor amine, a chemical that constricts blood vessel and raises blood pressure. If you eat a food that contains tyramine while you are taking an M AO inhibitor, the pressor amine cannot be eliminated from your body and the result may be a hypertensive crisis (sustained elevated blood pressure). Brandy, a distilled spirit made from wine (which is fermented) contains tyramine. All other distilled spirits may be excluded from your diet when you are taking an M AO inhibitor because the spirits and the drug, which are both sedatives, may be hazard- ous in combination.... distilled spirits
Lavender (Lavandula angustifolia).Plant Part Used: Dried flower buds.Dominican Medicinal Uses: The dried flower buds are traditionally prepared as a tea and taken orally for anxiety/nervousness, stomach ache, indigestion, gas, menopausal hot flashes, common cold and flu.Safety: Lavender is generally regarded as safe when used in moderation. Potential adverse effects include drowsiness, gastrointestinal upset and skin irritation.Contraindications: Excessive internal use of this herb is contraindicated during early pregnancy due to its emmenagogue effect demonstrated in laboratory studies. Due to lack of sufficient data on safety, avoid use during lactation and in small children.Drug Interactions: Concomitant use of this herb with sedative or tranquilizing drugs, such as pentobarbital, may potentiate their effects based on evidence from animal studies. Additional herb-drug interactions may occur in medications with effects similar to those demonstrated by this plant clinical and preclinical studies (see below).Clinical Data: The following effects of this plant have been investigated in human clinical trials: antianxiety, antidepressant, anti-stress, anxiolytic, dysmenorrhea treatment, hypnotic, insomnia treatment, retrospective pain perception and sedative.Laboratory & Preclinical Data: This plant has shown the following biological activities in laboratory and preclinical studies: acaricidal, antibacterial, anticonvulsant, antifungal, anti-inflammatory, antimicrobial, antineoplastic, antitumor, sedative and hypolipidemic.* See entry for Alucema in “Part 3: Dominican Medicinal Plant Profiles” of this book for more information, including references.... alucema
A group of drugs which depress the CENTRAL NERVOUS SYSTEM by inhibiting the transmission of impulses between certain neurons. Thus they cause drowsiness or unconsciousness (depending on dose), reduce the cerebral metabolic rate for oxygen, and depress respiration. Their use as sedatives and hypnotics has largely been superseded by more modern drugs which are safer and more e?ective. Some members of this group of drugs – for instance, phenobarbitone – have selective anticonvulsant properties and are used in the treatment of GRAND MAL convulsions and status epilepticus (see EPILEPSY). The short-acting drugs thiopentone and methohexitone are widely used to induce general ANAESTHESIA. (See also DEPENDENCE.)... barbiturates
This refers to an e?ect of a drug which is not that which doctor and patient require. Some side-effects are almost inevitable: for example, drowsiness with older ANTIHISTAMINE DRUGS; others are very rare, such as REYE’S SYNDROME with ASPIRIN. Some can be predicted to occur if the dose is raised, while others may occur at the lowest of doses due to the individual patient’s susceptibility. In deciding whether to prescribe or take a drug, a balance must always be struck between its bene?ts and risks. (See also MEDICINES – Safe use of medicines.)... side-effects
These consist either of expanding masses (lumps or tumours), or of areas of shrinkage (atrophy) due to degeneration, or to loss of blood supply, usually from blockage of an artery.
Tumours All masses cause varying combinations of headache and vomiting – symptoms of raised pressure within the inexpansible bony box formed by the skull; general or localised epileptic ?ts; weakness of limbs or disordered speech; and varied mental changes. Tumours may be primary, arising in the brain, or secondary deposits from tumours arising in the lung, breast or other organs. Some brain tumours are benign and curable by surgery: examples include meningiomas and pituitary tumours. The symptoms depend on the size and situation of the mass. Abscesses or blood clots (see HAEMATOMA) on the surface or within the brain may resemble tumours; some are removable. Gliomas ( see GLIOMA) are primary malignant tumours arising in the glial tissue (see GLIA) which despite surgery, chemotherapy and radiotherapy usually have a bad prognosis, though some astrocytomas and oligodendronogliomas are of low-grade malignancy. A promising line of research in the US (in the animal-testing stage in 2000) suggests that the ability of stem cells from normal brain tissue to ‘home in’ on gliomal cells can be turned to advantage. The stem cells were chemically manipulated to carry a poisonous compound (5-?uorouracil) to the gliomal cells and kill them, without damaging normal cells. Around 80 per cent of the cancerous cells in the experiments were destroyed in this way.
Clinical examination and brain scanning (CT, or COMPUTED TOMOGRAPHY; magnetic resonance imaging (MRI) and functional MRI) are safe, accurate methods of demonstrating the tumour, its size, position and treatability.
Strokes When a blood vessel, usually an artery, is blocked by a clot, thrombus or embolism, the local area of the brain fed by that artery is damaged (see STROKE). The resulting infarct (softening) causes a stroke. The cells die and a patch of brain tissue shrinks. The obstruction in the blood vessel may be in a small artery in the brain, or in a larger artery in the neck. Aspirin and other anti-clotting drugs reduce recurrent attacks, and a small number of people bene?t if a narrowed neck artery is cleaned out by an operation – endarterectomy. Similar symptoms develop abruptly if a blood vessel bursts, causing a cerebral haemorrhage. The symptoms of a stroke are sudden weakness or paralysis of the arm and leg of the opposite side to the damaged area of brain (HEMIPARESIS), and sometimes loss of half of the ?eld of vision to one side (HEMIANOPIA). The speech area is in the left side of the brain controlling language in right-handed people. In 60 per cent of lefthanders the speech area is on the left side, and in 40 per cent on the right side. If the speech area is damaged, diffculties both in understanding words, and in saying them, develops (see DYSPHASIA).
Degenerations (atrophy) For reasons often unknown, various groups of nerve cells degenerate prematurely. The illness resulting is determined by which groups of nerve cells are affected. If those in the deep basal ganglia are affected, a movement disorder occurs, such as Parkinson’s disease, hereditary Huntington’s chorea, or, in children with birth defects of the brain, athetosis and dystonias. Modern drugs, such as DOPAMINE drugs in PARKINSONISM, and other treatments can improve the symptoms and reduce the disabilities of some of these diseases.
Drugs and injury Alcohol in excess, the abuse of many sedative drugs and arti?cial brain stimulants – such as cocaine, LSD and heroin (see DEPENDENCE) – can damage the brain; the effects can be reversible in early cases. Severe head injury can cause localised or di?use brain damage (see HEAD INJURY).
Cerebral palsy Damage to the brain in children can occur in the uterus during pregnancy, or can result from rare hereditary and genetic diseases, or can occur during labour and delivery. Severe neurological illness in the early months of life can also cause this condition in which sti? spastic limbs, movement disorders and speech defects are common. Some of these children are learning-disabled.
Dementias In older people a di?use loss of cells, mainly at the front of the brain, causes ALZHEIMER’S DISEASE – the main feature being loss of memory, attention and reasoned judgement (dementia). This affects about 5 per cent of the over-80s, but is not simply due to ageing processes. Most patients require routine tests and brain scanning to indicate other, treatable causes of dementia.
Response to current treatments is poor, but promising lines of treatment are under development. Like Parkinsonism, Alzheimer’s disease progresses slowly over many years. It is uncommon for these diseases to run in families. Multiple strokes can cause dementia, as can some organic disorders such as cirrhosis of the liver.
Infections in the brain are uncommon. Viruses such as measles, mumps, herpes, human immunode?ciency virus and enteroviruses may cause ENCEPHALITIS – a di?use in?ammation (see also AIDS/HIV).
