Case Report
65-year-old man who presented to the emergency department with
syncope, hypotension (80/60 mm Hg), tachycardia (110 bpm), diffuse
erythema, hypothermia (35.5oC), and shivering. Laboratory tests
revealed metabolic acidosis (pH 7.33, lactate 8.7 mmol/L).
He was initially treated for anaphylactic shock, as well as with
broad-spectrum antibiotics for possible sepsis. He reported
drinking a half liter of wine shortly before symptoms onset.
Additional history elicited that he had also ingested disulfiram
500 mg 1 hour before the wine intake. All manifestations resolved
within 6 hours. Cultures were negative.
The final diagnosis was severe disulfiram ethanol reaction
(DER).
Questions:
1. What is disulfiram?
2. What is mechanism of action of interaction in above case?
3. Which other drugs can have disulfiram like reaction with
ethanol?
4. What amount of alcohol is required to produce this
reaction?
6. What is treatment?
7. What is treatment of methanol poisoning?
1 and 2. Disulfiram is a antabuse drug used to manage chronic alcoholism. It is not a cure for alcoholism. It acts by inducing nausea and other unpleasant effects following an ingestion of alcohol. So, when an individual who is on disulfiram takes a small quantity of alcoholism, it produces a unpleasant reaction that interferes with the metabolic degradation of alcohol. This causes an acetic acetyldehyde reaction to accumulate which leads to symptoms of tightness in the chest, palpitations, anxiety and vomiting.
3.The other drugs which have disulfiram like reaction with ethanol is
a) Metronidazole (an antibiotic)
b) Some Cephalosporin group drugs
c) First generation sulfonylurea hypoglycemic drugs and
d) Chloral hydrate
4. A small amount of alcohol with disulfiram can cause this reaction. After the intake of alcohol, the concentration of acetyldehyde will be 5 to 10 times found more higher. This increase in the concentration cause the symptoms of nausea and vomiting which further leads to negative reaction to alcohol intake.
6. Medication assisted treatment (MAT) is suggested for a patient with disulfiram to reduce the symptoms.
7. Methanol poisoning can cause retinal toxicity which leads to blindness. Treatment can be given by a) treating the metabolic acidosis through administration of bicarbonate and assisted ventilation b) antidote therapy can be given and c) by hemodialysis
Case Report 65-year-old man who presented to the emergency department with syncope, hypotension (80/60 mm Hg),...
65-year-old man who presented to the emergency department with syncope, hypotension (80/60 mm Hg), tachycardia (110 bpm), diffuse erythema, hypothermia (35.5oC), and shivering. Laboratory tests revealed metabolic acidosis (pH 7.33, lactate 8.7 mmol/L). He was initially treated for anaphylactic shock, as well as with broad-spectrum antibiotics for possible sepsis. He reported drinking a half liter of wine shortly before symptoms onset. Additional history elicited that he had also ingested disulfiram 500 mg 1 hour before the wine intake. All manifestations...