Pizon Anthony F, Becker Charles E, Bikin Dale
University of Pittsburgh School of Medicine, Department of Emergency Medicine, Division of Medical Toxicology, Pittsburgh, PA, USA.
J Med Toxicol. 2007 Jun;3(2):63-72. doi: 10.1007/BF03160911.
Many variables affect the interpretation of an isolated ethanol level in an acutely intoxicated patient. This review demonstrates the significant variability in metabolism and elimination of ethanol, how it can differ between individuals, and the clinical importance of these variables.
Isolated ethanol values in a clinical scenario are only a snapshot of a dynamic process. The individual pharmacokinetic differences of people make it extremely difficult to estimate ethanol elimination rates or calculate previous ethanol concentrations at the time of an accident because of medical-legal reasons. Not only are the techniques used in measuring ethanol concentrations in bodily fluids (blood, serum, breath, and urine) not equivalent, but also the units used to report ethanol concentrations are often misinterpreted. Acute and chronic tolerance and social adaptive changes make interpreting this isolated ethanol level extremely difficult. The purpose of this review is to enable the clinician to appropriately interpret ethanol concentrations.
The clinical evaluation of a patient's inebriation is always more reliable than an isolated ethanol level for determining disposition. Only an estimation of a current serum ethanol level can be made if the blood draw was performed hours earlier. This review is clinically important because it shows the clinically significant variability in metabolism and elimination of ethanol and how it can differ between individuals. It will also describe different ways to measure ethanol concentrations and how to compare them. Finally, the interpretation of isolated ethanol levels will be discussed.
许多变量会影响对急性中毒患者单一乙醇水平的解读。本综述展示了乙醇代谢和消除过程中的显著变异性、个体之间的差异以及这些变量的临床重要性。
临床场景中的单一乙醇值只是一个动态过程的快照。由于医学法律原因，个体的药代动力学差异使得很难估计乙醇消除率或计算事故发生时之前的乙醇浓度。不仅用于测量体液（血液、血清、呼气和尿液）中乙醇浓度的技术并不等效，而且用于报告乙醇浓度的单位也常常被误解。急性和慢性耐受性以及社会适应性变化使得解读这个单一乙醇水平极其困难。本综述的目的是使临床医生能够正确解读乙醇浓度。
对于确定处置方式，对患者醉酒状态的临床评估始终比单一乙醇水平更可靠。只有在采血时间为数小时前时，才能对当前血清乙醇水平进行估计。本综述具有临床重要性，因为它展示了乙醇代谢和消除过程中具有临床意义的变异性以及个体之间的差异。它还将描述测量乙醇浓度的不同方法以及如何进行比较。最后，将讨论单一乙醇水平的解读。