Bacteria or viruses may infect the membrane covering the brain, causing MENINGITIS. Viral meningitis is normally a mild, self-limiting infection lasting only a few days; however, bacterial meningitis – caused by meningococcal groups B and C, pneumococcus, and (now rarely) haemophilus – is a life-threatening condition. Antibiotics have allowed a cure or good control of symptoms in most cases of meningitis, but early diagnosis is essential. Severe headaches, fever, vomiting and increasing sleepiness are the principal symptoms which demand urgent advice from the doctor, and usually admission to hospital. Group B meningococcus is the commonest of the bacterial infections, but Group C causes more deaths. A vaccine against the latter has been developed and has reduced the incidence of cases by 75 per cent.
If infection spreads from an unusually serious sinusitis or from a chronically infected middle ear, or from a penetrating injury of the skull, an abscess may slowly develop. Brain abscesses cause insidious drowsiness, headaches, and at a late stage, weakness of the limbs or loss of speech; a high temperature is seldom present. Early diagnosis, con?rmed by brain scanning, is followed by antibiotics and surgery in hospital, but the outcome is good in only half of affected patients.
Cerebral oedema Swelling of the brain can occur after injury, due to engorgement of blood vessels or an increase in the volume of the extravascular brain tissue due to abnormal uptake of water by the damaged grey (neurons) matter and white (nerve ?bres) matter. This latter phenomenon is called cerebral oedema and can seriously affect the functioning of the brain. It is a particularly dangerous complication following injury because sometimes an unconscious person whose brain is damaged may seem to be recovering after a few hours, only to have a major relapse. This may be the result of a slow haemorrhage from damaged blood vessels raising intracranial pressure, or because of oedema of the brain tissue in the area surrounding the injury. Such a development is potentially lethal and requires urgent specialist treatment to alleviate the rising intracranial pressure: osmotic agents (see OSMOSIS) such as mannitol or frusemide are given intravenously to remove the excess water from the brain and to lower intracranial pressure, buying time for de?nitive investigation of the cranial damage.... brain, diseases of
This is a colourless, odourless, tasteless, nonirritating gas formed on incomplete combustion of organic fuels. Exposure to CO is frequently due to defective gas, oil or solid-fuel heating appliances. CO is a component of car exhaust fumes and deliberate exposure to these is a common method of suicide. Victims of ?res often suffer from CO poisoning. CO combines reversibly with oxygen-carrying sites of HAEMOGLOBIN (Hb) molecules with an a?nity 200 to 300 times greater than oxygen itself. The carboxyhaemoglobin (COHb) formed becomes unavailable for oxygen transportation. In addition the partial saturation of the Hb molecule results in tighter oxygen binding, impairing delivery to the tissues. CO also binds to MYOGLOBIN and respiratory cytochrome enzymes. Exposure to CO at levels of 500 parts per million (ppm) would be expected to cause mild symptoms only and exposure to levels of 4,000 ppm would be rapidly fatal.
Each year around 50 people in the United Kingdom are reported as dying from carbon monoxide poisoning, and experts have suggested that as many as 25,000 people a year are exposed to its effects within the home, but most cases are unrecognised, unreported and untreated, even though victims may suffer from long-term effects. This is regrettable, given that Napoleon’s surgeon, Larrey, recognised in the 18th century that soldiers were being poisoned by carbon monoxide when billeted in huts heated by woodburning stoves. In the USA it is estimated that 40,000 people a year attend emergency departments suffering from carbon monoxide poisoning. So prevention is clearly an important element in dealing with what is sometimes termed the ‘silent killer’. Safer designs of houses and heating systems, as well as wider public education on the dangers of carbon monoxide and its sources, are important.
Clinical effects of acute exposure resemble those of atmospheric HYPOXIA. Tissues and organs with high oxygen consumption are affected to a great extent. Common effects include headaches, weakness, fatigue, ?ushing, nausea, vomiting, irritability, dizziness, drowsiness, disorientation, incoordination, visual disturbances, TACHYCARDIA and HYPERVENTILATION. In severe cases drowsiness may progress rapidly to COMA. There may also be metabolic ACIDOSIS, HYPOKALAEMIA, CONVULSIONS, HYPOTENSION, respiratory depression, ECG changes and cardiovascular collapse. Cerebral OEDEMA is common and will lead to severe brain damage and focal neurological signs. Signi?cant abnormalities on physical examination include impaired short-term memory, abnormal Rhomberg’s test (standing unsupported with eyes closed) and unsteadiness of gait including heel-toe walking. Any one of these signs would classify the episode as severe. Victims’ skin may be coloured pink, though this is very rarely seen even in severe incidents. The venous blood may look ‘arterial’. Patients recovering from acute CO poisoning may suffer neurological sequelae including TREMOR, personality changes, memory impairment, visual loss, inability to concentrate and PARKINSONISM. Chronic low-level exposures may result in nausea, fatigue, headache, confusion, VOMITING, DIARRHOEA, abdominal pain and general malaise. They are often misdiagnosed as in?uenza or food poisoning.
First-aid treatment is to remove the victim from the source of exposure, ensure an e?ective airway and give 100-per-cent oxygen by tight-?tting mask. In hospital, management is largely suppportive, with oxygen administration. A blood sample for COHb level determination should be taken as soon as practicable and, if possible, before oxygen is given. Ideally, oxygen therapy should continue until the COHb level falls below 5 per cent. Patients with any history of unconsciousness, a COHb level greater than 20 per cent on arrival, any neurological signs, any cardiac arrhythmias or anyone who is pregnant should be referred for an expert opinion about possible treatment with hyperbaric oxygen, though this remains a controversial therapy. Hyperbaric oxygen therapy shortens the half-life of COHb, increases plasma oxygen transport and reverses the clinical effects resulting from acute exposures. Carbon monoxide is also an environmental poison and a component of cigarette smoke. Normal body COHb levels due to ENDOGENOUS CO production are 0.4 to
0.7 per cent. Non-smokers in urban areas may have level of 1–2 per cent as a result of environmental exposure. Smokers may have a COHb level of 5 to 6 per cent.... carbon monoxide (co)
Drugs whose main actions are to increase the force of myocardial contraction and reduce the conductivity of the nerve ?bres in the atrioventricular node of the heart. They are useful in treating supraventricular tachycardias (rapid heart rhythm) and some forms of heart failure. Glycosides are a traditional group of cardiac drugs, originally derived from the leaves of foxglove plants and used as digitalis. The active principle has long been synthesised and used as DIGOXIN. They are potentaially toxic and their use, especially during initial treatment, should be monitored. Side-effects include ANOREXIA, nausea, vomiting, diarrhoea and abdominal pain; drowsiness, confusion and DEPRESSION may occur. An abnormally slow heart rate may develop. The glycosides should be used with special care in the elderly who are sometimes particularly susceptible to their toxic effects.... cardiac glycosides
Relating to the space between the strong outer layer of the MENINGES, the membranes which cover the BRAIN, and the arachnoid, which is the middle layer of the meninges. A subdural haemorrhage occurs when bleeding takes place into this space. The trapped blood forms a large blood clot or haematoma within the skull and this causes pressure on the underlying brain. Bleeding may occur slowly as the result of disease or suddenly as the result of injury. Headaches, confusion and drowsiness result, sometimes with paralysis. Medical attention is required urgently if a serious haematoma occurs soon after injury.... subdural
The drug of choice for adults infected with the intestinal parasite Strongyloides stercoralis (see STRONGYLOIDIASIS). Its side-effects, including ANOREXIA, nausea, vomiting, diarrhoea, abdominal pain, itching and drowsiness, are more troublesome in elderly patients.... thiabendazole
Laryngo-tracheo-bronchitis. Acute bacterial or viral inflammation of the respiratory tract. Spread by airborne infection.
Symptoms: difficult breathing. Breathing-in is noisy, spasmodic and prolonged. Effusion of a plastic-like material which coagulates to form a false membrane. Fretfulness. Symptoms of a ‘cold’ disappear but towards evening skin becomes hot, pulse rises, and a sense of anxiety takes over.
