Ul Abideen Zain, Abbas Syed Farhat, Farooq Madeeha, Rasheed Amna, Ali Furqan
Nephrology and Renal Transplant, Shifa International Hospital, Islamabad, Pakistan.
Department of Nephrology, Shifa International Hospital, Islamabad, Pakistan.
Cureus. 2016 Dec 1;8(12):e905. doi: 10.7759/cureus.905.
Acute alcohol intoxication is a common cause of emergency visits worldwide. Although moderate alcohol consumption is protective against coronary artery disease, binge drinking is associated with adverse cardiovascular and neurological outcomes and may even cause sudden death. Although, few past accounts of venous thrombosis with alcohol binge drinking are available, arterial thrombosis with the condition has never been reported in the literature. We present the unusual case of a young Afghan male, who presented to us with painful, tender and swollen legs three days after a heavy alcohol binge on a Saturday night. He was diagnosed as a case of acute limb ischemia secondary to massive abdominal aorta and bilateral femoral artery thrombosis. He also had acute renal failure secondary to rhabdomyolysis. Cardiac workup revealed new onset paroxysmal atrial fibrillation and a large thrombus in the left ventricular cavity. His blood ethanol level was high. He was treated by a multidisciplinary team; urgent surgical thrombectomy for thrombotic complications, intravenous fluid hydration and later renal replacement therapy for acute renal failure. To the best of our knowledge, such a constellation of clinical features in association with severe acute alcohol intoxication has not been reported in the literature. We believe, the procoagulant nature of high blood ethanol levels and the onset of atrial fibrillation after the heavy alcohol binge, known as the holiday heart syndrome, precipitated the thrombotic events leading to rhabdomyolysis and acute renal failure. Through this case, we conclude that a very heavy alcohol binge may cause thrombotic occlusion of the abdominal aorta and femoral arteries resulting in ischemic rhabdomyolysis and acute renal failure. A high index of suspicion must be kept, especially for a patient presenting with tender, swollen lower limbs and acute renal failure after an alcohol binge.
急性酒精中毒是全球急诊就诊的常见原因。虽然适度饮酒对冠状动脉疾病有预防作用，但暴饮则与不良的心血管和神经学后果相关，甚至可能导致猝死。尽管过去关于暴饮酒精导致静脉血栓形成的报道较少，但文献中从未报道过因这种情况导致的动脉血栓形成。我们报告了一例不寻常的病例，一名年轻的阿富汗男性在周六晚上暴饮大量酒精三天后，出现腿部疼痛、压痛和肿胀。他被诊断为急性肢体缺血，继发于腹主动脉和双侧股动脉的大面积血栓形成。他还因横纹肌溶解继发急性肾衰竭。心脏检查发现新发阵发性心房颤动和左心室腔内有一个大血栓。他的血液乙醇水平很高。他接受了多学科团队的治疗；针对血栓形成并发症进行了紧急手术血栓切除术，静脉补液，随后针对急性肾衰竭进行了肾脏替代治疗。据我们所知，文献中尚未报道过与严重急性酒精中毒相关的如此一系列临床特征。我们认为，高血液乙醇水平的促凝性质以及暴饮大量酒精后出现的心房颤动（即假日心脏综合征）引发了血栓形成事件，导致横纹肌溶解和急性肾衰竭。通过这个病例，我们得出结论，非常大量的酒精暴饮可能导致腹主动脉和股动脉的血栓闭塞，从而导致缺血性横纹肌溶解和急性肾衰竭。必须保持高度的怀疑指数，尤其是对于在暴饮酒精后出现下肢压痛、肿胀和急性肾衰竭的患者。
