CAN WE GET POISONING BY DRINKING ALCOHOL OR VINEGAR?

Article 3


(Just for Academic Stimulation and Fun Reading only)


Lim Ju Boo


The article below was written after a light academic reflection. It has little to do with first-aid.
It was written just for interest, and for argument sake only. It is just a brain-storming session within me. I am sure some drinkers don’t agree with me.


As a hind thought after writing the previous article, cause me to wonder whether some itchy readers may ask me whether or not after the jellyfish venom has entered the body, can the victim drink a lot of whisky, brandy, wine and toddy (as an excuse for drinking) and vinegar to combat the venom since the BAA first aid manual prescribed applying alcohol or vinegar.

If a small quantity of drinkable alcohol (ethanol) from say whisky, brandy, wine, toddy, fermented beverages, beer and stout is drunk, nothing happens. The body is capable of dealing with it. Alcohol is like a nutrient. It is easily burnt off and supplies the calories like any other energy-giving food substances. At the most, people may show up a little tipsy, a little more talkative and boisterous. We can easily see this effect gradually building up, say in the case of our colleagues in St John Ambulance Malaysia, Regional Superintendent Lee Wing Kwong and the then Regional Secretary (now Regional Superintendent) Michael Yeow Kiew Meng who sat at the same table as myself during a dinner at Shah Alam Club on the 28th November in honour of Dato’ Dr. Low Bon Tick. I could see that once a while they really enjoyed themselves harmlessly. Very soon their enjoyment and merriment spread to the adjourning table where other officers were just as high and boisterous. While this was going on, others would react differently. They suddenly become very quiet, but very flashed-up on the face (due to vaso-dilation). This was the case with ADO Lim Kian Tong who became an ‘instant mat salleh’ on the face even after one sip of beer. The effect of alcohol on me is nausea. The effects of alcohol may delay the reflexes, and the response time lengthened. In severe alcohol intoxication, besides inebriation, we will be presented with ataxia (defective muscular control), blurred vision, tachycardia (increased heart rate of > 100 b/m), impaired level of conciousness (stupor), including coma, severe hypoglycaemia (low blood sugar), convulsions, slow respiration and possibly death. We will never be able to reach a level of alcohol concentration in the blood sufficient to denature jellyfish toxin. It would probably dehydrate and denature the protein make-up of our tissues first ? That is why alcohol can be used as a preservative for preserving the carcasses of small animals kept in the laboratory. At low very low levels, the alcohol is easily burnt off with the help of a liver enzyme – alcohol oxidoreductase (formerly called alcohol dehydrogenase). It will require an alcohol concentration of at least 75% to denature any soluble protein, say in a serum or venom. Well, before the blood concentration can reach that level, you might have to be treated for alcohol poisoning instead of for jellyfish poisoning. That’s the effect of short-term ‘alcoholism’ or rather acute alcohol intoxication. But if you are a chronic drinker, anything can happen even if you take small quantities each time over many years. There are a number of alcohol-related disorders (pathological intoxication) you may choose from; anything from delirium tremens, alcoholic hepatitis, alcoholic cirrhosis, hepatocellular carcinoma, cardiomyopathies (diseases of the heart muscles), hypophosphataemia (low blood phosphate level), down the long list, to thiamin deficiency and Wernicke’ encephalopathy (a neurological disorder associated with chronic alcoholism). This condition coexists with another condition ‘Korsakoff syndrome’ and Korsakoff psychosis which are also associated with alcoholism and nutritional (thiamin) deficiency. I am not going down the list any further. This list is frightening enough. The chose is ours. Either way, don’t drink, nor try to treat jellyfish sting by drinking. First-aid books do not prescribe alcohol for drinking. It’s only for external application.

