Whisky/brandy 40 700 mL 28

*1 unit = 8 g

In the example of a glass of whisky (above), the calculation would be: 25 mL

× 40% divided by 1,000 = 1 unit Or for a 250 mL glass of wine with ABV

12%, the number of units is: 250 mL × 12% divided by 1,000 = 3 units. A

330 mL bottle of lager (ABV 5%) contains: 330 mL × 5% divided by 1,000 =

1.65 units.

Complications of Alcohol

Neurologic

Blackouts

Withdrawal syndromes (e.g. tremors, hallucinations, rum fits, and delirium tremens)

Cerebellar degeneration

Alcoholic dementia

Alcoholic myopathy

Autonomic neuropathy

Peripheral neuropathy

Marchiafava–Bignami disease (demyelination of corpus callosum)

Central pontine myelinolysis

Traumatic brain injury

Hepatic encephalopathy

Hemorrhagic stroke

Seizures

Cardiovascular

Cardiomyopathy

Cardiac arrhythmias (holiday heart

syndrome), and atrial fibrillation

Hypertension

Gastrointestinal

Acute gastric erosions

GI bleeding—Mallory–Weiss tears, gastric erosions,

esophageal varices, and peptic ulcers

Pancreatitis (acute, recurrent or chronic)

Diarrhea

Watery diarrhea due to alcohol itself

Steatorrhea due to pancreatitis or alcoholic liver

disease

Hepatomegaly (alcoholic hepatitis, fatty liver, and

chronic liver disease)

Chronic liver disease and associated complications

Respiratory

Increased susceptibility to pneumonia

and tuberculosis

Musculoskeletal

Increased risk of fractures and osteonecrosis of

femoral head

Increased risk of fall

Myopathy

Osteoporosis

Cancers

Oral cavity

Oropharynx

Esophageal

Colorectal

Breast

Hepatocellular carcinoma

Pancreatic

Metabolic

Hyponatremia

Hypoglycemia

Hypokalemia

Hypomagnesemia

Hypocalcemia

Hypophosphatemia

Gout

Hypercholesterolemia

Ketoacidosis

Psychiatric

Unipolar depressive disorders

Anxiety

Chronic suicidality

Amnestic disorder

Psychosis

Cognitive impairment

Impulsivity

Behavioral and psychosocial

Injuries

Violence

Crime

Partner or child abuse

Tobacco and other drug abuse

Unemployment

Legal problems

Poor hygiene

Hematologic

Anemia

Iron deficiency from blood loss

Dietary folate deficiency

B12 deficiency with pancreatitis

Direct toxic suppression of bone

marrow

Sideroblastic anemia

Zieve’s syndrome (hemolytic anemia)

Thrombocytopenia due to bone

marrow suppression or hypersplenism

Leukopenia

Nutritional

Thiamine deficiency—Wernicke’s encephalopathy,

Korsakoff psychosis, and peripheral neuropathy

Niacin deficiency—Pellagra

Folate deficiency

B12 deficiency

Vitamin D deficiency

Zinc deficiency

Endocrine

Diabetes mellitus

Gynecomastia

Testicular atrophy

Amenorrhea

Infertility

Miscellaneous

Erectile dysfunction

Fetal alcohol syndrome

Spontaneous abortions

Increased susceptibility to infections like HIV

SMOKING

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Cigarette smoking is the leading preventable cause of mortality,

responsible for nearly 6 million deaths worldwide.

The three major causes of smoking-related mortality are atherosclerotic

cardiovascular disease, lung cancer, and chronic obstructive pulmonary

disease (COPD).

Pack years = number of packs of cigarettes smoked per day × number of

years the patient has smoked

More pack years correlates with higher lung disease risk including lung

cancer.

Patients should be considered for screening with low-dose CT if they are

≥55 years with ≥30 pack years history.

Pack years = No. of packs of cigarettes/day × No. of years smoked

Smoking index is defined as the product of average number of cigarettes

smoked per day and the total duration of smoking in years.

Example: If a patient is smoking 1 cigarette per day for 10 years the

smoking index will be 10.

