Intensivist Interview: Chronic diseases and conditions related to alcohol use

Ataxia, GI bleeds, ascites, jaundice… patient’s with long term, heavy alcohol consumption can have head-to-toe problems. Dr. Natalie Htet, emergency physician and intensivist, and I go over the expected assessment findings of the ETOH patient, what to look out for, and long-term management of alcoholic cirrhosis.

Classic presentation of patients with long-term heavy alcohol consumption:

  • Ataxia: loss of balance, tremors
  • Dilated cardiomyopathy that ultimately leads to a decrease in ejection fraction
  • Hypotension
  • Weakness
  • Beer potomania: expect all electrolytes, especially Na+, to be low
  • Renal failure
  • Jaundice, bruising, coagulopathies
  • Ascites, gastritis
  • Shortness of breath when sitting or standing-up due to hepatopulmonary syndrome

Keep an eye out for the following potential disasters:

  • Subdural hematoma. Patients may have an undiagnosed head bleed due a forgotten fall. Remember: a headache is never just a headache for an alcoholic patient
  • Aspiration pneumonia due to an impaired gag reflex (among other reasons)
  • Upper GI bleed. An esophageal variceal rupture can cause life-threatening bleeding
  • Lower GI bleed: hemorrhoids

Long Term Management of Chronic Alcoholic Cirrhosis

The Liver Transplant Route

The Palliative Route

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