Clinical features

• Acute intoxication symptoms
• Alcohol amblyopia
• Alcohol induced fits
• Amnesic episodes
• Atrial fibrillation
• Ascites
• Blood
• Cardiomyopathy
• Cerebellar degeneration
• Cognitive impairment and dementia
• Gross ascites
• Heart
• Hepatic encephalopathy
• Liver damage
• Myopathy
• Oesophageal varices
• Pancreatitis
• Peripheral neuropathy
• Pathological jealousy
• Psychiatric conditions
• Wernicke Korsakoff syndrome
• Other physical conditions

Excess alcohol consumption has toxic effects on every organ in the body, can cause physical and psychiatric symptoms and social damage.

Acute intoxication symptoms

Rising blood levels of alcohol result in neurological symptoms that escalate from euphoria and inco-ordination to confusion, ataxia [gross unsteadiness], stupor and eventually coma.

Alcohol amblyopia

This is a rare visual condition unique to those who have a history of chronic, severe drinking problems. The disorder involves lost vision, including scotomas (blind spots) and decreased visual acuity within the central portion of the visual field. The condition can be treated with proper diet and vitamin supplementation. It is generally reversible, but may lead to permanent vision loss if untreated.

Alcohol induced fits

Amnesic episodes [blackouts]

Atrial fibrillation.

Atrial fibrillation can cause disabling symptoms such as breathlessness and may be associated with an increased risk of stroke. However, the majority of people respond to treatment and have little disability.

Ascites

This is accumulation of fluid in the abdominal cavity. The fluid may accumulate over many weeks or rapidly over a couple of days. It commonly causes abdominal discomfort.

Blood

Alcohol excess can cause:

• Anaemia due to deficiency of folic acid, resulting in fatigue.
• A reduction in the white blood cells [leucopaenia] resulting in an increased susceptibility to infections.
• A reduction in the platelet count [thrombocytopaenia] resulting in an increased tendency to bleeding and bruising.

Cardiomyopathy

The person may suffer fatigue, reduced exercise tolerance and breathlessness. However, disability varies considerably, depending upon the severity of the underlying condition.

Cerebellar degeneration

This results in unsteadiness [ataxia].

Cognitive impairment and dementia

Damage to the brain occurs, especially the frontal lobe. This results in loss of memory, deterioration of personality and loss of intellectual ability. Interpersonal skills, attendance to usual interests and responsibilities may deteriorate and self-neglect may result.

Depression caused by a direct effect of alcohol on the brain and exacerbated by social problems that include unemployment, divorce and debt. There is an increased incidence of deliberate self-harm. The suicide rate is increased six fold in people who are dependent upon alcohol.

Anxiety. People often use alcohol to relieve symptoms of stress and anxiety. However, anxiety symptoms increase during periods of withdrawal, leading to a cycle of increased consumption.

Psychosis. Alcoholic hallucinosis is a rare condition that is not due to alcohol withdrawal. Auditory hallucinations, often derogatory, develop in an otherwise clear consciousness. The condition usually lasts for a few days, but can persist after several months of abstinence.

Gross ascites

If the volume of fluid is large it can cause difficulty in breathing and eating. However it can usually be controlled by paracentesis [drainage of the fluid] or by the use of diuretics [water tablets].

Heart

Alcohol can cause arrhythmias [abnormalities of cardiac rhythm]

Hepatic encephalopathy

This can be acute or chronic.

Acute. There is sudden onset of drowsiness and coma, usually with a precipitating cause [examples include constipation or infection].

Chronic. There is disorder of personality, mood and intellect. The course may be fluctuating. The person is irritable, confused, disorientated and has slow slurred speech.

The mortality rate is high. Emergency hospital admission is required.

Liver damage

There is progressive liver damage that may be reversible in the early stages. Eventually, however, cirrhosis [irreversible liver damage] occurs. Early cirrhosis may not necessarily result in severe disability. However, when advanced with resulting liver failure is likely to result in severe disability.

The following effects of cirrhosis are indications of severe liver disease. However the disabling effects of individual conditions varies from moderate to severe.

Myopathy

This is damage to muscles resulting in muscle pain and weakness of muscles.

Oesophageal varices

These are enlarged veins in the oesophagus that may rupture spontaneously. The person presents with haematemesis [vomiting blood] of sudden onset. Emergency hospital admission is required. The mortality rate is high. Treatment usually involves injecting a sclerosing agent or placing a band around the varix. Further episodes of bleeding after the initial episode are common [60 to 80% within 2 years]. Preventative treatment is therefore required. This usually involves repeated banding or injection of the varices, although surgery is sometimes necessary.

Pancreatitis

This can be acute, recurrent or chronic.

Acute and recurrent. The person presents with a sudden onset of severe upper abdominal pain. Emergency hospital admission is warranted. The majority of cases are mild and self-limiting to but approximately 25% are severe and complicated. The mortality rate for the severe group can be up to 50%.

Chronic. The symptoms are of upper abdominal pain that may be severe and intermittent or chronic and unremitting. During periods of severe pain, loss of appetite occurs. Weight loss may be severe, especially in people with chronic unremitting pain. Treatment usually involves use of analgaesic medication, antidepressants, nerve blocks and surgical intervention for people with debilitating pain. The prognosis is variable, but about 60% of people will become pain free in a 6 to 10 year period with abstinence.

Other gastrointestinal conditions.

There is an increased incidence of peptic ulcer and carcinoma of the mouth, throat and oesophagus.

Pathological jealousy

A false belief that the person’s partner is unfaithful. This may be associated with other abnormal beliefs, for example that the partner is plotting against the person or trying to poison him. The person searches incessantly for evidence of the partner’s infidelity. The person becomes increasingly angry and hostile and this results in violent confrontations. There is an increased risk of homicide and physical injury to the partner. Treatment is difficult, and the condition may persist for many years.

Peripheral neuropathy

This is damage to peripheral nerves, resulting in burning sensation in the feet, loss of pain sensation and in severe cases, weakness and wasting of the muscles.

Psychiatric conditions

There are several psychiatric conditions that can result from alcohol misuse:

Other physical conditions

Excess alcohol consumption is associated with an increased susceptibility to:

• Gout.
• High blood pressure [hypertension].
• Osteoporosis and osteomalacia, both of which may result in an increased risk of fractures.
• Impaired psychosexual function may exacerbate marital difficulties.
• Nutritional deficiency – protein and vitamins [especially B vitamins and folic acid].

Wernicke Korsakoff syndrome

This is caused by vitamin B deficiency, which may persist after abstinence from alcohol and vitamin replacement.

Wernicke’s Disease results in unsteadiness, paralysis of eye movement and confusion.

Korsakoff Syndrome resulting in severe amnesia for recent events with confabulation [making things up to compensate for memory loss].