Excessive alcohol intake (EAC) causes approximately 140,000 deaths annually in the U.S., leading to a number of acute and chronic diseases. Worldwide, approximately 3 million people die each year from the harmful effects of EAC, representing 5.3% of all deaths. The economic burden of EAC related to loss of workplace productivity, motor vehicle crashes, legal issues, and health care costs is $249 billion each year.2-5 EAC affects all organs and systems of the body and causes a number of diseases and conditions.6-9 In addition, the health of those around the individual engaging in EAC can be adversely affected and social distress such as divorce and job termination can occur. Intoxication, poor judgment, mood instability, and aggression during EAC may result in intentional or unintentional injury to the individual and others.2 This article presents priority nursing assessments and interventions that address the multicellular assault of EAC on bodily organs and the impact on the patient. Standard of living.
Prevalence and epidemiology
About 55% of men and 51% of women consume alcohol every month.10-13 Moderate alcohol consumption is limited to 2 drinks for men and 1 drink for women on any given day (see standard drink size in the US). EAC is a global term that includes heavy drinking and binge drinking.10-13 Heavy drinking occurs when a man drinks 5 or more drinks in 2 hours, and a woman drinks 4 or more drinks.10-13 Of all people who consume alcohol, 29.7% of men and 22.2% of women in the US drink heavily.2 Heavy drinking occurs when a man consumes 4 or more drinks in 1 day or at least 14 drinks in a week. and when a woman consumes 3 or more drinks on 1 day or at least 7 drinks a week.10-13 Heavy drinking is much less prevalent than binge drinking among men and women. Of all people who consume alcohol in the U.S., 7% of men and 6% of women engage in heavy drinking.10-13 Binge drinking is characterized by a blood alcohol concentration of 0.08 grams of alcohol per deciliter or higher, leading to difficulty speaking, incoordination, unsteady gait, nystagmus, loss of attention or memory, and stupor or coma.10 Approximately 39 million people in the U.S. drink alcohol excessively; only 1 in 6 have visited a physician or advanced practice clinician about their drinking patterns. More than 14 million adults in the U.S. have been diagnosed with alcohol use disorder (AUD). AUD and EAC are not necessarily the same thing. Many people who engage in EAC are not alcohol dependent. However, they are at increased risk of developing AUD. Active AUD is a progressive, chronic disorder characterized by an inability to control drinking despite health, work, or social consequences. Active AUD means that the person continues to consume alcohol despite ill effects; a person with AUD who abstains from alcohol consumption is considered recovered. According to the American Psychiatric Association Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM 5), a person is diagnosed with AUD when he or she meets 2 or more of the 11 criteria for AUD occurring sequentially or simultaneously within 12 months. Selected examples of criteria include: (1) alcohol is consumed in greater quantities or for longer periods of time than planned, (2) unsuccessful attempts to reduce or control alcohol intake, (3) craving or strong desire to consume alcohol, and (4) exhibiting alcohol withdrawal syndrome when alcohol consumption is reduced. Risk factors for AUD include continued drinking over time, childhood trauma, depression, low self-esteem, chronic illness, and having a parent with AUD. Adverse childhood experiences are traumatic situations – physical, emotional and sexual abuse, domestic violence, estrangement, and parental substance abuse disorder – that put the child at high risk for developing cognitive, emotional and social impairments, including abuse and misuse of alcohol. Genetic influences are present in approximately 40%-60% of people with AUD. Causes of EAC include falls, drowning, motor vehicle accidents, unsafe sexual behavior, drug overdose, combining alcohol with other substances and drugs, and relationship breakdown. Alcohol abuse and misuse is responsible for more pathologic conditions than any other drug.Effects on body organs and systems
EAC impairs every organ and system in the body. Vitamin B1 (thiamine) plays a vital nutritional role in EAC because it is essential for converting carbohydrates into energy and for optimal functioning of muscles and the central and peripheral nervous, gastrointestinal, hepatobiliary, cardio vascular and immune systems. Thiamine must be obtained from nutritional sources as it is not produced naturally in the body. People who engage in EAC may not have adequate intake of nutrients, including thiamine, in their diets. Alcohol also interferes with nutrient absorption, leading to thiamine deficiency and subsequent dysfunction of the central and peripheral nervous systems. Alcohol is degraded in the liver by the enzyme alcohol dehydrogenase and a complex system of enzymes called the microsomal ethanol-oxidizing system that generates acetaldehyde. This toxic, carcinogenic substance interferes with nutritional metabolism.Gastrointestinal effects
Gastritis, gastric ulcers, duodenal ulcers, cirrhosis, pancreatitis, and bleeding from gastric and esophageal varices occur in at least 15% of people who engage in EAC. Such individuals are more likely to develop oral, esophageal, and gastric carcinomas because of the toxic effects of alcohol on the mucosa and the breakdown of alcohol into acetaldehyde.
