Alcohol and respiratory and body temperature changes during tepid water immersion

Breast pumping and lactational state exert differential effects on ethanol pharmacokinetics

Prior research revealed that breast stimulation altered the way the lactating body handles alcohol. Its effects depended upon when it occurred relative to drinking. The goal of the present study was to determine whether breast pumping works independently of the physiological and metabolic changes that accompany lactation. To this end, we tested 12 women when they were exclusively breastfeeding 3-5-month-old infants and then again several months after lactation had ceased. Subjects were randomly assigned to one of two groups that differed in the timing of breast pumping relative to drinking a 0.4g/kg dose of alcohol: one group breast pumped 0.6h after drinking (pumped after group) and the other pumped 1h before drinking (pumped before group). For each reproductive stage, subjects were tested on 2 separate days, consuming a standardized meal 1 h before drinking during 1 test day and remaining fasted during the other. Breath alcohol concentrations (BrAC) and temperature readings were obtained before and at fixed intervals after drinking. Pumping before drinking significantly decreased BrAC during both reproductive stages, whereas pumping after drinking resulted in different BrAC time curves during lactation when compared with after lactation. That is, levels were significantly lower during the descending phase of the time curve during than after lactation. The interactions between pumping and reproductive stage were most apparent during fed condition. Furthermore, women were more sensitive to hypothermic effects of both fasting and drinking alcohol during lactation. These findings add to the growing literature that lactating women metabolize alcohol differently, in part, due to the frequent breast stimulation during breastfeeding and the pronounced physiological changes that accompany one of the most energetically costly mammalian activities.

Effects of alcohol on respiratory variables in normal humans

The study is designed to clarify the effect of low doses of alcohol on respiratory variables in air breathing normal subjects. Each subject was given an initial loading dose of alcohol (0.270 g/kg) followed, half an hour later, by a second dose (0.135 g/kg). Blood alcohol increased to a mean value of 52.0 +/- 3.0 (SEM) mg/100 ml at 1 hour. Resting ventilation increased significantly from a mean value of 6.25 +/- 0.41 litres min(-1) to 7.20 +/- 0.31 litres min(-1) 1 hour after alcohol (p= 0.025). Mean inspiratory flow was also increased (p= 0.045). End-tidal PCO² (PET CO²) showed a highly significant fall (1.87 +/- 0.35 mm Hg; p < 0.001) without a significant change in CO2 production rate (p > 0.05). PET CO² variability (100 x SD/mean) was low (mean 2.4%) and unaffected by alcohol. The longest end-expiratory pauses (apnoeas) observed for each subject were shortened significantly by alcohol (1.030 +/- 0.194 s and 0.690 +/- 0.138 s; p = 0.01). Moderate doses of alcohol in normal subjects, therefore lower PET CO² and shorten end-expiratory pauses (apnoeic periods) but do not affect PET CO² variability.

Alcohol and its variable effect on human thermoregulatory response to exercise in a warm environment

The aim of this study was to observe the effect of alcohol ingestion on body temperature and local sweat rate during endogenous and exogenous heat stress. After ingesting either alcohol (1.2 g alcohol/kg of body weight) or a placebo drink, 8 subjects exercised for 60 minutes at 45% VO2max in a warm environment (35 degrees C, 45% RH). Varying patterns of response were observed in these subjects, with no consistent effect on the thermoregulatory response seen. The absence of any significant change in skin and body temperature and in sweat rate suggests that the capacity of the body to struggle against exogenous and endogenous heat is not fundamentally altered by alcohol ingestion. The difference in individual response observed in our experiment is in accord with the previous lack of clearcut effect of alcohol reported in the literature.