Laryngeal muscles are held in spasm, calling for antispasmodics. If the course of the disease has not been arrested on the third or fourth day a crisis is at hand and modern hospital treatment necessary. The condition is always worse at night. Treatment varies with each individual case. Stimulating diaphoretics induce gentle sweating, de-toxicate, and relieve tension on respiration.
Lobelia is unsurpassed as a croupal remedy and may be given alone either by infusion (tea) liquid extract or acid tincture. Given as a powder it works too slowly in a condition where speed saves lives.
While copious drinks of Catnep (Catmint) tea help, stronger medicines are indicated. Where resistance runs low, add Echinacea. Should any of these induce vomiting, it would be regarded as a favourable sign after which a measure of relief is felt.
Alternatives. Liquid extracts. Formula. Pleurisy root 2; Lobelia 1; Ginger half. Dose: one 5ml teaspoon in hot water every 2 hours. Infants: 10-30 drops.
Tinctures. Formula: Pleurisy root 2; Blue Cohosh 1; Lobelia 1. One to two 5ml teaspoons in hot water every 2 hours. Infants 10-20 drops.
Practitioner. Formula: 2 drops Tincture Belladonna BP 1980, 4 drops Tincture Ipecuanha BP 1973. Water to 2oz. One 5ml teaspoon in water every 15 minutes for 2 or 3 doses to enable child to sleep until morning; then once every hour or two for 3 days. Not to press medicines on children feeling comfortable. Inhalant. Friar’s Balsam. Steam kettle on hand. Or:–
Aromatherapy. Inhale. Drops. Thyme 1; Eucalyptus 2; Hyssop 1. In bowl of boiling water at the bedside at night or when necessary.
Drowsiness requires diffusive stimulants: Tinctures: Echinacea 2; Ginger quarter; Pleurisy root 1. One to two 5ml teaspoons in hot water every 2 hours; infants 5-20 drops according to age.
Collapse. When confronted with an ashen face, depression and collapse, powerful stimulants are necessary: tinctures – Formula. Prickly Ash bark 3; Blue Cohosh 2; Ginger 1. One 5ml teaspoon in hot water every 10 minutes; (infants 5-20 drops).
Topical. Relaxing oil. Ingredients: 3oz olive oil; half an ounce Liquid Extract or tincture Lobelia; Tincture Capsicum (Cayenne) 20 drops. Shake vigorously. Rub freely on throat, winding round a strip of suitable material wrung out in hot water. Cover with protective bandage or plastic film. Renew hot flannel every 10-15 minutes until paroxysms subside.
Poultice. Dissolve coffeespoon Cayenne powder or chillies in cup cider vinegar. Simmer gently 10 minutes. Strain. Saturate a piece of suitable material and wind round throat to relieve congested blood vessels.
Diet: No dairy foods which increase phlegm. No solid meals. Herb teas, vegetable and fruit juices only.
Steam kettle on hand, or Friar’s Balsam inhalation. See: FRIAR’S BALSAM. Regulate bowels. The condition is worsened in a dry hot atmosphere; reduce central heating to ensure adequate ventilation. Many a serious stridor and cough have been relieved by running some hot water into a bath or basin and sitting the child in a homemade Turkish bath.
Treatment by or in liaison with a general medical practitioner. ... croup
St Anthony’s Fire. An acute contagious disease caused by Group A Beta Haemolytic Streptococcus erysipelatis, or pyogenes. Onset with chilliness followed by rigor, thirst, feverishness, drowsiness. Burning, irritating skin lesions which ulcerate with great pain. Symptoms include nervous prostration, delirium from pain, fast and full pulse, swollen eyes and turgid face.
Treatment. Bedrest. Alteratives, analgesics, sedatives. Spreads via the lymphatic system (Poke root, Clivers). Sustain heart (Hawthorn or Lily of the Valley); kidneys (Buchu or Juniper); as appropriate. Yarrow – to reduce temperature. Echinacea to strengthen immune system.
Tea: Formula: Yarrow 1; Raspberry leaves 1; Red Clover 1; Clivers 1; Liquorice root half. 2 teaspoons to each cup boiling water; infuse 5-15 minutes. Half-1 cup every 2 hours, or as tolerated. If ingredients not available: substitute Elderflowers, Boneset, or Balm.
Alternatives. Tablets/capsules. Echinacea, Lobelia.
Powders. Formula: Sarsaparilla 2; Poke root 1; Liquorice 1. Dose: 500mg (two 00 capsules or one-third teaspoon) every 2 hours or as tolerated.
Tinctures. Alternatives: (1) Echinacea 2; Fringe Tree 1. (2) Sarsaparilla 2; Queen’s Delight 1. (3) Clivers 2; Echinacea 2. 1-2 teaspoons in water every 2 hours, or as long as tolerated.
Topical. Ointments or creams: Marigold, Comfrey, Evening Primrose, Echinacea, Logwood, Aloe Vera gel.
Traditional: Equal parts Houseleek and dairy cream.
Early Florida settlers: Powdered Slippery Elm as a dusting powder or with a little milk to form a paste. Maria Treben. Application of crushed leaves of cabbage, Coltsfoot, Houseleek and Speedwell all have their successes in reducing pain and facilitating healing.
Cleansing wash: warm infusion of Yarrow or Marshmallow.
Diet. Lacto-vegetarian. Abundant Vitamin C in lemon and other fruit juices.
Supplements. Vitamin A, B-complex, C, D.
To be treated by or in liaison with a general medical practitioner. ... erysipelas
A group of drugs used to treat hypertension (high blood pressure) and urinary symptoms due to enlargement of the prostate gland. Alpha-blockers are also used to treat urinary retention caused by an enlarged prostate gland (see prostate, enlarged). Side effects of the drugs may include dizziness and fatigue due to a sudden drop in blood pressure, nausea, dry mouth, and drowsiness.... alpha-blocker drugs
A tricyclic antidepressant drug with a sedative effect. It is useful in the treatment of depression accompanied by anxiety or insomnia. Possible adverse effects include blurred vision, dizziness, and drowsiness.... amitriptyline
An antidepressant drug related to the tricyclics. Possible adverse effects include blurred vision, dizziness, drowsiness, abnormal muscular movements, menstrual irregularities, and breast enlargement.... amoxapine
Bone marrow tumour. Neoplastic, with presence of high globulin levels in the blood. Bone marrow becomes impregnated with plasma cells. Lesions appear in pelvis and dorsal spine, skull and rib cage.
Symptoms: weight loss, back pain, anaemia, impaired kidney function. Usual symptoms of anaemia: weakness, fatigue, pallor, drowsiness, indigestion.
Differential diagnosis. Important. Early X-ray confirms. Patient may be treated for back pain long before true condition is revealed.
Special investigations: for anaemia, plasma cells in the bone marrow. Check ESR (erythrocyte sedimentation rate), kidney function and for excess calcium in the blood.
Treatment. Chemotherapy; radiotherapy. Anti-tumour agents with a tendency to reduce side-effects: Echinacea, Poke root. Comfrey: potential benefit outweighs possible risk. Thuja.
Tea. Combine, equal parts, Red Clover, Gotu Kola, Clivers, Plantain. 1 heaped teaspoon to each cup boiling water; infuse 15 minutes. 1 cup 3 or more times daily.
Decoction. Combine: Echinacea 2; Comfrey root 1; Poke root half. 1 heaped teaspoon to each cup water simmered gently 20 minutes. Half-1 cup 3 or more times daily.
Tablets/capsules: Echinacea, Comfrey, Poke root. Liquid Extracts: Echinacea 2; Comfrey 1; Poke root half; few drops Tincture Capsicum. Dose: 1 teaspoon, thrice daily.
Tinctures: Echinacea 2; Yellow Dock 1; Horsetail 1; Tincture Capsicum quarter. Dose: 2 teaspoons, thrice daily.
Powders: Echinacea 2; Comfrey 1; Yellow Dock 1; pinch Cayenne. Dose: 500mg (two 00 capsules or one-third teaspoon), thrice daily.