Cardiovascular effects
EAC causes hypertension and accelerates coronary artery disease by increasing triglycerides and low-density lipoprotein cholesterol, leading to cardiomyopathy, myocardial infarction, heart failure, and stroke. Systemic effects of EAC and evaluation findingsCentral and peripheral nervous system ----
• Altered level of consciousness, mood and affect • Altered speech, memory and attention and apraxia: inability to perform skilled movements and gestures • Nystagmus, impaired reflexes, tremors, seizures • Impaired gait and balance • Impaired sensory and general motor movement • Paresthesia with or without pain in feet, fingers and lips • Impaired bowel, bladder and sexual function • Increased blood alcohol level • Elevated serum ammonia level from hepatic encephalopathy • Abnormal psychometric hepatic encephalopathy score • Abnormal brain CT and MRI, EEG and electrolyte imbalance • Nutrient deficiencies, especially thiamine • Changes in sleep pattern (changes in rapid eye movements)
Hepatobiliary and Gastrointestinal System ------
• Altered level of consciousness, mood, and affect • Bleeding and easy bruising • Increased weight and abdominal girth • Jaundice and pruritus • Melena and hematochezia • Acholic stools • Anorexia, nausea, vomiting, and abdominal pain • Elevated serum ALT, AST, alkaline phosphatase, amylase, lipase, and bilirubin levels • Altered serum sodium, potassium, and chloride levels • Altered acid-base balance • Decreased serum albumin and protein levels • Elevated serum ammonia levels • Elevated serum creatinine, BUN, and decreased eGFR • Decreased RBC, HGB, HCT, PLT, and prolonged aPTT
Cardiovascular System ----
• Pain, pressure, or discomfort in the chest, arm, or back • Symptomatic or asymptomatic hypotension and hypertension • Decreased pulse amplitude • Elevated D-dimer and dysrhythmias • Abnormal ECG, echocardiogram • Elevated serum B-type natriuretic peptide • Elevated serum low-density lipoprotein and triglyceride levels • Shortness of breath and cough • Fatigue, dizziness, and lightheadedness • Pulmonary crackles and wheezes • Abnormal chest x-ray • Oxygen saturation below 94% • Peripheral edema y Changes in mental status • Changes in pupil size, congruence, and response to light • Signs or symptoms of stroke
Pulmonary system ---
• Chest pain, pressure, or discomfort • Fatigue and shortness of breath • Pulmonary crackles and wheezes • Productive and nonproductive cough and hemoptysis • Oxygen saturation below 94% • Fever, fatigue, night sweats and weight loss • Abnormal chest X-ray • Pulmonary embolism on CT pulmonary angiography • Abnormal pulmonary function tests • Hypoxia and hypercarbia • Coma
Renal system ----
• Abdominal and flank pain or discomfort • Fatigue and anorexia • Urinary tract infection • Proteinuria, albuminuria and hematuria • Increased creatinine and decreased eGFR • Fluid retention and weight gain • Changes in serum electrolytes, especially potassium and sodium • Decreased RBC counts • Abnormal results of renal CT, ultrasound and biopsy • Portal high Hepatorenal syndrome from blood pressure