Alcohol lowers the vasoconstriction threshold in humans without affecting core cooling rate during mild cold exposure

Elevated blood alcohol levels are often seen in hypothermia and hyperthermia related deaths, leading to the belief that alcohol renders humans poikilothermic. We examined the core temperature (Tco) thresholds for sweating, vasoconstriction and shivering as well as core cooling rates of seven subjects immersed in 28 degrees C water. On two separate days, subjects exercised on an underwater cycle ergometer to elevate Tco above the sweating threshold. They then rested and cooled until they shivered vigorously. Subjects drank orange juice (7 ml.kg-1) prior to immersion during the control trial and 1 ml.kg-1 absolute ethanol, added to orange juice in a 1:6 ratio, during the alcohol trial. Mean blood alcohol concentration (breath analysis) was 0.097 +/- 0.010 g% at the start of cooling and 0.077 +/- 0.008 g% at the end of the cooling period. Alcohol lowered the vasoconstriction threshold by 0.32 +/- 0.2 degrees C and elevated finger tip blood flow, but had no effect on thresholds for sweating and shivering or core cooling rate. Considering these minor effects it is unlikely that moderate alcohol consumption predisposes individuals to hypothermia or hyperthermia via impaired thermoregulation, but rather likely due to behavioral factors.

The effects of acute and chronic ingestion of ethanol on the autonomic nervous system

Evidence is reviewed linking clinical effects of ethanol with actions on the sympathetic and parasympathetic nervous systems. The studies reported include a series of investigations by the authors. Acutely, ethanol causes peripheral vasodilation and may also result in changes in heart rate and blood pressure. Ethanol may contribute to acute problems which may present clinically, including micturition syncope, accidental hypothermia and facial flushing. However, increased sympathetic nervous activity plays a role in causing hypertension and other symptoms during ethanol withdrawal in chronic alcoholics. Some chronic alcoholics may have neuropathy involving sympathetic nerves, and this can result in distal sweating loss and occasionally in orthostatic hypotension. Also, hypothalamic lesions associated with Wernicke's encephalopathy may result in hypothermia. Neuropathy involving parasympathetic nerves in not uncommon in alcoholics with other evidence of nervous system damage, but it is generally asymptomatic. Occasionally, vagal neuropathy may cause disorder of gastrointestinal motility, and neuropathy affecting the sacral innervation may be a factor in alcoholic impotence.

Effects of ethanol on thermoregulation

Clinical reports of accidental hypothermia in alcohol intoxicated individuals exposed to low ambient temperature ( Paton , 1983) have generally been borne out by experimental studies in healthy volunteers. Small doses of ethanol, given to human subjects at normal ambient temperature (Ta), have very little effect on body temperature but a combination of large dose, low Ta and vasodilatation provoked by strenuous exercise, causes a sharp fall in rectal temperature. In experimental animals, the use of relatively larger doses of alcohol and more extreme temperatures, both above and below the thermoneutral zone, has shown that the effect of ethanol is essentially poikilothermic, i.e. an impairment of adaptation to both heat and cold. This effect has been studied in greater detail, in relation to each of the basic thermoregulatory processes. Though small doses of alcohol may increase the metabolic rate under some circumstances, the most common effect at low Ta is inhibition of shivering and therefore reduction of thermogenesis. At the same time it tends to cause increased heat loss by cutaneous vasodilatation. This makes for a greater feeling of comfort in the cold exposed subjects but increases in rate of fall of core temperature. The combination of decreased thermogenesis and increased heat loss, despite falling body temperature, is suggestive of a lowering of the set-point of the thermoregulatory control mechanisms. Consistent with this is a slight increase in ventilatory heat loss after low doses of ethanol but larger doses cause respiratory depression, so that heat loss through the lungs is minor. However, at high Ta ethanol caused hyperthermia in experimental animals and shows enhanced lethality, so that impairment of thermoregulatory effector mechanisms seems to be at least as important as change in set-point. Studies of the effects of ethanol on electrophysiological activity of single neurons in the pre-optic area and anterior hypothalamus (POAH), biochemical activities of neuronal membranes, hypothalamic blood flow, conventional neurotransmitters, amino acid putative neurotransmitters, neuropeptides, prostaglandins and inorganic ions have all failed so far to yield a clear comprehensive picture of the mechanisms by which ethanol affects thermoregulation. In each case, contradictory evidence has been obtained concerning the consequences of ethanol administration, whether by oral, intraperitoneal, intravenous, intracerebroventricular, or direct local (POAH) route.(ABSTRACT TRUNCATED AT 400 WORDS)