Dr William Boericke. Poke root often assuages pain in bone cancers and tumours. Supplements. Vitamins B12, C, D, E, Selenium.
At the discretion of the physician, any of the above alternatives may be used secondary to hospital treatment.
Treatment by a general medical practitioner or hospital specialist. ... myeloma
An antihistamine drug used to control nausea and vomiting due to travel sickness or to reduce nausea and vertigo in inner-ear disorders, such as labyrinthitis and Ménière’s disease. High doses are sometimes used to improve circulation in peripheral vascular disease and Raynaud’s disease. Side effects may include drowsiness, lethargy, dry mouth, and blurred vision.... cinnarizine
Diarrhoea or looseness of the bowels is increased frequency, ?uidity or volume of bowel movements compared to usual. Most people have occasional attacks of acute diarrhoea, usually caused by contaminated food or water or excessive alcohol consumption. Such attacks normally clear up within a day or two, whether or not they are treated. Chronic diarrhoea, on the other hand, may be the result of a serious intestinal disorder or of more general disease.
The commonest cause of acute diarrhoea is food poisoning, the organisms involved usually being STAPHYLOCOCCUS, CLOSTRIDIUM bacteria, salmonella, E. coli O157 (see ESCHERICHIA), CAMPYLOBACTER, cryptosporidium, and Norwalk virus. A person may also acquire infective diarrhoea as a result of droplet infections from adenoviruses or echoviruses. Interference with the bacterial ?ora of the intestine may cause acute diarrhoea: this often happens to someone who travels to another country and acquires unfamiliar intestinal bacteria. Other infections include bacillary dysentery, typhoid fever and paratyphoid fevers (see ENTERIC FEVER). Drug toxicity, food allergy, food intolerance and anxiety may also cause acute diarrhoea, and habitual constipation may result in attacks of diarrhoea.
Treatment of diarrhoea in adults depends on the cause. The water and salts (see ELECTROLYTES) lost during a severe attack must be replaced to prevent dehydration. Ready-prepared mixtures of salts can be bought from a pharmacist. Antidiarrhoeal drugs such as codeine phosphate or loperamide should be used in infectious diarrhoea only if the symptoms are disabling. Antibacterial drugs may be used under medical direction. Persistent diarrhoea – longer than a week – or blood-stained diarrhoea must be investigated under medical supervision.
Diarrhoea in infants can be such a serious condition that it requires separate consideration. One of its features is that it is usually accompanied by vomiting; the result can be rapid dehydration as infants have relatively high ?uid requirements. Mostly it is causd by acute gastroenteritis caused by various viruses, most commonly ROTAVIRUSES, but also by many bacteria. In the developed world most children recover rapidly, but diarrhoea is the single greatest cause of infant mortality worldwide. The younger the infant, the higher the mortality rate.
Diarrhoea is much more rare in breast-fed babies, and when it does occur it is usually less severe. The environment of the infant is also important: the condition is highly infectious and, if a case occurs in a maternity home or a children’s hospital, it tends to spread quickly. This is why doctors prefer to treat such children at home but if hospital admission is essential, isolation and infection-control procedures are necessary.
Treatment An infant with diarrhoea should not be fed milk (unless breast-fed, when this should continue) but should be given an electrolyte mixture, available from pharmacists or on prescription, to replace lost water and salts. If the diarrhoea improves within 24 hours, milk can gradually be reintroduced. If diarrhoea continues beyond 36–48 hours, a doctor should be consulted. Any signs of dehydration require urgent medical attention; such signs include drowsiness, lack of response, loose skin, persistent crying, glazed eyes and a dry mouth and tongue.... diarrhoea
A recently introduced skeletal-muscle relaxant used in patients whose muscle spasticity is associated with MULTIPLE SCLEROSIS (MS) or injury to the SPINAL CORD. Its side-effects include drowsiness, tiredness, dizziness, dry mouth, nausea and lowered blood pressure.... tizanidine
Remedies that inhibit release of acetylcholine as a neuro-transmitter. Given for anti-depressant therapy. May have side-effects of dry mouth, drowsiness, blurred vision. Administered by a qualified practitioner. Two chief remedies: Belladonna (atropa) and Henbane (hyoscyamus). They reduce acid secretion but are sometimes given with Comfrey and other tissue builders to promote healing. Anti-cholinergics decrease secretion of gastric juices by their control of the vagus nerve. ... anti-cholingergics
(See also FIT; SEIZURE.) Epilepsy is the name given to any condition in which a person suffers repeated ?ts or seizures. It is present in one in 200 (0·5 per cent) of the population and up to 5 per cent of all children will have had a ?t by the age of 12, although most of these are harmless accompaniments of an acute feverish illness.
It is a recurrent and paroxysmal disorder starting suddenly and ceasing spontaneously due to occasional sudden excessive rapid and local discharge of the nerve cells in the grey matter (cortex) of the BRAIN. Epilepsy always arises in this way from the brain, but its origin is often of microscopic size. It is diagnosed by the clinical symptoms based on the observations of witnesses. Its cause can sometimes be established by laboratory tests, and brain scanning. Fits can be the ?rst sign of a tumour, or follow a stroke, brain injury or infection, but in the large majority no underlying cause is found – so-called idiopathic epilepsy.
A single epileptic ?t is not epilepsy. Of those people who have a single seizure, a signi?cant minority (20 per cent) have no further attacks.
Major (generalised) seizures have a sudden, often unprovoked onset; the patient emits a cry, then falls to the ground, rigid, blue, and then twitching or jerking both sides of the body: the tonic-clonic convulsion. Drowsiness and confusion may last for some hours after recovering consciousness. Some experience a momentary warning (AURA): a smell, or sensation in the head or abdomen, vision, or déjà vu.
Partial seizures: focal motor (Jacksonian) begin with twitching of the angle of the mouth, the thumb, or the big toe. If the seizure discharge then spreads, the twitching or jerking spreads gradually through the limbs. Consciousness is preserved unless the seizure spreads to produce a secondary generalised ?t. In some attacks the eyes and head may turn, the arm may rise, and the body may turn, while some patients feel tingling in the limbs.
Complex partial seizures (temporal lobe epilepsy) The patient usually appears blank, vacant and may be unable to talk, or may mumble or chatter – though later they often have no memory of this period. They may be able to carry out complex tasks, taking o? gloves or clothes, and may smack their lips or rub repeatedly on one limb (automatisms). A sense of strangeness supervenes: unreality, or a feeling of having experienced it all before (déja vu). There may be a sense of panic. Strange unpleasant smells and tastes are olfactory and gustatory hallucinations. The visual hallucinations evoke complex scenes. An initial rising sense of warmth or discomfort in the stomach, or ‘speeding-up’ of thoughts are common psychomotor symptoms. All these strange symptoms are brief, disappearing within a few seconds or up to 3–4 minutes.
Minor seizures (petit mal) Attacks start in childhood. They last a few seconds. The child ceases what he or she is doing, stares, looks a little pale, and may ?utter the eyelids. The head may drop forwards. Attacks are commonly provoked by overbreathing. The child and parents may be unaware of the attacks
– ‘just daydreaming’. Major ?ts develop in one-third of subjects. By contrast with other types of epilepsy, the ELECTROENCEPHALOGRAM (EEG) is diagnostic.
Precautions Children with epilepsy should take normal school exercises and games, and can swim under supervision. Adults must avoid working at heights, with exposed dangerous machinery, and driving vehicles on public roads. Current legislation allows driving after two years of complete freedom from attacks during waking hours; those who for more than three years have had a history of attacks only while asleep may also drive.
