Loss of the ability to produce smooth, muscular movements, leading to clumsiness and unsteady balance. Incoordination can also mean the failure of a group of organs to work together successfully. (See also ataxia.)
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
Examples of dysarthria may be found in strokes, CEREBRAL PALSY and the latter stages of PARKINSONISM, MULTIPLE SCLEROSIS (MS) and MOTOR NEURONE DISEASE (MND). Whatever the cause, a speech therapist can assess the extent of the dysarthria and suggest exercises or an alternative means of communication.... dysarthria
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)
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
Sodium valproate has widespread metabolic effects and may have dose-related side-effects. There has been concern over severe hepatic or pancreatic toxicity, but such adverse effects are rare. Other adverse effects include digestive upsets, drowsiness, muscle incoordination and skin rashes. Rare reports have been given of behavioural disturbances, with occasional aggression. Initiation and withdrawal of treatment should always be slow. Patients should reduce their alcohol intake; any other drugs they are taking that are metabolised by the liver should be carefully monitored.... sodium valproate
Essential fatty acids have an important role in the function of the nervous system, being closely related to the fatty (myelin) sheath and cell membranes. Disturbance in their metabolism may result in nerve disorder. Thus, vegetable oils of Soya, corn, safflower and sunflower should replace animal fats and dairy products.
Symptoms. Numb, prickling, tickling sensation on the skin, paralysis, incoordination, physical weakness and visual complaints.
Treatment. Indeterminate diagnosis.
Tablets/capsules. Prickly Ash, Black Cohosh, Ginseng, Ginkgo.
Powders, Liquid Extracts, Tinctures. Formula. Equal parts: Black Cohosh, Prickly Ash, Ginseng. Doses. Powders: two 00 capsules or one-third teaspoon, (500mg). Liquid Extracts: 1 teaspoon. Tinctures: 2 teaspoons. In water, honey or fruit juice.
Evening Primrose oil capsules or tablets: two 500mg thrice daily.
Aromatherapy. Rosemary spinal rub: 6 drops Oil Rosemary in 2 teaspoons Almond oil.
Diet. High protein, low fat, oily fish or 2 teaspoons Cod Liver oil daily. Gluten-free diet. Cholesterol- free – avoid milk, meat fat and dairy products. Avoid coffee and other caffeine stimulants. Dandelion coffee.
Supplements. B-complex, B3, B6, B12, C, E. Dolomite, Manganese, Zinc. ... demyelinating diseases
Symptoms of ataxia depend on the site of damage, although a lurching, unsteady gait is common to most forms. In addition, damage to certain parts of the brain may cause nystagmus and slurred speech. CT scanning or MRI may be used to determine the cause of ataxia. Treatment of the condition depends on the cause.... ataxia
Hypoxia in muscles forces the muscle cells to produce energy anaerobically, which can lead to cramps. Hypoxia in heart muscle may cause angina pectoris. Hypoxia of the brain causes confusion, dizziness, and incoordination, causing unconsciousness and death if persistent. Hypoxia can be assessed by using an oximeter to measure the oxygen concentration of blood in the tissues. Severe hypoxia may require oxygen therapy or artificial ventilation.... hypoxia
After entering the body, mercury accumulates in organs, principally the brain and kidneys. Mercury deposits in the brain cause tiredness, incoordination, excitability, tremors, and numbness in the limbs. In severe cases, there may be impaired vision and dementia. Deposits of mercury in the kidneys may lead to kidney failure.
Treatment may involve chelating agents, which help the body to excrete the mercury quickly; haemodialysis (see dialysis); and induced vomiting or pumping out the stomach, if mercury has been swallowed within the previous few hours.... mercury poisoning
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