Human body temperature and controlled cold exposure during moderate and severe experimental alcohol-intoxication

In an attempt to obtain more conclusive data, especially concerning the condition in many cases of very high alcohol concentration, two groups of healthy volunteers were exposed to controlled cold surroundings in a climate chamber after i.v. infusion of 96% ethyl alcohol, 1-2 1/2 ml per kg bodyweight, supplemented with alcohol perorally; the maximum blood alcohol concentration measured was 57 mmol/l, corresponding to 2.62%. One group was not habituated to drinking; the other group was habituated to heavy drinking, but functioned well socially. During the stay in a neutral environment, the alcohol infusion caused a rapid elevation of skin temperature with a short, but significant delay in temperature elevation in the alcohol-habituated group. After controlled exposure to cold, a rapid fall in surface temperature back to pre-alcoholic infusion values was seen in both groups. During cold exposure, core temperature remained unchanged in both groups. No changes in plasma catecholamines were found. A 12-18% increase in metabolic rate was seen in both groups during cold exposure, probably as an expression of the specific dynamic effect of alcohol. That the observed vasoconstriction was sufficient to prevent an undue fall in core temperature is further supported by the fact that neither shivering, nor non-shivering thermogenesis was activated, as no visible shivering occurred and no rise in plasma catecholamines was seen.

Thermoregulatory mechanisms and ethanol hypothermia

The mechanisms underlying the hypothermic effect of ethanol have been investigated in rats. At an ambient temperature of 26 degrees C, at which tail skin blood flow will normally be expected to play a role in regulating core temperature, no change in tail cutaneous temperature occurred during the period in which the core temperature was falling after administration of ethanol. As the drug effect waned tail skin temperature fell below the initial temperature as the hypothermia was corrected. This last observation confirms earlier results indicating a shift in the thermoregulatory set point after administration of ethanol. There was no significant change in oxygen consumption related to the ethanol induced fall in core temperature so decreased heat production would not appear to be a factor in the thermal imbalance. Neither was there any change in respiratory rate or minute volume to account for an increase in convective or evaporative heat loss via the lungs. From these results it is not clear by what mechanism the ethanol induced lowering of the set point leads to a fall in core temperature. Other avenues of heat loss, for example from other cutaneous surfaces, and further detailed thermal balance studies will be needed to resolve this problem.

Changes in body temperature after administration of antipyretics, LSD, delta 9-THC, CNS depressants and stimulants, hormones, inorganic ions, gases, 2,4-DNP and miscellaneous agents

This survey concludes a series of complications of data from the literature, primarily published since 1965, on thermoregulatory effects of antipyretics in afebrile as well as in febrile subjects, LSD and other hallucinogens, cannabinoids, general CNS depressants, CNS stimulants including xanthines, hormones, inorganic ions, gases and fumes, 2,4-dinitrophenol and miscellaneous agents including capsaicin, cardiac glycosides, chemotherapeutic agents, cinchona alkaloids, cyclic nucleotides, cycloheximide, 2-deoxy-D-glucose, dimethylsulfoxide, insecticides, local anesthetics, poly I:poly C, spermidine and spermine, sugars, toxins and transport inhibitors. The information listed includes the species used, route of administration and dose of drug, the environmental temperature at which the experiments were performed, the number of tests, the direction and magnitude of body temperature change and remarks on the presence of special conditions such as age or lesions, or on the influence of other drugs, such as antagonists, on the response to the primary agents.