DRUNKENNESS

DRUNKENNESS

“It is a condition produced in a person, who has

taken alcohol in a quantity sufficient to cause
him to loose control of his faculties to such an
extent that he is unable to execute safely the
occupation in which he was engaged at the
particular time”
The doctors, especially CMO’s, are requested by
police to examine the persons involved in:

public nuisance,
disorderly behavior,
rash driving endangering the public safety,
accused in an assault,
attempt murder or rape

in order to find out whether the individual is under

the influence or not
 STAGES OF ALCOHOL INTOXICATION

1. Stage of sobriety Smell +

(BAC – upto 50mg%) No effect

Decent Normal and decent

behavior
2. Stage of Euphoria Sense of well being

(BAC – 50-100 mg%) Delighted, talkative

Delighted Increased self confidence

Improved social
communication
Lack of inhibitions
3. Stage of excitement Action less restrained
(BAC – 100- 150mg%) Decreased visual acuity

Delirious Time and space perception

altered
Dilated pupils
Alcohol gaze nystagmus
(40-100mg%)
Increase sexual desire but
decreased perfomance
4. Stage of incordination Decreased sense perception
and skilled movts.
(BAC – 150-200mg%)
Boisterous and less restrained
Dazed
Irritable and excitable
Clumsy and ill coordinated
Altered speech
Nausea and vomiting
Decreased sensations and
temperature

5. Stage of stupor Diminished response to stimuli

(BAC 200 – 300 mg%) Unable to stand/ walk
Vomiting/ LOC
Dejected
6. Stage of coma Depression of motor and
(BAC – 300 - 500mg%) sensory cortex
Stertorious breathing
Dead drunk
Hypothermia
Contracted pupils – Mc
Ewan's sign
Progressive medullary
paralysis
Respiratory depression

7. Stage of death •Death due to respiratory

(BAC - >500 mg%) failure
Dead
Consent and alcoholic examination
 Consent is a must
 If unconscious or not fit to give consent:
 Examine him and note the findings
 Wait for him to be oriented and get consent

Clinically to diagnose a person as drunk –

it depends on combination of signs and symptoms
and not merely from the smell of alcohol on his
breath
 DD for alcoholic intoxication
 Head injury (severe)
 Metabolic disorders
 hypoglycemia, hypothyroidism, uraemia
 Neurologic
 disseminated sclerosis, IC tumors, Parkinsons,
Epilepsy
 Drugs
 insulin, barbiturates, antihistamines, sedative
hypnotics
 Fever
CLINICAL EXAMINATION:
 General physical examination
 Neurological examination
 Locomotor system examination

LAB INVESTIGATION
 Blood examination
 Urine examination
 Breath analysis
 EXAMINATION OF A DRUNKEN
PERSON
 History
 General behaviour:
 State of dress
 Speech
 Self control
 Memory
 Handwriting
 Vitals
 Skin
 Mouth
 Eyes
 Intrinsic muscles:
 Pupils
 Reaction to light
 Extrinsic muscles:
 Convergence
 Strabismus
 Nystagmus
 Visual acuity
 Conjunctiva
 Ears
 Gait
 Muscle cordination Tests
 Reflexes
 BLOOD FOR ALCOHOL ESTIMATION
Best and accurate method of assessment

Technique:
 Skin should not be wiped with alcohol
 1:1000 HgCl or soap and water
2
 Screw capped bottle with NaF or Koxalate for
10mL
 No rubber stoppers
 Refrigerated but not frozen
 Not to be stored for more than 1 week
 Serum or plasma BAC is 10-12% more than whole
blood
 WIDMARKS FORMULA
To calculate amount of alcohol consumed:
For blood: a = prc
[a= alcohol(g), p=body weight(kg), c=BAC, r=constant
(0.6 for males, 0.5 for females]

For urine: a = 3/4prq

[a= alcohol(g), p=body weight(kg), q=UAC, r=constant
(0.6 for males, 0.5 for females]

 Macro method: kozalka and Hine method

 Micro method: Cavett test
 Gas chromatography
Breath analyzers/ alcometers/ drunkometers:
Reacts with oxidizing substance – color change
Color change to a predetermined distance
Crystalline bichromate and H2SO4 mix

Newer analyzers:
 Fuel cell variety
 Infrared photometry
ALCOHOL AND THE LAW

 S84 IPC : Insanity

 S85 IPC : involuntary intoxication
 S86 IPC : Punishment as if he was not drunk

Drinking and Driving – is it legal??

 Motor Vehicle Act (S185)
 permitted BAC – 30mg%
 1st punishment – 2000+/-6months
 2nd +punishment – 3000+/- 2 years
 In Europe: 50mg%, In USA : 80mg%
 OPINION

 Not consumed alcohol

 Consumed and not under its influence
 Consumed and under its influence
Thank you