Treatment identi?es, and avoids where possible, any factors (such as shortage of sleep or excessive ?uids) which aggravate or trigger attacks. If ?ts are very infrequent, treatment may not be recommended. However, frequent ?ts may be embarassing, may cause injury or may cause long-term brain damage so treatment is advisable. Anti-epileptic drugs are usually necessary for several years under medical supervision. Carbamazepine and sodium valproate are the most frequently prescribed. The dose is governed by the degree of control of ?ts and sometimes drug levels can be monitored by blood tests to check on dosage. Strict adherence to the drug schedule gives a reasonable chance of total suppression of ?ts, especially in younger patients whose ?ts have started recently. The table summarises anticonvulsant drugs in use. Interactions can occur between anti-epileptics and, if drug treatment is changed, the patient needs careful monitoring. In particular, abrupt withdrawal of a drug should be avoided as this may precipitate severe rebound seizures.
Indications First-choice drugs: Ethosuximide PM, JME Phenobarbitone M, P Phenytoin M, P, CP Carbamazepine M, P, CP Valproate M, PM, JME Second-line drugs: Primidone M, P, CP Clobazam M, CP Vigabatrin M, P, CP Lamotrigine M, P, CP Gabapentin M, P, CP Topirimate P
M = major generalised tonic-clonic; P = partial or focal; CP = complex partial (temporal lobe); PM = petit mal; JME = juvenile myoclonic epilepsy.
Anticonvulsant drugs
As all anticonvulsant drugs have an e?ect on the brain, it is not surprising that there may be side-effects, especially inolving alertness or behaviour. In each case careful assessment is necessary for doctor and patient to agree on the best compromise between stopping ?ts and avoiding ill-effects of medication.
Patients who have an epileptic seizure should not be restrained or have a gag or anything else placed in their mouths; nor should they be moved unless in danger of further injury. Any tight clothing around the neck should be loosened and, when the seizure has passed, the person should be placed in the recovery position to facilitate a return to consciousness (see APPENDIX 1: BASIC FIRST AID).
Patients with epilepsy and their relatives can obtain further advice and information from the British Epilepsy Association or Epilepsy Action Scotland.... epilepsy
A very common condition which may vary considerably in severity, type, signi?cance and cause. At one extreme, headache may indicate the presence of a tumour or MENINGITIS, while at the other it may merely indicate a common cold or tiredness. Even so, persistent or recurrent headaches should always be taken seriously. Although the brain itself is insensitive to pain, the surrounding membranes – meninges – are very sensitive, and changes in intracranial arteries, or spasm of the neck or scalp muscles, which may occur for various reasons, may cause considerable pain. In most cases a clinical diagnosis should be possible; further investigations should only be necessary following head injury, if headaches recur, or if neurological signs such as drowsiness, vomiting, confusion, seizures or focal signs develop.
Stress and anxiety are probably the most common causes of headache and, where possible, the reasons – overwork, family problems, unemployment, ?nancial diffculties, etc. – should be tackled. An unpleasant environment such as tra?c pollution or badly ventilated or overcrowded working conditions may provoke headaches in some people, as may excessive smoking or ca?eine intake. MIGRAINE is a characteristic and often disabling type of headache; high blood pressure may cause the condition (see HYPERTENSION); and, occasionally, refractive errors of the eyes (see EYE, DISORDERS OF) are associated with headaches. SINUS infections are often characterised by frontal headaches. Rheumatism in the muscles of the neck and scalp produce headaches; fever is commonly accompanied by a headache; and sunstroke and HEAT STROKE customarily result in headaches. Finally, diseases in the brain such as meningitis, tumours and HAEMORRHAGE may ?rst manifest themselves as persistent or recurrent headaches.
Treatment Obtaining a reliable diagnosis – with the help of further investigations, including CT (see COMPUTED TOMOGRAPHY) or MRI scanning when indicated – should always be the initial aim; treatment in most cases should then be aimed at the underlying condition. Particular concerns include headache that worsens at night or in the early morning; ever-increasing headaches; those associated with abnormal neurological signs on examination; or those associated with ?ts (see FIT).
Whether the cause is physical or stress-induced, used sensibly and for a limited period a low dose of aspirin or paracetamol may be helpful. In many cases of stress-induced headache, however, the most e?ective treatment is relaxation. There are many speci?c treatments for migraine and hypertension. Sinusitis is treated with antibiotics and sometimes by surgery.... headache
These are drugs that induce SLEEP. Before a hypnotic is prescribed, it is vital to establish – and, where possible, treat – the cause of the insomnia (see under SLEEP, DISORDERS OF). Hypnotics are most often needed to help an acutely distressed patient (for example, following bereavement), or in cases of jet lag, or in shift workers.
If required in states of chronic distress, whether induced by disease or environment, it is especially important to limit the drugs to a short time to prevent undue reliance on them, and to prevent the use of hypnotics and sedatives from becoming a means of avoiding the patient’s real problem. In many cases, such as chronic depression, overwork, and alcohol abuse, hypnotics are quite inappropriate; some form of counselling and relaxation therapy is preferable.
Hypnotics should always be chosen and prescribed with care, bearing in mind the patient’s full circumstances. They are generally best avoided in the elderly (confusion is a common problem), and in children – apart from special cases. Barbiturates should not now be used as they tend to be addictive. The most commonly used hypnotics are the BENZODIAZEPINES such as nitrazepam and temazepam; chloral derivatives, while safer for the few children who merit them, are generally second choice and should be used in the lowest possible dose for the minimum period.
Side-effects include daytime drowsiness – which may interfere with driving and other skilled tasks – and insomnia following withdrawal, especially after prolonged use, is a hazard. Occasionally benzodiazepines will trigger hostility and aggression. Zolpidem and zopiclone are two drugs similar to the benzodiazepines, indicated for short-term treatment of insomnia in the elderly. Adverse effects include confusion, incoordination and unsteadiness, and falls have been reported.
FLUNITRAZEPAM is a tranquilliser/hypnotic that has been misused as a recreational drug.... hypnotics
Brief unconsciousness due to disturbance of the electrical activity in the brain following a violent blow to the head or neck. Common symptoms following concussion include confusion, inability to remember events immediately before the injury, dizziness, blurred vision, and vomiting. If symptoms persist, or new ones develop, such as drowsiness, difficulty breathing, repeated vomiting, or visual disturbances, they could signify brain damage or an extradural haemorrhage. Repeated concussion can cause punchdrunk syndrome. (See also head injury.)... concussion
Over-the-counter medications for treating a cough. There are various preparations, but the effectiveness of most is unproven. Expectorant cough remedies are purported to encourage expulsion of sputum. Cough suppressants, which control the coughing reflex, include some antihistamine drugs and codeine. All cough suppressants may cause drowsiness.... cough remedies
Lead and lead compounds are used in a variety of products including petrol additives (in the UK, lead-free petrol is now mandatory), piping (lead water pipes were once a common source of poisoning), weights, professional paints, dyes, ceramics, ammunition, homeopathic remedies, and ethnic cosmetic preparations. Lead compounds are toxic by ingestion, by inhalation and, rarely, by skin exposures. Metallic lead, if ingested, is absorbed if it remains in the gut. The absorption is greater in children, who may ingest lead from the paint on old cots
– although lead-containing paints are no longer used for items that children may be in contact with.
Acute poisonings are rare. Clinical features include metallic taste, abdominal pain, vomiting, diarrhoea, ANOREXIA, fatigue, muscle weakness and SHOCK. Neurological effects may include headache, drowsiness, CONVULSIONS and COMA. Inhalation results in severe respiratory-tract irritation and systemic symptoms as above.
Chronic poisonings cause gastrointestinal disturbances and constipation. Other effects are ANAEMIA, weakness, pallor, anorexia, insomnia, renal HYPERTENSION and mental fatigue. There may be a bluish ‘lead line’ on the gums, although this is rarely seen. Neuromuscular dysfunction may result in motor weakness and paralysis of the extensor muscles of the wrist and ankles. ENCEPHALOPATHY and nephropathy are severe effects. Chronic low-level exposures in children are linked with reduced intelligence and behavioural and learning disorders.
