Thesis supervisors: Professor Marika Väli, knd, (TÜ patoloogilise anatoomia ja kohtuarstiteaduse instituut) and Professor Vallo Tillmann, dr med (UT Departments of Pediatrics).
Opponent: Professor of Forensic Medicine Henrik Druid, MD, PhD (Karolinska Institutet, Sweden).
Ethanol is the most frequently abused drug in the Western countries, including in Estonia. Increasing alcohol consumption is accompanied by the growing problem of alcohol intake by children and adolescents. Aim of the study was to study the prevalence of clinical signs in different alcohol intoxication levels and the correlation with the SAC. The legal purpose was to establish the ratio between serum and blood alcohol concentrations. The aims of the study were also the prevalence of vital biochemical (glucose - Glu, lactate - Lac, potassium - K, and sodium - Na) changes in children with acute alcohol intoxication (AAI), and to establish the impact of serum alcohol concentration (SAC) or hormonal (testosterone, estradiol, progesterone, cortisol) status on the biochemical changes. In the research were all children with acute alcohol intoxication, who were hospitalised in Tartu University Children’s Clinic and Tallinn Children’s Hospital over a 3-year period (2005-2008). There were 226 to 264 children in the age 8.4-17.9 years, forming a male: female ratio of 1.46:1.
The severity of alteration of consciousness was the leading sign in the clinical evaluation of children with AAI, and correlated well to the SAC. Disturbances of speech and balance are also common in AAI. The average efficiency to diagnose the right AAI severity group, determined by the SAC, was 67.7% in AAI children. Clinically, doctors tended to estimate the severity of drunkenness to be one level more severe than determined by SAC. The serum and blood alcohol concentrations ratio of 1.19:1 was established, and should be used in children.
The most important results in the biochemistry were that plasma Glu, Lac, K and Na levels should be measured in all children hospitalized with AAI, and biochemical changes could be assessed in SAC above 1.50 g/L for hyperlactinaemia, hyperglycaemia and hypokalaemia. Increased plasma cortisol level above reference values is also common finding in children with AAI, and cortisol correlated with plasma glucose level and in girls, with plasma progesterone concentration.