Alcohol and Drug Related Deaths 71 Alcohol

Alcohol is one of the most commonly used drugs in the world. The small ethyl alcohol molecule can pass easily through the blood-brain barrier to the CNS where it has direct suppressant affects on the whole of the CNS. At low concentrations, the specialized cells of the cerebral cortex are affected, but as the concentration increases, the depressive effects involve the higher areas of the brain, resulting in increasingly disinhibited behavior. Still higher levels of alcohol result in the depressant effects involving the lower levels of brain function, including the vital cardiorespiratory centers in the midbrain and the medulla, predisposing the intoxicated individual to cardiorespiratory depression or arrest. Alcohol levels in excess of 300 mg/dL are considered to be potentially lethal, and although some individuals have survived, usually with medical attention, with higher levels, it should be remembered that some individuals have died with far lower levels of alcohol in their blood stream.

However, the effects of alcohol are not confined to the brain; there is also marked peripheral vasodilation, resulting in increased heat loss that may occasionally lead to hypothermia. The adverse effects of alcohol on the coronary circulation, particularly when associated with coronary atheroma, may lead to myocardial ischemia and the development of dysrhythmias and sudden death.

Alcohol also has marked diuretic effects and, when combined with the ingestion of large quantities of fluid (particularly in beer and lager drinking), it may result in electrolyte disturbances, particularly hyponatremia.

The chronic effects of alcohol involve many of the internal organs; alcoholic cardiomyopathy, hepatic steatosis, and cirrhosis are the most common, and all can lead to sudden death.

Alcohol may also be a major factor in causing death by predisposing the individual to accidental trauma and by obscuring the effects of that trauma. This is particularly the case in head injuries when the changes in the level of consciousness are attributed to the effects of alcohol rather than an identified or unidentified head injury.

Alcohol is also a gastric irritant and may precipitate vomiting when taken in excess. This, combined with the effects of decreased consciousness and the reduced laryngeal reflexes associated with intoxication may result in a significantly increased risk of aspiration of vomit into the airways and death. Such an event is unpredictable and, without constant supervision, unpreventable.

The anesthetic effects of alcohol may also result in deaths from asphyxiation. These deaths are the result of the intoxicated individual moving into or being placed or left in a position that impedes respiration either by occlusion of the external respiratory orifices or the internal airways (particularly the larynx) or restricts the free movement of the chest wall. These positions may result from lying face down on a bed, marked extension or flexion of the neck, or lying across an edge with the head down. Deaths resulting from impairment of respiration in this manner classically result in profound asphyxial changes involving the upper body, and these deaths are ascribed to postural asphyxia.

Given the speed with which an individual under the influence of alcohol can die from either the aspiration of vomit or postural asphyxia, it is doubtful if a police station cell is the correct environment for his or her recovery from intoxication.

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