Treatment Management of patients who have been poisoned is supportive, with removal from source, gastric decontamination if required, and X-RAYS to monitor the passage of metallic lead through the gut if ingested. It is essential to ensure adequate hydration and renal function. Concentrations of lead in the blood should be monitored; where these are found to be toxic, chelation therapy should be started. Several CHELATING AGENTS are now available, such as DMSA (Meso-2,3dimercaptosuccinic acid), sodium calcium edetate (see EDTA) and PENICILLAMINE. (See also POISONS.)... lead poisoning
If you’re a fan of herbal teas, you have to try motherwort tea. Although it has a pretty bitter taste, it helps you stay healthy thanks to its many health benefits. Find out more about motherwort tea and its main ingredient.
About Motherwort Tea
The main ingredient of the motherwort tea is the motherwort plant. The motherwort is an herbaceous perennial plant, belonging to the mint family, Lamiaceae. It has square stem and opposite leaves with serrated margins. During summer, small, pink to lilac flowers bloom in leaf axils on the upper part of the plant. It comes from Middle Asia, although now it grows in places all around the world.
The plant’s binomial name is Leonurus cardiac. The word “leonurus” is a combination of the Latin “leo”, which means lion, and the Greek “oura”, meaning tail. Because of this, it is also known as Throw-wort, Lion’s Ear, and Lion’s Tail. The name of the species, “cardiaca”, comes from the Greek word “kardiaca”, which means heart.
How to prepare Motherwort Tea
It’s easy to prepare a cup of motherwort tea. To each cup, add one teaspoon of the dried herb. Let it steep for about 10 minutes before removing the leaves.
If you’ve got a problem with the bitter taste, you can try to sweeten it. Add sugar, honey, and/or lemon to your cup of motherwort tea, and mix well. You can also improve its flavor by mixing it with other types of herbal beverages.
Motherwort Tea Benefits
A cup of this tea brings many health benefits thanks to its main ingredient. Among motherwort’s constituents, there are alkaloids, glycosides, essential oils, tannins, and vitamin A. Because of this, the plant has been used for centuries as a herb in traditional medicine in Europe, Asia and North America.
First of all, motherwort tea has two health benefits which are related to the plant’s name: one is for women after giving birth, while the other is related to heart problems.
It isn’t recommended to drink motherwort tea during pregnancy, but it is good to drink it after you give birth. You can even drink it during labor, as it will ease the pain and help you relax; it is also thought that it reduces the risk of getting post partum depression. Drinking it regularly after you’ve given birth can help stimulate the uterus to contract; this way, it prevents uterine infections.
This type of teais also good for your heart. It helps normalize the heart functions by lowering blood lipid levels and high blood pressure. As a cardiac tonic, it works as a hypotensive, sedative, and antispasmodic. It helps calm heart palpitations.
Motherwort tea is helpful if you need to regulate your menstruation, and it is also used also used to ease insomnia, menopausal problems, stomach gas and cramping. It is useful when it comes to treating thyroid hyperfunction, and can work as a mild tranquilizer for anxiety.
Motherwort tea Side Effects
Although it has many health benefits, don’t forget that motherwort tea has also a few side effects.
Despite its important role after child delivery, you should keep in mind that it’s not good to drink motherwort tea during pregnancy. As it is used to regulate menstruation, during pregnancy, it might cause bleeding and even miscarriages.
You should avoid drinking motherwort tea if you’re taking anti-coagulants or are experiencing a heavy menstrual flow. It will only cause more bleeding.
Also, if you drink this tea for a longer period of time, be careful when you’re out in the sun. You might become more prone to getting sunburn. In this case, make sure that you’re wearing sunscreen when going outside, especially if you’re at the seaside.
Motherwort tea might cause drowsiness, as well. Avoid drinking it if you know you need to stay focused on something. Also, if you take any medicine that causes drowsiness as a side effect, drinking this type of tea will only make it worse.
Lastly, don’t drink more than six cups of motherwort tea a day. This applies to other types of tea, as well. If you drink too much tea, you might get the following side effects: headaches, dizziness, insomnia, irregular heartbeats, vomiting, diarrhea and loss of appetite.
Despite its bitter taste, don’t give up on motherwort tea. It is very good for your health, and it helps you a lot especially after giving birth. Just sweeten it and you’re free to enjoy a cup of tea full of many health benefits!... motherwort tea benefits
A severe form of malnutrition in young children that occurs principally in poor rural areas in the tropics. Affected children have stunted growth and a puffy appearance due to oedema. The liver often enlarges, dehydration may develop, and the child loses resistance to infection, which may have fatal consequences. The more advanced stages are marked by jaundice, drowsiness, and a fall in body temperature. Initially, the child is frequently fed with small amounts of milk, and vitamin and mineral tablets. A nutritious diet is then gradually introduced. Most treated children recover, but those less than 2 years old may suffer from permanently stunted growth.... kwashiorkor
Rauvolfia serpentinaApocynaceaeSan: SarpagandhaHin: ChandrabhagaMal: Sarpagandhi, AmalporiTam: Chivan amelpodiKan: SutranbhiTel: PatalagandhiIntroduction: Serpentwood is an erect, evergreen , perennial undershrub whose medicinal use has been known since 3000 years. Its dried root is the economical part which contains a number of alkaloids of which reserpine, rescinnamine, deserpidine, ajamalacine, ajmaline, neoajmalin, serpentine, -yohimbine are pharmacologically important. The root is a sedative and is used to control high blood pressure and certain forms of insanity. In Ayurveda it is also used for the treatment of insomnia, epilepsy, asthma, acute stomach ache and painful delivery. It is used in snake-bite, insect stings, and mental disorders. It is popular as “Madman’s medicine” among tribals. ‘Serpumsil’ tablet for high blood pressure is prepared from Rauvolfia roots. Reserpine is a potent hypotensive and tranquillizer but its prolonged usage stimulates prolactine release and causes breast cancer. The juice of the leaves is used as a remedy for the removal of opacities of the cornea.Distribution: Rauvolfia serpentina is native to India. Several species of Rauvolfia are observed growing under varying edaphoclimatic conditions in the humid tropics of India, Nepal, Burma, Thailand, Bangladesh, Indonesia , Cambodia, Philippines and Sri Lanka. In India, it is cultivated in the states of Uttar Pradesh, Bihar, Tamil Nadu, Orissa, Kerala, Assam, West Bengal and Madhya Pradesh (Dutta and Virmani, 1964). Thailand is the chief exporter of Rauvolfia alkaloids followed by Zaire, Bangladesh, Sri Lanka, Indonesia and Nepal. In India, it has become an endangered species and hence the Government has prohibited the exploitation of wild growing plants in forest and its export since 1969.Botany: Plumier in 1703 assigned the name Rauvolfia to the genus in honour of a German physcian -Leonhart Rauvolf of Augsburg. The genus Rauvolfia of Apocynaceae family comprises over 170 species distributed in the tropical and subtropical parts of the world including 5 species native to India. The common species of the genus Rauvolfia and their habitat as reported by Trivedi (1995) are given below.R. serpentina Benth. ex Kurz.