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- Common pitfalls
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Indd 37 09/02/12 12:59 AM 38 SECTION 2 ALcohol-Related agents and conditions as it provides a more rapid and constant serum concentration (1,5,6). 100 mg/dL (5,6). 5 mL/kg/h of 10% ethanol) (1,5,6). Serum ethanol and glucose concentrations should be monitored and the dose of ethanol adjusted, as necessary, to maintain a therapeutic ethanol concentration. Hemodialysis rapidly removes both EG and glycolic acid (5–7). Elimination half-lives are reduced to approximately 3 hours for each, as compared with 19 and 10 hours, respectively, with alcohol dehydrogenase inhibitor therapy alone (1,2,7,9).
In addition, disulfiram may cause inhibition of dopamine-βb-hydroxylase, blocking the conversion of dopamine to norepinephrine, which may lead to hypotension. Myocardial ischemia is usually only associated with severe hypotension. In general, deaths attributable to DERs are extremely rare. Manifestations of DER usually begin within 30 minutes of ethanol exposure and may last for several hours. 2). Often, the source of ethanol may be elusive because ethanol-containing products in the home are ubiquitous.
Alcohol Clin Exp Res 1999;23:991–1007. 4. Martinez R. Alcoholism and society. Emerg Med Clin North Am 1990;8:904–909. 5. Moskowitz H, Burns M, Ferguson S. Police officer’s detection of breath odors from alcohol ingestion. Accid Anal Prev 1999;31:175–180. 6. Ragland G. Electrolyte abnormalities in the alcoholic patient. Emerg Med Clin North Am 1990;8: 761–773. 7. Ross SM, Chappel JN. Diagnostic dilemmas, part II: substance use disorders—difficulties in diagnoses. Psychiatr Clin North Am 1998;21:803–828.