Intensive Care Medicine

, Volume 28, Issue 10, pp 1475–1482

Blood alcohol concentration for monitoring ethanol treatment to prevent alcohol withdrawal in the intensive care unit

  • Verena Eggers
  • Joke Tio
  • Tim Neumann
  • Fritz Pragst
  • Christian Müller
  • Lutz G. Schmidt
  • Wolfgang J. Kox
  • Claudia D. Spies
Original

DOI: 10.1007/s00134-002-1413-4

Cite this article as:
Eggers, V., Tio, J., Neumann, T. et al. Intensive Care Med (2002) 28: 1475. doi:10.1007/s00134-002-1413-4

Abstract

Objective. Alcohol withdrawal syndrome (AWS) is a serious complication during postoperative treatment in chronic alcoholics. Despite prophylactic treatment, AWS occurs in at least 25% of these patients after elective surgery. An established protocol for the prevention of AWS is ethanol administration. The aim of this study was to evaluate possible differences in ethanol dose and levels between successfully treated patients and those who developed AWS.

Design. Prospective, observational study with retrospective post hoc analysis.

Setting. Intensive care unit (ICU).

Patients. Thirty-two alcohol-dependent patients undergoing elective or emergency surgery after trauma with postoperative admission to ICU.

Interventions. Continuous postoperative i.v. ethanol substitution.

Measurements and results. Despite treatment, 13 patients developed AWS (failure group) and therapy was successful in the other 19 patients (success group). Major complications occurred more frequently in the failure group. The total dose of ethanol treatment and ethanol levels did not differ between the groups. Ethanol levels were determined in whole arterial blood (aBAC) and simultaneously taken in venous blood (vBAC), urine (UAC) and exhaled air (EAC). The following bias and precision, compared with aBAC, were found: vBAC less than UAC less than EAC.

Conclusions. There is a high failure rate for i.v. ethanol prophylaxis. None of the methods to determine alcohol concentration were sufficient to monitor suitable ethanol treatment. It therefore seems to be more useful to titrate the individual dose for each patient by closer monitoring of the clinical status, adding additional therapy to counteract AWS if higher ethanol doses are required.

Alcohol Ethanol substitution Alcohol withdrawal syndrome Blood alcohol concentration (BAC) Intensive care unit Complications

Copyright information

© Springer-Verlag 2002

Authors and Affiliations

  • Verena Eggers
    • 1
  • Joke Tio
    • 2
  • Tim Neumann
    • 1
  • Fritz Pragst
    • 3
  • Christian Müller
    • 4
  • Lutz G. Schmidt
    • 5
  • Wolfgang J. Kox
    • 1
  • Claudia D. Spies
    • 1
  1. 1.Department of Anesthesiology and Intensive Care Medicine, University Hospital Charité, Charité Campus Mitte, Schumannstrasse 20/21, 10117 Berlin, Germany
  2. 2.Department of Gynecology and Obstetrics, Klinikum Bayreuth, Preuschwitzer Strasse 101, 95455 Bayreuth, Germany
  3. 3.Institute of Forensic Medicine, Charité Campus Mitte, Humboldt University of Berlin, Schumannstrasse 20/21, 10117 Berlin, Germany
  4. 4.Department of Clinical Chemistry and Biochemistry, Charité Campus Virchow Klinikum, Humboldt University of Berlin, Augustenburger Platz 1, 13353 Berlin, Germany
  5. 5.Department of Psychiatry, Johannes Gutenberg University, Untere Zahlbacher Strasse 8, 55131 Mainz, Germany