(Indian serpentwood) - India ,Bangladesh, Burma, Sri Lanka, Malaya, IndonesiaR. vomitoria Afz. (African serpentwood) - West Africa, Zaire, Rwanda, Tanzania R. canescens Linn. syn. R. tetraphylla (American serpentwood) - America, India R. mombasina - East Africa , Kenya, MozambiqueR. beddomei - Western ghats and hilly tracts of KeralaR. densiflora - Maymyo, IndiaR. microcarpa - ThandaungR. verticillata syn. R. chinensis - HemslR. peguana - Rangoon-Burma hillsR. caffra - Nigeria, Zaire, South AfricaR. riularis - Nmai valleyR. obscura - Nigeria, ZaireR. serpentina is an erect perennial shrub generally 15-45 cm high, but growing upto 90cm under cultivation. Roots nearly verticle, tapering up to 15 cm thick at the crown and long giving a serpent-like appearance, occasionally branched or tortuous developing small fibrous roots. Roots greenish-yellow externally and pale yellow inside, extremely bitter in taste. Leaves born in whorls of 3-4 elliptic-lanceolate or obovate, pointed. Flowers numerous borne on terminal or axillary cymose inflorscence. Corolla tubular, 5-lobed, 1-3 cm long, whitish-pink in colour. Stamens 5, epipetalous. Carpels 2, connate, style filiform with large bifid stigma. Fruit is a drupe, obliquely ovoid and purplish black in colour at maturity with stone containing 1-2 ovoid wrinkled seeds. The plant is cross-pollinated, mainly due to the protogynous flowers (Sulochana ,1959).Agrotechnology: Among the different species of Rauvolfia, R. serpentina is preferred for cultivation because of higher reserpine content in the root. Though it grows in tropical and subtropical areas which are free from frost, tropical humid climate is most ideal. Its common habitats receive an annual rain fall of 1500-3500 mm and the annual mean temperature is 10-38 C. It grows up to an elevation of 1300-1400m from msl. It can be grown in open as well as under partial shade conditions. It grows on a wide range of soils. Medium to deep well drained fertile soils and clay-loam to silt-loam soils rich in organic matter are suitable for its cultivation. It requires slightly acidic to neutral soils for good growth.The plant can be propagated vegetatively by root cuttings, stem cuttings or root stumps and by seeds. Seed propagation is the best method for raising commercial plantation. Seed germination is very poor and variable from 10-74%. Seeds collected during September to November give good results. It is desirable to use fresh seeds and to sock in 10% sodium chloride solution. Those seeds which sink to the bottom should only be used. Seeds are treated with ceresan or captan before planting in nursery to avoid damping off. Seed rate is 5-6 kg/ha. Nursery beds are prepared in shade, well rotten FYM is applied at 1kg/m2 and seeds are dibbled 6-7cm apart in May-June and irrigated.Two months old seedlings with 4-6 leaves are transplanted at 45-60 x 30 cm spacing in July -August in the main field. Alternatively, rooted cuttings of 2.5-5cm long roots or 12-20cm long woody stems can also be used for transplanting. Hormone (Seradix) treatment increases rooting. In the main field 10-15 t/ha of FYM is applied basally. Fertilisers are applied at 40:30:30kg N: P2O5 :K2O/ha every year. N is applied in 2-3 splits. Monthly irrigation increases the yield. The nursery and the main field should be kept weed free by frequent weeding and hoeing. In certain regions intercroping of soybean, brinjal, cabbage, okra or chilly is followed in Rauvolfia crop.Pests like root grubs (Anomala polita), moth (Deilephila nerii), caterpillar (Glyophodes vertumnalis), black bugs and weevils are observed on the crop, but the crop damage is not serious. The common diseases reported are leaf spot (Cercospora rauvolfiae, Corynespora cassiicola), leaf blotch (Cercospora serpentina), leaf blight (Alternaria tenuis), anthracnose (Colletotrichum gloeosporioides), die back (Colletotrichum dematrium), powdery mildew (Leviellula taurica), wilt (Fusarium oxysporum), root-knot (Meloidogyne sp.), mosaic and bunchy top virus diseases. Field sanitation, pruning and burning of diseased parts and repeated spraying of 0.2% Dithane Z-78 or Dithane M-45 are recommended for controlling various fungal diseases. Rauvolfia is harvested after 2-3 years of growth. The optimum time of harvest is in November -December when the plants shed leaves, become dormant and the roots contain maximum alkaloid content. Harvesting is done by digging up the roots by deeply penetrating implements (Guniyal et al, 1988).Postharvest technology: The roots are cleaned washed cut into 12-15cm pieces and dried to 8-10% moisture.The dried roots are stored in polythene lined gunny bags in cool dry place to protect it from mould. The yield is 1.5-2.5 t/ha of dry roots. The root bark constitutes 40-45% of the total weight of root and contributes 90% of the total alkaloids yield.Properties and activity: Rauvolfia root is bitter, acrid, laxative, anthelmintic, thermogenic, diuretic and sedative. Over 200 alkaloids have been isolated from the plant. Rauvolfia serpentina root contains 1.4-3% alkaloids. The alkaloids are classsified into 3 groups, viz, reserpine, ajmaline and serpentine groups. Reserpine group comprising reserpine, rescinnamine, deserpine etc act as hypotensive, sedative and tranquillising agent. Overdose may cause diarrhoea, bradycardia and drowsiness. Ajmaline, ajmalicine, ajmalinine, iso-ajmaline etc of the ajmaline group stimulate central nervous system, respiration and intestinal movement with slight hypotensive activity. Serpentine group comprising serpentine, sepentinine, alstonine etc is mostly antihypertensive. (Husain,1993; Trivedi, 1995; Iyengar, 1985).... serpentwood
The BRAIN is the organ of the mind. Normal conscious alertness depends upon its continuous adequate supply with oxygen and glucose, both of which are essential for the brain cells to function normally. If either or both of these are interrupted, altered consciousness results. Interruption may be caused by three broad types of process affecting the brain stem: the reticular formation (a network of nerve pathways and nuclei-connecting sensory and motor nerves to and from the cerebrum, cerebellum, SPINAL CORD and cranial nerves) and the cerebral cortex. The three types are di?use brain dysfunction – for example, generalised metabolic disorders such as URAEMIA or toxic disorders such as SEPTICAEMIA; direct effects on the brain stem as a result of infective, cancerous or traumatic lesions; and indirect effects on the brain stem such as a tumour or OEDEMA in the cerebrum creating pressure within the skull. Within these three divisions are a large number of speci?c causes of unconsciousness.
Unconsciousness may be temporary, prolonged or inde?nite (see PERSISTENT VEGETATIVE STATE (PVS)), depending upon the severity of the initiating incident. The patient’s recovery depends upon the cause and success of treatment, where given. MEMORY may be affected, as may motor and sensory functions; but short periods of unconsciousness as a result, say, of trauma have little obvious e?ect on brain function. Repeated bouts of unconsciousness (which can happen in boxing) may, however, have a cumulatively damaging e?ect, as can be seen on CT (COMPUTED TOMOGRAPHY) scans of the brain.
POISONS such as CARBON MONOXIDE (CO), drug overdose, a fall in the oxygen content of blood (HYPOXIA) in lung or heart disease, or liver or kidney failure harm the normal chemical working or metabolism of nerve cells. Severe blood loss will cause ANOXIA of the brain. Any of these can result in altered brain function in which impairment of consciousness is a vital sign.
Sudden altered consciousness will also result from fainting attacks (syncope) in which the blood pressure falls and the circulation of oxygen is thereby reduced. Similarly an epileptic ?t causes partial or complete loss of consciousness by causing an abrupt but temporary disruption of the electrical activity in the nerve cells in the brain (see EPILEPSY).
In these events, as the brain’s function progressively fails, drowsiness, stupor and ?nally COMA ensue. If the cause is removed (or when the patient spontaneously recovers from a ?t or faint), normal consciousness is usually quickly regained. Strokes (see STROKE) are sometimes accompanied by a loss of consciousness; this may be immediate or come on slowly, depending upon the cause or site of the strokes.
Comatose patients are graded according to agreed test scales – for example, the GLASGOW COMA SCALE – in which the patient’s response to a series of tests indicate numerically the level of coma.
Treatment of unconscious patients depends upon the cause, and range from ?rst-aid care for someone who has fainted to hospital intensive-care treatment for a victim of a severe head injury or massive stroke.... unconsciousness
A feeling of tiredness, drowsiness, or lack of energy.... lethargy
A drug used in the long-term treatment of mania and manic-depressive illness. High levels of lithium in the blood may cause vomiting, diarrhoea, blurred vision, tremor, drowsiness, rash, and, in rare cases, kidney damage.... lithium
A neurotic and metabolic condition, mostly in young women who suppress appetite by refusing food in an effort to be thin. Such starvation may result in death.