Smoking index (si) = No. of cigarettes/day × No. of years smoked

SI <100 = Mild smoker

SI <101–300 = Moderate smoker

SI <300 = Heavy smoker

Lung cancer is common if Smoking index more than 300

Complications of Tobacco Use

Cardiovascular disease

Premature coronary artery disease

Peripheral vascular disease and erectile dysfunction

Cerebrovascular disease

Aortic aneurysm

Respiratory disease

Chronic obstructive pulmonary

disease

Cancer of lung, bronchus, and

trachea

Increased incidence of

postoperative respiratory

complications

Increased incidence of

respiratory infections including

tuberculosis

ILD

Pneumothorax

Gastrointestinal

GERD

Pregnancy

Spontaneous abortion

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Peptic ulceration

Gallstones and cholecystitis in women

Pancreatitis

Crohn’s disease

Abruptio placentae

Premature rupture of

membranes

Fetal death

Neonatal death

Sudden infant death syndrome

Postpartum venous

thromboembolism

Renal

Increased risk of CKD

Endocrine

Increased risk of diabetes

mellitus

Infections—increased risk of several types of infection

including tuberculosis, pneumococcal pneumonia,

Legionnaires’ disease, meningococcal disease, influenza,

and the common cold

Osteoporosis and hip fracture

—smoking accelerates bone loss

and is a risk factor for hip fracture

in women

Neurological

Dementia and cognitive decline

Increased risk of amyotrophic lateral sclerosis

Ophthalmological

Age-related macular

degeneration

Increased risk of cataract

Drug interactions

Induces hepatic microsomal enzyme systems, e.g. increased metabolism of propranolol and

theophylline

Other cancers

Larynx

Oral cavity and lip

Nasopharynx, oropharynx, and hypopharynx

Nasal cavity and paranasal sinus

Esophagus

Stomach

Pancreas

Colorectal

Kidney

Bladder

Uterine

Cervix

Acute myeloid leukemia

B. DEFINITIONS

PULSE

Pulse is the pressure distension wave produced by contraction of left

ventricle against a partially filled aorta, which is transmitted to peripheries

and is felt on a peripheral artery against a bony prominence.

BLOOD PRESSURE

Arterial blood pressure (BP) can be defined as the lateral pressure exerted

by the moving column of blood on the walls of the arteries (Table 15B.1).

BP = Cardiac output × Peripheral resistance

Systolic BP (SBP)

Defined as the maximum

BP in the arteries

Attainable during systole

Normal 120+/–20 mm Hg

Diastolic BP (DBP)

Defined as the minimum pressure that is

obtained at the end of the ventricular

diastole.

Normal range 60–90 mm Hg

Pulse pressure (PP)

Denotes the difference between systolic and

diastolic pressure. PP = SBP − DBP = 40 mm

Hg

Mean arterial pressure (MAP)

DBP + 1/3 pulse pressure normal = 95 mm

Hg

Table 15B.1: Blood pressure measurement and definitions.

BP measurement Definition

SBP First Korotkoff sound

DBP Fifth Korotkoff sound

Pulse pressure SBP minus DBP

Mean arterial pressure DBP pulse one-third pulse pressure

Mid-BP Sum of SBP and DBP, divided by 2

Reference

Williams B, Mancia G, Spiering W, et al. 2018 ESC/ESH Guidelines for the management of

arterial hypertension. Eur Heart J. 2018;39(33):3021-104.

HYPERTENSION

“Hypertension” is defined as the level of BP at which the benefits of

treatment (either with lifestyle interventions or drugs) unequivocally outweigh

the risks of treatment, as documented by clinical trials.

Reference

Williams B, Mancia G, Spiering W, et al. 2018 ESC/ESH Guidelines for the management of

arterial hypertension. Eur Heart J. 2018 1;39(33):3021-104

Hypertension is most commonly defined as systolic blood pressure

(SBP) ≥140 mm Hg or diastolic blood pressure (DBP) ≥90 mm Hg, but

definitions vary by professional organization.

ACC/AHA - >130/80

ESC/ESH - >140/90.

RESISTANT HYPERTENSION

Elevated blood pressure despite concurrent use of three antihypertensive

drugs of different classes including a diuretic.

Reference

Williams B, Mancia G, Spiering W, et al. 2018 ESC/ESH Guidelines for the management of

arterial hypertension. Eur Heart J. 2018;39(33):3021-104.

REFRACTORY HYPERTENSION

A subgroup of patients with resistant hypertension that remains uncontrolled

despite maximal medical therapy, often with four or more antihypertensive

drugs.

Reference

Rimoldi SF, Scherrer U, Messerli FH. Secondary arterial hypertension: when, who, and how

to screen? Eur Heart J. 2014;35(19):1245-54.

PSEUDORESISTANT HYPERTENSION

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