Alcohol intoxication in the emergency room: effect on some common laboratory tests

Excessive alcohol consumption and abuse are widely observed around the world and contribute to high health care and social costs in developed as well as in developing countries (1,2). Excessive consumption of alcohol may lead to a variety of gastrointestinal, neurologic, cardiovascular and malignant diseases, being also a high-risk factor in all causes of death (3-5). However, alcohol related diseases are not observed in every individual who drinks hazardous amounts of alcohol. Many changes in biochemical and hematological laboratory values have been observed in habitual heavy drinkers. Some of those tests, such as MCV (6-8), serum GGT (9, 10) and AST (11) have been widely used as markers of alcohol abuse. MCV has emerged as the most specific commonly available laboratory marker (12) and as the best single discriminant test in identifying heavy drinkers (13). Chronic alcohol abuse is related to the risk of cirrhosis (14) and other physical harm and in alcoholics the risk of complication after trauma increased twofold with longer hospital stays (15, 16). In subjects referred to an emergency room, with suspected clinical signs of alcohol intoxication, systematic blood sampling was performed to determine the BAC together with other routine tests. The purpose of this study is to evaluate the serum values of some commonly used laboratory analytics in both non-alcoholics and alcoholics with different BAC levels. We also evaluated the clinical diagnoses by comparing non-alcoholics and alcoholics. Background. Excessive alcohol consumption and alcohol abuse may lead to a variety of diseases. Many changes in biochemical and hematological laboratory parameters have been observed in alcoholic subjects. The present paper evaluates the serum concentration of some common laboratory tests in subjects with acute alcohol intoxication. Methods. Blood alcohol concentration (BAC) levels were determined in 877 subjects treated in the emergency room; 774 (93.1%) of them, 631 (81.52%) males and 143 (18.48%) females, had a detectable alcohol concentration (>10 mg/dL). Erythrocyte mean corpuscular volume (MCV) and serum glucose, urea, creatinine, sodium (Na+), potassium (K+) and aspartate aminotransferase (AST), alanine-aminotransferase (ALT), creatine phosphokinase (CK), lactate dehydrogenase (LDH), amylase (AMY) activities were also measured. Results. 462 males (73.21%) and 100 females (69.93%) were alcohol intoxicated with BAC levels higher than 80 mg/dL. 142 (22.9%) males and 27 (20%) females were alcoholics with a MCV value higher than 97 fL. The mean value of BAC levels was not significantly different in alcoholic versus nonalcoholic males and females. However, significant differences were observed in AST, ALT, AMY values. In non-alcoholic subjects significant changes of urea, AST, ALT, LDH values in males and AST and ALT in females were associated with BAC levels higher than 80mg/dL and significant glucose changes. AMY and Na+ changes were observed where BAC levels were higher than 200 mg/dL in both males and females; significant MCV and glucose changes were associated with the highest BAC levels in both males and females. In alcoholic subjects significant changes for urea, AST, ALT and Na+ values were observed for BAC levels higher than 200 mg/dL in both males and females. AST levels in both alcoholic and non-alcoholic males and females and LDH activities in non-alcoholic males were outside the reference interval. Conclusions. Acute alcohol intoxication significantly affects the above laboratory tests in both alcoholic and non-alcoholic subjects. Acute intoxication affects more tests in non-alcoholics than it does in alcoholics; moreover the significant changes that take place in alcoholics occur at lower BAC levels than in non-alcoholics.