The patient may start as a food faddist with depressive tendencies. Some gorge huge meals (bulimia) and induce vomiting later. Such women are known to be oestrogen deficient; most have a low dietary intake of calcium, resulting in reduced bone density (osteoporosis). Lack of exercise has a worsening influence, often with severe loss of weight.
It is now established that one cause is a deficiency of zinc in the diet. Individuals suffering from the condition (with its depression) may recover when given 15mg zinc daily. Starvation causes increased urinary zinc secretion, thus further reducing body levels of the mineral. Most anorectics complain of loss of sense of taste and smell which is a symptom of zinc deficiency. Loss of these two senses reduces further the desire for food.
Symptoms. Excessive thinness. Anaemia. Poor haemoglobin levels. Absence of menses. Episodic hyperactivity. Slow pulse when resting. Teeth decay, brittle bones. Heart weakness. Low blood pressure, hormonal disorders, yellowing skin, blood disorders, abnormal drowsiness and weakness. Reduced bone density may develop during the illness, the subject being prone to bone fracture for years afterwards. Treatment. Correct anaemia with iron-bearing herbs, Vitamin B12, mineral supplements and nourishing food.
Angelica root, Barberry, Bogbean, Burdock root, Calamus, Centuary herb, Chamomile flowers, Condurango bark, Dandelion (coffee), Garden Sage, Gentian, Ginkgo, Helonias, Hops, Marshmallow root, Milk Thistle, Quassia chips, White Poplar.
Alternatives:– Tea. Formula. Equal parts, Centuary, Chamomile, Peppermint. 1 heaped teaspoon to each cup boiling water; infuse 5-15 minutes. Dose: 1 cup thrice daily, before meals.
Decoction. Formula. Combine Angelica root 1; Burdock root 1; Condurango bark half. 1 teaspoon to each cupful water simmered gently 20 minutes. Dose: Half-1 cup thrice daily before meals.
Powders. Formula. German Chamomile 2; Gotu Kola 1; Ginkgo 1. Dose: 500mg (two 00 capsules or one- third teaspoon) before meals thrice daily.
Tinctures. Formula. Combine: Condurango quarter; Burdock root half; White Poplar 1; Ginkgo 1; add 2- 10 drops Tincture Capsicum fort. 1-2 teaspoons in water thrice daily, before meals.
Tincture: Tincture Gentian Co BP. Dose: 2-4ml (30-60 drops).
Ginger, stem. Success reported.
Milk Thistle and Turmeric: popular in general herbal practice.
Diet. High protein, low fat, low salt. Dandelion coffee. Liver. Artichokes. 2-3 bananas (for potassium) daily.
Supplements. Daily. Vitamin B-complex. Vitamin C, 1g. Vitamin E, 200iu. Zinc, 15mg. Magnesium, 250mg morning and evening. ... anorexia nervosa
An antibiotic drug used to treat and/or to prevent urinary tract infection. Possible adverse effects include nausea, vomiting, increased sensitivity to sunlight, blurred vision, drowsiness, and dizziness.... nalidixic acid
An opioid analgesic drug used to relieve moderate or severe pain caused by injury, surgery, cancer, or childbirth. It is rarely used because of its adverse affects, which include dizziness, drowsiness, nausea, vomiting, and, rarely, hallucinations. Drug dependence may develop if high doses are taken for prolonged periods.... pentazocine
Rubella. An infectious virus disease spread by droplet transmission. Incubation: between 2-3 weeks. A notifiable disease.
Symptoms. Mild fever, temperature rising to 101°F (38°C), headache, drowsiness, runny nose, sore throat, swelling of glands side of neck and behind ears; itchy rash of small pink spots spreads from face downwards to whole of the body, lasting 3 days.
Complication: inflammation of the brain (rare).
If patient is pregnant professional care is necessary as congenital defects, stillbirth or abortion may follow in early pregnancy. There is evidence of a link between the virus and juvenile joint disease and arthritis later in life.
Treatment. Bedrest. Plenty of fluids (herb teas, fruit juices). Should not be suppressed by drugs. Alternatives:– Teas. Any one. Balm, Chamomile flowers, Elderflowers and Peppermint, Hyssop, Wild Thyme, Marigold. Sage, Peppermint. Combination: equal parts, Marigold flowers, Elderflowers, Yarrow. Prepare: 2 teaspoons to each cup boiling water; infuse 15 minutes. Half-1 cup freely.
Tablets/capsules. Echinacea.
Tinctures. Echinacea: 5-30 drops in water every 2 hours. OR: Combine, equal parts Echinacea and Wild Indigo with few drops Tincture Capsicum; 5-30 drops every 2 hours.
Absence of urine: add 1 part Pleurisy root.
For swollen glands: add 1 part Clivers.
For nervousness: add 1 part Skullcap.
For sore throat: Cinnamon.
Diet. Commence 3-day fast with no solid food. Abundant Vitamin C drinks, fruit juices, etc.
To be treated by or in liaison with a qualified medical practitioner. ... german measles
The kidneys are susceptible to a wide range of disorders. However, since only 1 normal kidney is needed for good health, disease is rarely life-threatening unless it affects both kidneys and is at an advanced stage.
Congenital abnormalities, such as horseshoe kidney, are fairly common and usually harmless. Serious inherited disorders include polycystic kidney disease (see kidney, polycystic), Fanconi’s syndrome, and renal tubular acidosis.
Blood vessels in the kidneys can be damaged by shock, haemolytic–uraemic syndrome, polyarteritis nodosa, diabetes mellitus, and systemic lupus erythematosus. The filtering units may be inflamed (see glomerulonephritis). Allergic reactions to drugs, prolonged treatment with analgesic drugs, and some antibiotics can damage kidney tubules. Noncancerous kidney tumours are rare, as is kidney cancer. Metabolic disorders, such as hyperuricaemia, may cause kidney stones (see calculus, urinary tract). Infection of the kidney is called pyelonephritis. Hydronephrosis is caused by urinary tract obstruction. In crush syndrome, kidney function is disrupted by proteins released into the blood from damaged muscle. Hypertension can be a cause and an effect of kidney damage.Other effects of serious damage include nephrotic syndrome and kidney failure. kidney failure A reduction in the function of the kidneys. Kidney failure can be acute or chronic. In acute kidney failure, kidney function often returns to normal once the underlying cause has been discovered and treated; in chronic kidney failure, function is usually irreversibly lost. Causes of acute kidney failure include a severe reduction in blood flow to the kidneys, as occurs in shock; an obstruction to urine flow, for example due to a bladder tumour; or certain rapidly developing types of kidney disease, such as glomerulonephritis. Chronic kidney failure can result from a disease that causes progressive damage to the kidneys, such as hypertension, longstanding obstruction to urine flow, and excessive use of analgesic drugs.The most obvious symptom of acute kidney failure is usually oliguria (reduced volume of urine). This leads to a build-up of urea and other waste products in the blood and tissues, which may cause drowsiness, nausea, and breathlessness. Symptoms of chronic kidney failure develop more gradually and may include nausea, loss of appetite, and weakness. If acute kidney failure is due to sudden reduction in blood flow, blood volume and pressure can be brought back to normal by saline intravenous infusion or blood transfusion. Surgery may be needed to remove an obstruction in the urinary tract. Acute kidney disease may be treated with corticosteroid drugs. Treatment may also involve diuretic drugs and temporary dialysis (artificial purification of the blood). A high-carbohydrate, lowprotein diet with controlled fluid and salt intake is important for both types of kidney failure. Chronic kidney failure may progress over months or years towards end-stage kidney failure, which is life-threatening. At this stage, longterm dialysis or a kidney transplant is the only effective treatment.... kidney disorders
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