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The signs of alcoholic intoxication are the same as those of overdosage with any other central nervous system depressant: drowsiness, errors of commission, psychomotor dysfunction, disinhibition, dysarthria, ataxia, and nystagmus For a 70-kg person, an ounce of whiskey, a 4- to 6-oz glass of wine, or a 12-oz bottle of beer (roughly 15, 11, and 13 grams of alcohol, respectively) may raise the level of alcohol in the blood by 25 mg/dL For a 50-kg person, the blood alcohol level would rise even higher (35 mg/dL) with the same consumption Blood alcohol levels below 50 mg/dL rarely cause significant motor dysfunction Intoxication as manifested by ataxia, dysarthria, and nausea and vomiting indicates a blood level above 150 mg/dL, and lethal blood levels range from 350 to 900 mg/dL In severe cases, overdosage is marked by respiratory depression, stupor, seizures, shock syndrome, coma, and death Serious overdoses are frequently due to a combination of alcohol with other sedatives

Major criteria:

It is important to understand the different effects of prefix and postfix, as illustrated in Example 4-3. Note the output.

Physiologic dependence as manifested by evidence of withdrawal when intake is interrupted Tolerance to the effects of alcohol Evidence of alcohol-associated illnesses, such as alcoholic liver disease, cerebellar degeneration Continued drinking despite strong medical and social contraindications and life disruptions Impairment in social and occupational functioning Depression Blackouts

Other signs:

Alcohol stigmas: alcohol odor on breath, alcoholic facies, flushed face, scleral injection, tremor, ecchymoses, peripheral neuropathy Surreptitious drinking Unexplained work absences Frequent accidents, falls, or injuries of vague origin; in smokers, cigarette burns on hands or chest Laboratory tests: elevated values of liver function tests, mean corpuscular volume, serum uric acid, and triglycerides

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calls an operating system or Toolbox routine, a trap (exception) is generated. The trap dispatcher looks up the call in one of the tables and transfers control to the routine s stored address. Once the trapped routine is complete, control returns to the caller. Extensions usually work by first patching a trap dispatch table entry to point to the address of the Extension code instead of the stored routine. When the patched routine is called, control transfers to the Extension and its code is executed rather than the original routine s code. After the Extension code has executed, the original code needs to then be chained and executed. This process sounds simple, but in practice there are various implementation techniques and subtle details to get right. If you make a simple mistake, you can cause unexpected system behavior or, worse, take down the entire operating system.

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There is a wide spectrum of manifestations of alcoholic withdrawal, ranging from anxiety, decreased cognition, and tremulousness through increasing irritability and hyperreactivity to full-blown delirium tremens Symptoms of mild withdrawal, including tremor, elevated vital signs, and anxiety, begin within about 8 hours after the last drink and usually have passed by day 3 Generalized seizures occur within the first 24 38 hours and are more prevalent in persons who have a history of withdrawal syndromes Delirium tremens is an acute organic psychosis that is usually manifest within 24 72 hours after the last drink (but may occur up to 7 10 days later) It is characterized by mental confusion, tremor, sensory hyperacuity, visual hallucinations (often of snakes, bugs, etc), autonomic hyperactivity, diaphoresis, dehydration, electrolyte disturbances (hypokalemia, hypomagnesemia), seizures, and cardiovascular abnormalities The acute withdrawal syndrome is often completely unexpected and occurs when the patient has been hospitalized for some unrelated problem and presents as a diagnostic problem Suspect alcohol withdrawal in every unexplained delirium The mortality rate from delirium tremens has steadily decreased with early diagnosis and improved treatment In addition to the immediate withdrawal symptoms, there is evidence of persistent longer-term ones, including sleep disturbances, anxiety, depression, excitability, fatigue, and emotional volatility These symptoms may persist for 3 12 months, and in some cases they become chronic

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