COMMENTARY

The Science and Treatment of Alcoholism

Derick E. Vergne, MD; Sivan Mauer, MD

Disclosures

September 30, 2015

In This Article

Case Presentation: Drunk and Disheveled

A 55-year-old white man, Mr Y, was brought by ambulance to a medical center facility after being found acutely intoxicated, lying down along a sidewalk on one of the busiest streets of the city. Upon initial evaluation by the EMT team, the patient was arousable but unaware of his surroundings. The team noticed a strong alcohol odor emanating from the patient. His vital signs were as follows: blood pressure 139/91 mm Hg, respirations 18 breaths/min, pulse 110 beats/min, and temperature 98.3° F. Inspection of his belongings yielded a near empty pint of whiskey. After ensuring that the airway, breathing, and circulation protocol was followed, and making sure that the patient didn't have any life-threatening physical injuries, he was placed in a splint bed, with his neck well secured. Intravenous access was obtained, and an infusion of thiamine and glucose was initiated. A blood sample was drawn for general analysis. The patient was then driven to the local emergency department (ED) and immediately seen and evaluated by the ED physician.

Dr X performed a complete physical exam on Mr Y, who was now more alert and oriented to self and situation. The exam revealed a disheveled man who appeared older than his stated age. He appeared to be sedated but was arousable on command. He was found to have a slightly yellowish skin tone that was also apparent in his sclera. He had a significantly distended abdomen and 2+ pitting edema of his lower extremities. He was also found to have a partially healed bruise on his left shoulder that appeared to have been the result of a recent fall. The rest of his physical exam was noncontributory.

Laboratory results were significant and revealed the following:

  • Alanine aminotransferase: 65 IU/L

  • Aspartate aminotransferase: 102 IU/L

  • Gamma glutamyltransferase: 300 IU/L

  • Carbohydrate deficient transferrin (%CDT): 4.3

  • Albumin 3.4 g/dL

  • Mean corpuscular volume: 102.2 fL

  • Alkaline phosphatase: 260 U/L

  • Prothrombin time: 11.10 sec

  • Bilirubin (total): 2.8 mg/dL

  • Lactate dehydrogenase: 150 U/L

  • Ammonia (NH3): 50 mg/dL

  • Blood alcohol level: 120 mg/%

  • Renal function values within normal limits

  • Urine toxicology positive for the presence of cannabinoids but no other illicit substances

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