Hirschl M M, Derfler K, Bieglmayer C, Röggla H, Zeiner A, Seidler D, Laggner A N
Department of Emergency Medicine, University of Vienna, Austria.
Alcohol Clin Exp Res. 1994 Jun;18(3):761-6. doi: 10.1111/j.1530-0277.1994.tb00943.x.
Controversial results of fluid and electrolyte derangements in patients with moderate alcohol intoxication have been described. However, no information is available about severe alcohol intoxication. We investigated differences of hormonal disorders between alcohol-habituated and alcohol-naive subjects with severe ethanol intoxication. The hormonal derangements and recommendations on therapy of these patients are discussed. Thirty-three patients [10 alcohol-naive (group A) and 23 alcohol-habituated (group B) subjects] with severe alcohol intoxication (blood ethanol > 200 mg/dl) were selected for the study. Electrolytes and osmolarity of serum and urine, blood ethanol, vasopressin, renin, and aldosterone were determined on admission 2, 4, and 6 hr later. Fluid balance was calculated for each hour. All patients received isotonic saline solution according to urine production. Group A: On admission, serum osmolarity was increased (308 mOsmol/kg). Concomitantly, vasopressin level was elevated on admission (9.12 pg/ml). Increased serum osmolarity was correlated with elevated vasopressin levels (r = 0.8211; p < 0.005). Serum electrolytes, renin, and aldosterone values were within normal ranges. Group B: On admission, vasopressin level was significantly decreased (0.9 pg/ml), despite an elevated serum osmolarity (309 mOsmol/kg). Serum osmolarity remained high despite a sufficient fluid substitution. In addition, vasopressin level remained suppressed over the observation period. Aldosterone level was significantly increased on admission (319 ng/ml). Accordingly, serum sodium was increased from 142 to 148 mM/liter, and serum potassium was decreased from 3.9 to 3.4 mM/liter. Response to hyperosmolarity due to severe alcohol intoxication is different in alcohol-naive and alcohol-habituated subjects.(ABSTRACT TRUNCATED AT 250 WORDS)
已有文献报道中度酒精中毒患者体液和电解质紊乱的结果存在争议。然而，关于重度酒精中毒的信息却尚无可用资料。我们研究了重度乙醇中毒的嗜酒者和非嗜酒者之间激素紊乱的差异。并讨论了这些患者的激素紊乱情况及治疗建议。本研究选取了33例重度酒精中毒（血液乙醇含量>200mg/dl）患者[10例非嗜酒者（A组）和23例嗜酒者（B组）]。在入院时、2小时后、4小时后和6小时后测定血清和尿液的电解质及渗透压、血液乙醇、血管加压素、肾素和醛固酮水平。每小时计算液体平衡情况。所有患者根据尿量接受等渗盐溶液。A组：入院时血清渗透压升高（308mOsmol/kg）。同时，入院时血管加压素水平升高（9.12pg/ml）。血清渗透压升高与血管加压素水平升高相关（r = 0.8211；p<0.005）。血清电解质、肾素和醛固酮值在正常范围内。B组：入院时，尽管血清渗透压升高（309mOsmol/kg），但血管加压素水平显著降低（0.9pg/ml）。尽管进行了充分的液体补充，血清渗透压仍保持较高水平。此外，在观察期内血管加压素水平一直处于抑制状态。入院时醛固酮水平显著升高（319ng/ml）。相应地，血清钠从142mmol/L升高至148mmol/L，血清钾从3.9mmol/L降至3.4mmol/L。重度酒精中毒导致的高渗反应在非嗜酒者和嗜酒者中有所不同。（摘要截断于250字）
