Elimination

Von Noorden states that 1.5 to 6 per cent. is eliminated in the breath, 1 to 2 per cent. in the urine, and traces in the sweat. As we have seen above, from 6 one-ounce doses of whisky a day as little as 1.9 per cent. may escape combustion (Atwater and Benedict), and if quantities above 6 ounces are taken, aldehyde and other incompletely oxidized bodies may appear in the breath and urine (Goddard). Alcohol never appears in the feces; nor from any beverage amount does it appear in the milk of nursing mothers or affect its quality (Rosemann, Kline-mann). When taken by a pregnant woman, Nicloux found it in the same percentage in the fetal blood as in the mother's blood. The odorous principles of wines and distilled liquors are excreted by the lungs, and tend to pervade the breath in somewhat modified form.

Uterus

In experiments with pregnant rabbits alcohol in intoxicating amounts frequently caused abortion.

Kidneys

After excessive drinking there is regularly an increase in the excretion of urine. This may be the result of irritation of the kidney parenchyma, or of the ingestion of a large amount of fluid; or, as in the case of ether, it may result from a secondary dilatation of the renal arterioles. Long-continued alcohol drinking may be a factor in the production of chronic nephritis. Warthin says he has never, postmortem, seen a normal kidney in an alcoholic. The alcoholic kidney is of the sclerotic type, but may look fairly normal to the naked eye. It is often not evident clinically.

Bladder., - In drunkenness there may be increased secretion of urine, yet at the same time, owing to depression of the reflexes, there may be inability to empty the bladder. If the bladder becomes greatly distended, the urine must be drawn off by catheter.

The Urine

Reid Hunt has shown that the ethereal sulphates of the urine are trebled in amount within a week of the commencement of regular doses of alcohol, and that the neutral sulphur is decreased. In drunkenness alcohol appears in the urine, even up to 0.57 per cent., and if it is below 1 in 1000 the person is not intoxicated (Widmark).

Excretion Of Uric Acid

In connection with the effect of alcohol upon physiologic oxidations by the liver, and because of the relation of alcoholic drinks to gout, the uric-acid factor becomes one of importance. While after alcohol some workers (Norris and Smith, Beebe, Rosenfeld, Mendel and Hilditch) have found an increase in the uric acid excreted in health, others (von Noorden, Leber, Rosemann, Chittenden, Hammett) have found no increase. After one or two bottles of wine there is no change in the uric-acid excretion (Rosemann), but after beer, a purin-containing liquid, the uric acid rises. (The malt liquors contain about 0.145 gm. purins per liter, while wines are free from purin bases - Strauss.) Mandel found that while refraining from food a young man excreted the same amount of uric acid when he took 900 c.c. of whisky as when he took nothing. In healthy young men (students), unaccustomed to alcohol, and on a general mixed diet, Beebe got a distinct increase in the uric acid after alcohol, but no increase when the men were placed on a purin-free diet. These experiments indicate that the amount of exogenous uric acid, that derived from purins in the food, may or may not be increased by alcohol, but that the amount of endogenous uric acid, derived from cell-metabolism, is uninfluenced. Lusk is of the opinion that the increase in exogenous uric acid may be due to an interference by alcohol with the formation of the normal oxidizable cleavage-products, or, in other words, is due to the effect of alcohol upon the food, rather than to its effect upon the liver. Beebe thinks that alcohol interferes with the urico-lytic power of the liver.

In gout the results of experiments have not been uniform. Most of the experiments in subjects of chronic gout have been performed during the quiescent stage of the gout, and show a distinct tendency of alcohol to lessen the excretion of uric acid. But whether this lessened excretion of uric acid means increased storage in the system, with the ultimate production of a new attack, or lessened formation of uric acid, has not been fully determined. Yet clinical experience favors the view that alcohol may precipitate an attack of gout; and particularly is this true of the malt liquors, which contain up to 0.145 gm. of purin bodies per liter.

Acidosis And Excretion Of Sugar

In diabetes, the distilled liquors, and sometimes the dry wines, are allowed in moderation; the malt liquors and sweet wines are forbidden because of their carbohydrate ingredients and acids. In severe diabetes both the alcohol and the acids of wine are harmful. As alcohol is oxidized in place of carbohydrate, and as deficient oxidation of alcohol shows in the development of acetone bodies, it would seem that in severe diabetes with deficient oxidation, as in acidosis, alcohol is contraindicated. Higgins, Peabody, and Fitz produced acidosis by a carbohydrate free diet, and found that not only did alcohol fail to stop the progress of the acidosis or to show any antiketonigenic action, but it increased the oxygen consumption and the disagreeable subjective symptoms. After large amounts of alcohol, as taken in a debauch, and in chronic alcoholism, glycosuria may appear even in a non-diabetic; and in a diabetic there may be not only increased sugar excretion, but the formation of acetone, diacetic acid, and beta-oxybutyric acid, with the development of pronounced acidosis and perhaps fatal diabetic coma. (The writer had a case in which fatal diabetic coma followed the ingestion of a quart of claret.)

Tolerance

Tolerance for alcohol is readily set up, owing partly to an increased power to oxidize the drug, and partly to an increased resistance of the cells. Schweisheimer found that in unaccustomed men intoxication usually came on when the percentage of alcohol in the blood reached 0.05 per cent., but sometimes at 0.02 per cent. In habitues the blood at the intoxication stage showed 0.12 to 0.23 per cent. After one liter of wine containing 10.35 per cent. of alcohol, the percentage in the blood of a habitual drinker quickly rose to its maximum, remained at that point about two hours, then rapidly fell to zero. The blood of an unaccustomed person slowly acquired its maximum percentage in one and one-half to two hours, held the same percentage for five or six hours, and did not reach zero till about the twelfth hour. This long period of maximum concentration in the blood is a special danger in acute alcoholism in the unaccustomed. Schweisheimer concludes that drinkers acquire a progressive ability to keep down the quantity and persistence of alcohol in the blood. In unaccustomed animals Grahant found that 6 parts per 1000 in the blood could be recovered from.