We may ask what about drinking vinegar then? Like alcohol, vinegar may also be considered a food item. Unfortunately, the ‘vinegar’ we buy these days is actually diluted synthetic acetic acid made from acetaldehyde by oxidation. Acetaldehyde solution, or formalin, is a preservative use for embalming a dead body. Sorry about that, because they don’t make the natural traditional vinegar from flour, tapioca, rice, and wine by fermenting the alcohol produced with bacteria anymore. Anything we put into our mouths these days seems man-made in the factory, including synthetic 'shark‘s fins' I had at a hotel yesterday. Taken in small quantities, vinegar, as we all do when we add it to shark’s fin soup, or any food preparation does us no harm. Vinegar, is a mild organic acid, and is easily handled by the body. It enters the Kreb Cycle (a circular metabolic pathway, also called citric acid cycle, which is the power house of the body) as an intermediary metabolite (acetate), and gets burned off by a process called oxidative phosphorylation without a trace. However, if very large quantities of vinegar or mild consumable acids are taken, it will upset a homeostatic mechanism called the acid-base balance (the buffering system) of the body. The acid-base control involves body buffers, lung function, and kidney function (in order of speed of response). The biochemistry and physiology of this balance is a very lengthy and complicated subject, but in a very brief way, all we can say is that all acids add hydrogen ions (H +) to the body. This is regulated by both kidneys and lungs as shown by the equations: H+ + HCO- 3 = H2O + CO2. The HCO- 3 is regulated by the kidneys, and the CO2, regulated by the lungs. If hydrogen ions (H +) is added to the blood, e.g. poisoning by an acid, this will give rise to a condition called ‘metabolic acidosis’, and the equation is pushed to the right. Respiration rate will increase (hyperventilation) to metabolically ‘blow off’ the excess CO2, giving rise to Kussmaul’s respiration (laboured, deep breathing), similar to one of the features of serve, uncontrolled diabetes. This is because the excess CO 2 (carbon dioxide) will trigger off chemoreceptors (small carotid bodies that can respond to changes in chemical substances in the body) lodged to a twig of a small branch of the external carotid artery close to the carotid sinus. Other chemosensitive areas responding to pH changes in the arterial blood are located very near the surface of the medulla near the point of entry of the glossopharyngeal and vagus nerves (9th and 10th cranial nerves respectively). It also involves the aortic bodies, located near the arch of the aorta, where stretch receptors (baroreceptors) that control blood pressure are also located. Carbon dioxide is a very powerful stimulus to ventilation; an increase in arterial blood paCO2 (partial pressure of CO2) of 2 to 3 mm Hg causes the rate of ventilation to double. If the CO2 continues to rise, the equation is pushed to the left, increasing the [H +] in the blood (respiratory acidosis). Electrolyte and acid-base balance is very complex and lengthy subject, and hyper or hypo conditions of acidosis and alkalosis give rise to various responses, anything from arrythmias (abnormal heart-beat, e.g. from hyperkalaemia - too much of serum potassium) to tetany (muscular cramps and spasms from low serum calcium or to alkalosis). Latent tetany is best recognised by eliciting the Trousseau’s manoeuvre – carpopedal spasm, or ‘obstetrician’s hand’, to confusional states, linked to various disease conditions. The understanding of acid-base balance, as well as electrolyte balance occupies full and very large chapters in almost all advanced textbooks of physiology, biochemistry, nutrition and medicine. We will of course not go into them. Suffice to say that their understanding has a good deal of applications in the care of critically ill patients, and I shall write a very brief example on this separately in a review paper later. (See article on “Acid-base responses to high-volume haemofiltration in the critically ill). However if you drink concentrated ‘vinegar’ which is glacial acetic acid, then the scenario is going to be entirely different. You will get acid burns on your mouth, throat, esophagus, stomach, and perhaps the small intestines. It will burn right through. We will have to immediately apply first-aid for corrosive substances for your GI (gastrointestinal) tract instead of treatment for jellyfish sting? So neither drinking alcohol nor vinegar is going to work. That’s not the way to do things. We will have to look for proper anti-venom. Whether or not vanilla taken in orally is going to work, is an interesting question. We (or at least myself) would sure like to examine carefully the data and findings of the University of Malaya medical team. This will have a bearing on the practice of first-aid which needs to be constantly updated through continuous research and education. In the meantime, I am very tempted to have a vanilla ice-cream with or without the jelly (fish). I am going out to buy one now. I will be right back to continue with more stories. Anyone care to join me?