Recognition of a disulfiram ethanol reaction in the emergency department is not always straightforward
| Autor: | Tania Desmet, Kristof Segher, Liesbeth Huys, Stefanie Chys, Evi Steen, Peter De Paepe, Walter Buylaert |
|---|---|
| Přispěvatelé: | Lin, Steve |
| Jazyk: | angličtina |
| Rok vydání: | 2020 |
| Předmět: |
Male
Critical Care and Emergency Medicine Physiology Health Care Providers Blood Pressure Vascular Medicine 0302 clinical medicine HYPOTENSION Disulfiram Medicine and Health Sciences Medicine Drug Interactions Medical Personnel 030212 general & internal medicine Medical diagnosis Prospective cohort study Alcohol Consumption Multidisciplinary PLASMA Organic Compounds Incidence (epidemiology) Middle Aged Body Fluids Alcoholism Chemistry Professions Blood Physical Sciences Female Anatomy Emergency Service Hospital Research Article medicine.drug Adult medicine.medical_specialty ACUTE MYOCARDIAL-INFARCTION Alcohol Drinking Science Acetaldehyde Blood Plasma 03 medical and health sciences Diagnostic Medicine Physicians Humans Medical history ACETALDEHYDE Retrospective Studies Nutrition Ethanol business.industry Organic Chemistry Chemical Compounds Biology and Life Sciences Retrospective cohort study PHARMACOTHERAPY Emergency department Diet Health Care METABOLITE ALCOHOL-USE DISORDER Alcohols People and Places Emergency medicine Population Groupings business 030217 neurology & neurosurgery Disulfiram overdose Alcohol Deterrents |
| Zdroj: | PLOS ONE PLoS ONE, Vol 15, Iss 12, p e0243222 (2020) PLoS ONE |
| ISSN: | 1932-6203 |
| Popis: | Objectives Disulfiram is an adjunct in the treatment of alcohol use disorders, but case reports indicate that disulfiram ethanol reactions are not always recognized in the emergency department. Our first aim is to remind of this risk with two case reports of life-threatening reactions not immediately considered by the emergency physician. The second aim is to estimate the probability that a disulfiram reaction goes unrecognized with the use of a retrospective study of patients admitted to the emergency department. Methods Clinical files of patients admitted between October 1, 2010 and September 30, 2014 to the emergency department were retrospectively screened for the key words “ethanol use” and “disulfiram”. Their diagnoses were then scored by a panel regarding the probability of an interaction. Results Seventy-nine patients were included, and a disulfiram-ethanol reaction was scored as either ‘highly likely’, ‘likely’ or ‘possible’ in 54.4% and as ‘doubtful’ or ‘certainly not present’ in 45.6% of the patients. The interrater agreement was 0.71 (95% CI: 0.64–0.79). The diagnosis was not considered or only after a delay in 44.2% of the patients with a ‘possible’ to ‘highly likely’ disulfiram interaction. One patient with a disulfiram overdose died and was considered as a ‘possible’ interaction. Discussion and conclusions A disulfiram ethanol interaction can be life threatening and failure to consider the diagnosis in the emergency department seems frequent. Prospective studies with documentation of the intake of disulfiram and evaluation of the value of acetaldehyde as a biomarker are needed to determine the precise incidence. Improving knowledge of disulfiram interactions and adequate history taking of disulfiram intake may improve the care for patients. |
| Databáze: | OpenAIRE |
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