To test the suggestion that chlorpropamide-alcohol flushing (CPAF) resembles the disulfiram effect and might be mediated by acetaldehyde, the initial metabolite of alcohol, blood concentrations of acetaldehyde were measured after a drink of alcohol in controls and diabetics positive and negative for CPAF. The CPAF-positive diabetics had significantly greater blood acetaldehyde concentrations after alcohol than the CPAF-negative diabetics both with a single dose of chlorpropamide and after two weeks' chlorpropamide treatment. Concentrations in the CPAF-positive group after chlorpropamide were also significantly greater than after a placebo tablet. There was also a clear separation in the increase in facial temperature after two weeks of chlorpropamide between the CPAF-positive and CPAF-negative groups (although there was some overlap after a single tablet). There was no difference in plasma chlorpropamide or alcohol concentrations between CPAF-positive and CPAF-negative diabetics. These findings show that CPAF is distinct from alcohol flushing and that the acetaldehyde concentration in the blood provides an objective measure of CPAF. The difference between flushing and non-flushing diabetics cannot be accounted for by differences in blood concentrations of chlorpropamide or alcohol.

Acetaldehyde↗

PubMed1981

Alcohol-induced hypertension.

Blood pressures of 132 alcoholic patients whose mean daily alcohol consumption exceeded 80 g where measured while drinking, during detoxification from alcohol, and after a period of abstinence. At the time of presentation blood pressure exceeded 140/90 in 51.5% of patients. There was a significant correlation between blood pressure and mean daily alcohol intake over the previous three months and also between the level of blood pressure and the severity of alcohol-withdrawal symptoms. There was no relation between blood pressure and degree of histological liver damage, but a correlation was found with serum gamma-glutamyl-transferase activity and with mean corpuscular volume. In most patients blood pressure fell to normal after detoxification, and remained so for at least a year in those who continued to abstain. However, blood pressure rose in those who started drinking again. Excessive alcohol consumption is an important and insufficiently recognised cause of hypertension and, although the exact mechanism is unknown, treatment is simple and effective if patients can be persuaded to abstain.U

Adult↗

PubMed1981

Do women develop alcoholic liver disease more readily than men?

The sudden increase in alcoholic liver disease among women in the past 10 years has caused much speculation that they may be more susceptible to the hepatotoxic effects of alcohol than men. Women tend to present with more severe liver disease, particularly alcoholic hepatitis, and do so after a shorter period of excessive drinking and at a lower daily alcohol intake. Differences in body size and composition are partly responsible for the greater susceptibility of women, but differences in immune reactivity between the sexes may also play a part. Greater emphasis must be placed on designing abstinence programmes specifically for female patients, on earlier detection of liver disease, and on educating women about hazardous drinking levels.

Alcohol Drinking↗

PubMed1981

A 20-year prospective study of cirrhosis.

A total of 512 people from a defined population in west Birmingham served by a district general hospital were found to have cirrhosis in the period 1959-76. The annual incidence rose from 5.6 per 100 000 to a peak of 15.3 per 100 000 in 1974. This was due to an increase in the incidence of alcoholic cirrhosis, which in the last six years accounted for two-thirds of cases. The proportion of patients with decompensated cirrhosis when first seen (65%) did not alter during the 18 years. This was reflected in a death rate of 78% among the 468 patients traced up to the end of 1978. Liver failure, hepatoma, and gastrointestinal haemorrhage accounted for almost three-quarters of the deaths. The proportion of patients who survived for five years was 36% for alcoholic cirrhosis, 14% for cryptogenic cirrhosis, and 60% for chronic active hepatitis, and these figures too remained constant throughout the 18 years. Modern methods of treatment for decompensated cirrhosis did not improve prognosis and only abstention in patients with alcoholic cirrhosis had a beneficial effect on survival. Since alcoholic cirrhosis is now the most common form of the disease it is important to recognise those at risk and to encourage abstinence; also, more efforts are needed to identify the causes of cryptogenic cirrhosis. Whatever the cause, cirrhosis needs to be diagnosed before decompensation occurs, if treatment is to have any effect.

Age Factors↗

PubMed1981

Alcoholism: what can the OH service do?

Explore the source record for details and available documents.

Alcoholism↗

PubMed1980

Predicting outcome of paracetamol poisoning by use 14C-aminopyrine breath test.

The 14C-aminopyrine (14C-amidopyrine) breath test, carried out within 24-36 hours of an overdosage of paracetamol, was used to predict the extent of liver damage in 30 seriously poisoned patients. Mean 14CO2 excretion was 4.4% in 20 healthy control subjects; 5.5% in six patients who escaped injury; and 2.9%, 1.5%, and 0.2% in those with mild to moderate (12 patients), severe (eight patients), and fatal (four patients) liver damage respectively. This test proved to be a more reliable predictor of the extent of liver damage than plasma paracetamol concentration or half life or the results of conventional liver function tests and may enable treatment of hepatic failure to be started at an early stage.

Acetaminophen↗

PubMed1980

Early diagnosis of alcoholic cirrhosis by the aminopyrine breath test.

The aminopyrine breath test was assessed as an indicator of liver damage in a consecutive series of 49 chronic alcoholics admitted for detoxification. Mean 14CO2 excretion for those with compensated cirrhosis was 1.6%, compared with 6.8% for those with histologically normal livers, 4.3% for those with fatty change, and 4.0% for those with fatty change and fibrosis. All patients with cirrhosis had a value below the lower limit of normal (3.2%), whereas only 6 of the other patients had a subnormal value. Repeat studies after 7-10 days' abstinence showed that 14CO2 excretion increased in patients with compensated cirrhosis. In view of the poor prognosis of alcoholic cirrhosis once decompensation occurs, early identification of those at risk is important. The aminopyrine breath test was found to be a conventient and sensitive method for detecting early cirrhosis and lends itself as a screening procedure in the management of alcoholic patients.

Adult↗

PubMed1979

Factors influencing blood pressure in chronic alcoholics.

1. Of 96 alcoholics admitted for detoxification, 48% were hypertensive (systolic blood pressure greater than 140 mmHg and/or diastolic pressure greater than 90 mmHg). 2. Elevation of both systolic and diastolic blood pressures was related to the severity of alcohol-withdrawal symptoms. 3. After these symptoms had abated only 9% of patients remained hypertensive. 4. Blood pressure remained normal if patients abstained from alcohol after discharge but rose in those who started drinking again. 5. Hypertension was not consistently related to the presence or severity of alcoholic liver disease. 6. Alcohol-related hypertension may be the result of the alcohol-withdrawal syndrome; increased noradrenergic activity is suggested as the likely mechanism.

Adult↗