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Der Alkoholkranke als Patient

The alcoholic patient in the daily routine

Relevanz und Umgang mit der Alkoholkrankheit im medizinischen Alltag

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Summary

Chronic alcohol abuse is of significant clinical and economic relevance. A major part of internal medical pathology is associated with chronic alcoholism. 50% of all accidents with subsequent traumatic injuries are related to alcohol intake. Patients who are chronic alcohol abusers have prolonged hospital stays and substantial increases in postoperative morbidity.

A sophisticated diagnosis of alcoholism within standard clinical routine is often difficult, and in most cases the treatment of alcohol-related diseases and complications is protracted and requires increased energy expenditure by the treating physicians. In surgical patients, chronic alcohol abuse is associated with a 3-to 4-fold risk of infections, sepsis, cardiac and bleeding complications. Therefore, the patients themselves, along with the general practitioner and an in-hospital interdisciplinary team should cooperate in medical and operative treatment in order to attain better clinical outcome. Each patient history should include a detailed assessment of the quantity of daily alcohol intake. Alcoholic diagnostic regimens including questionnaires (i.e. CAGE, AUDIT) in combination with specific laboratory markers (CDT, GGT, MCV), if implemented, could prove valuable, especially in cases where major surgical procedures are considered.

Strict abstinence by alcoholic patients with organ pathology in medical and elective surgical settings as well as the prophylactic treatment of pre-operative alcohol withdrawal appear to be useful strategies to reduce the risk of complications. Short-term interventions are associated with reduced alcohol intake and decreased incidence of re-trauma.

Considering the clinical relevance of alcohol abuse, sufficient screening, interventions, and open approaches to address alcohol problems should be important components of the daily clinical routine in outpatient clinics, emergency rooms, in GPs’ offices and in general hospitals.

Zusammenfassung

Die Alkoholkrankheit hat eine hohe klinische und ökonomische Relevanz für alle Disziplinen. Ein Großteil internistischer Krankheitsbilder ist alkoholassoziiert. Die Hälfte aller Unfälle mit Traumafolgen sind bedingt durch Alkohol. Alkoholkranke Patienten haben eine verlängerte Krankenhausverweildauer und eine signifikant höhere postoperative Morbidität.

Eine differenzierte Diagnose im klinischen Alltag gestaltet sich oft schwierig und die Behandlung der alkoholassoziierten Erkrankungen sowie Komplikationen sind langwierig und mit erhöhtem Aufwand verbunden. In der operativen Medizin treten in Zusammenhang mit chronischem Alkoholmissbrauch Infektionen, Sepsis, kardiale Komplikationen und Blutungen 3–4-fach häufiger auf. Insbesondere gilt daher, durch suffiziente präoperative Vorbereitung unter Einbeziehung des Patienten, des Hausarztes und eines interdisziplinären Teams im stationären Bereich die Versorgung Alkoholkranker zu verbessern. Eine sorgfältige Erhebung des Alkoholkonsumverhaltens sollte wichtiger Teil einer jeden Anamnese sein. Der Einsatz von Fragebögen (CAGE, AUDIT) hat sich in Kombination mit Alkohollabormarkern (CDT, GGT, MCV) in der klinischen Routine bewährt.

Eine strikte Abstinenz bei Organschäden in der Inneren Medizin sowie vor elektiven, chirurgischen Eingriffen und die entzugsprophylaktische Behandlung von alkoholkranken Patienten mit Operationen scheinen sinnvolle präventive Maßnahmen zur Reduktion des Risikos zu sein. Kurzinterventionen sind mit einer Reduktion des Alkohokonsums assoziiert und senken die Häufigkeit eines erneuten Traumas.

In Anbetracht der Relevanz von Alkoholmissbrauch sollten gezieltes Screening, Interventionen und das bewusste Thematisieren des Alkoholproblems tägliche Routine in Ambulanzen, Notaufnahmen, bei niedergelassen Kollegen und in Allgemeinkrankenhäusern sein.

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Authors and Affiliations

  1. Klinik für Psychiatrie und Psychotherapie, Charité-Universitätsmedizin Berlin, Campus Charité Mitte, Gemeinsame Einrichtung von Freier Universität Berlin und Humboldt-Universität zu Berlin, Berlin, Deutschland

    Andreas Heinz

  2. Klinik für Anästhesiologie und operative Intensivmedizin, Universitätsklinikum der Humboldt-Universität zu Berlin. Charité Campus Mitte, Schumannstraße 20-21, D-10117, Berlin, Deutschland

    Jan-Philipp Breuer, Tim Neumann, Wolfgang J. Kox & Claudia Spies

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  1. Jan-Philipp Breuer
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  2. Tim Neumann
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  3. Andreas Heinz
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  4. Wolfgang J. Kox
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  5. Claudia Spies
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Correspondence to Claudia Spies.

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Breuer, JP., Neumann, T., Heinz, A. et al. Der Alkoholkranke als Patient. Wien Klin Wochenschr 115, 618–633 (2003). https://doi.org/10.1007/BF03040467

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  • DOI: https://doi.org/10.1007/BF03040467

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