\Contributor: Don Stader, MD

Educational Pearls:

• Altered mental status/confusion are major symptoms associated with both alcohol use and withdrawal.
• Wernicke's encephalopathy is a triad of symptoms of confusion, internuclear ophthalmoplegia, and confabulation
• The treatment for Wernicke's is IV thiamine or vitamin B1
• Untreated Wernicke's leads to Korsakoff's syndrome where a prolonged thiamine deficiency leads to worsening brain function
• Subdural hematomas from torn bridging veins are common in alcoholics because of the combination of frequent falls and cerebral atrophy caused by alcohol.
• Alcohol is a major cause of heart failure and atrial fibrillation; "holiday heart" is a-fib induced by binge drinking where high levels of acetaldehyde from the metabolism of alcohol excite the heart.
• Frequent alcohol use is linked to esophageal cancer
• Alcoholic cirrhosis can lead to a multitude of complications including esophageal varices that can rupture often with fatal outcomes
• Aspiration pneumonia is more common in alcoholics because of a depressed gag reflex and alteration of oral flora

References

Brousse G, Geneste-Saelens J, Cabe J, Cottencin O. Alcool et urgences [Alcohol and emergencies]. Presse Med. 2018;47(7-8 Pt 1):667-676. doi:10.1016/j.lpm.2018.06.001

Chandrakumar A, Bhardwaj A, 't Jong GW. Review of thiamine deficiency disorders: Wernicke encephalopathy and Korsakoff psychosis. J Basic Clin Physiol Pharmacol. 2018;30(2):153-162. Published 2018 Oct 2. doi:10.1515/jbcpp-2018-0075

Simou E, Britton J, Leonardi-Bee J. Alcohol and the risk of pneumonia: a systematic review and meta-analysis. BMJ Open. 2018;8(8):e022344. Published 2018 Aug 22. doi:10.1136/bmjopen-2018-022344

Summarized by Jackson Roos, MS4 | Edited by Erik Verzemnieks, MD