Abstract
Many trauma patients are acutely intoxicated with alcohol. Animal studies have demonstrated that acute alcohol intoxication inhibits the normal release of epinephrine, norepinephrine, and vasopressin in response to acute hemorrhage. Ethanol also increases nitric oxide release and inhibits antidiuretic hormone secretion. This article studies the effects of alcohol intoxication (measured by blood alcohol level, BAL) on the presentation and resuscitation of trauma patients with blunt hepatic injuries. A retrospective registry and chart review was conducted of all patients who presented with blunt liver injuries at an ACS-verified, level I trauma center. Data collected included admission BAL, systolic blood pressure, hematocrit, International Normalized Ratio (INR), liver injury grade, Injury Severity Score (ISS), intravenous fluid and blood product requirements, base deficit, and mortality. From September 2002 to May 2008, 723 patients were admitted with blunt hepatic injuries. Admission BAL was obtained in 569 patients, with 149 having levels >0.08%. Intoxicated patients were more likely to be hypotensive on admission (p = 0.01) despite a lower liver injury grade and no significant difference in ISS. There was no significant difference in the percent of intoxicated patients requiring blood transfusion. However, when blood was given, intoxicated patients required significantly more units of packed red blood cells (PRBC) than their nonintoxicated counterparts (p = 0.01). Intoxicated patients also required more intravenous fluid during their resuscitation (p = 0.002). Alcohol intoxication may impair the ability of blunt trauma patients to compensate for acute blood loss, making them more likely to be hypotensive on admission and increasing their PRBC and intravenous fluid requirements. All trauma patients should have BAL drawn upon admission and their resuscitation should be performed with an understanding of the physiologic alterations associated with acute alcohol intoxication.
This is a preview of subscription content, log in via an institution to check access.
Similar content being viewed by others
References
Rivara FP, Jurkovich GJ, Gurney JG et al (1993) The magnitude of acute and chronic alcohol abuse in trauma patients. Arch Surg 128(8):907–912
Gentilello LM, Ebel BE, Wickizer TM et al (2005) Alcohol interventions for trauma patients treated in emergency departments and hospitals: a cost benefit analysis. Ann Surg 241:541–550
Soderstrom CA, Smith GS, Dischinger PC et al (1997) Psychoactive substance use disorders among seriously injured trauma center patients. JAMA 277(22):1769–1774
Maier RV (2001) Ethanol abuse and the trauma patient. Surg Infect (Larchmt) 2(2):133–141 discussion 141-144
Greiffensetin P, Molina PE (2008) Alcohol-induced alterations on host defense after traumatic injury. J Trauma 64:230–240
Zambell KL, Phelan H, Vande Stouwe C et al (2004) Acute alcohol intoxication during hemorrhagic shock: impact on host defense from infection. Alcohol Clin Exp Res 28(4):635–642
Phelan H, Stahls P, Hunt J et al (2002) Impact of alcohol intoxication on hemodynamic, metabolic, and cytokine responses to hemorrhagic shock. J Trauma 52:675–682
Molina P, Zambell K, Norenberg K et al (2004) Consequences of alcohol-induced early dysregulation of responses to trauma/hemorrhage. Alcohol 33:217–227
McDonough KH, Giaimo ME, Miller HI (2002) Low-dose ethanol alters the cardiovascular, metabolic and respiratory compensation for severe blood loss. J Trauma 53:541–548
Horton J (1992) Cardiac contractile effects of ethanolism and hemorrhagic shock. Am J Physiol 262:H1096–H1103
Council on Scientific Affairs (1986) Alcohol and driver. JAMA 255(4):522–527
Fell JC, Voas RB (2006) The effectiveness of reducing illegal blood alcohol concentration (BAC) limits for driving: evidence for lowering the limit to.05 BAC. J Safe Res 37:233–243
Moore E, Feliciano D, Mattox K (2004) Trauma, 5th ed. McGraw-Hill Professional, New York, p 639, Table 31-1
Yanar H, Ertekin C, Taviloglu K et al (2008) Nonoperative treatment of multiple intra-abdominal solid organ injury after blunt abdominal trauma. J Trauma 64:943–948
Moore EE, Cogbill TH, Jurkovich GJ (1995) Organ injury scaling: spleen and liver (1994 revision). J Trauma 38:323–324
Davis J, Kaups K, Parks S (1997) The effect of alcohol on the utility of base deficit in trauma. J Trauma 43:507–510
Spoerke N, Underwood S, Differding J (2010) Effects of ethanol intoxication and gender on blood coagulation. J Trauma 68:1106–1111
Lacoste L, Hung J, Lam JY (2001) Acute and delayed antithrombotic effects of alcohol in humans. Am J Cardiol 87(1):82–85
de Lange DW, Hijmering ML, Lorsheyd A (2004) Rapid intake of alcohol (binge drinking) inhibits platelet adhesion to fibrinogen under flow. Alcohol Clin Exp Res 28(10):1562–1568
Hamazaki T, Shishido H (1983) Increase in blood viscosity due to alcohol drinking. Thromb Res 30:587–594
American College of Surgeons (2008) ATLS: Advanced Trauma Life Support for Doctors (Student Course Manual), 8th ed. Chicago: American College of Surgeons, Chap 3
Graeme E, Johnson RH (1982) Effect of ethanol ingestion on plasma vasopressin and water balance in humans. Am J Physiol 242(5):R522–R527
Collins GB, Brosnihan KB, Zuti RA et al (1992) Neuroendocrine, fluid balance, and thirst responses to alcohol in alcoholics. Alcohol Clin Exp Res 16(2):228–233
Author information
Authors and Affiliations
Corresponding author
Rights and permissions
About this article
Cite this article
Bilello, J., McCray, V., Davis, J. et al. Acute Ethanol Intoxication and the Trauma Patient: Hemodynamic Pitfalls. World J Surg 35, 2149–2153 (2011). https://doi.org/10.1007/s00268-011-1191-7
Published:
Issue Date:
DOI: https://doi.org/10.1007/s00268-011-1191-7