Patients admitted to emergency services for drunkenness: moderate alcohol users or harmful drinkers?

OBJECTIVE: Most of the patients admitted to hospital emergency services are drunk. Some of them may need specific treatment after acute intoxication remits. At present, treatment for alcoholism is offered to less than 5% of these patients. The authors evaluated the biological markers carbohydrate-deficient transferrin (CDT) and gamma-glutamyltransferase (GGT) in patients admitted for acute alcohol intoxication (per DSM-IV criteria) supported by blood alcohol assay. These tests distinguished between otherwise moderate alcohol users who were acutely intoxicated and harmful drinkers or alcohol-dependent patients. METHOD: The authors conducted an exhaustive survey 24 hours a day during 2 nonconsecutive months. The study involved 166 patients (124 men and 42 women) who were admitted for acute alcohol intoxication as a principal or additional diagnosis. Their blood was analyzed for alcohol, GGT, and CDT levels. The CAGE questionnaire was administered, and social and demographic data were collected. RESULTS: About 80% of the population studied displayed elevated GGT or CDT levels (65.7% had CDT levels >60 mg/liter; 41.6% had GGT levels >65 IU/liter). Less than 10% of the patients with acute alcohol intoxication revealed results in the normal range for both markers and a negative finding on the CAGE questionnaire. CONCLUSIONS: Patients admitted to emergency services with high blood alcohol levels should not be assumed to be moderate drinkers. Any drunkenness should be interpreted as a sign of likely harmful alcohol consumption or alcohol dependency requiring clinical and biological tests, including GGT and CDT assays. Specific treatment for alcoholism should be systematically offered to these patients.

Basal production of pentane in expired gas from healthy humans.

BACKGROUND: Pentane in exhaled gas is often used as an index of lipoperoxidation, but today, there is no standardization for its measurement. In this study, with our technical experience, we determined basal production of pentane in healthy subjects, and we evaluated variability of pentane flow 1 month later. METHODS: 18 subjects inhaled hydrocarbon-free air (HCFA) in order to realize a lung washout. Ambient air and three samples (at T0, T10, T30 min) of expired gas were concentrated using a "trap-and-purge" procedure. For the analysis of pentane, an Al(2)O(3)/KCl plot column contained in a gas chromatograph equipped with a flame ionization detector was used. RESULTS: After 10 min of washout, mean (+/-SD) exhalation rate of pentane was 1+/-0.6 pmol min(-1) kg(-1). After 30 min of washout, mean (+/-SD) exhalation rate of pentane was 0.7+/-0.5 pmol min(-1) kg(-1). No significant difference in pentane flow was shown 1 month later for eight subjects who repeated the protocol. CONCLUSION: With our results and data of the literature, exhalation rates of pentane from healthy adults appear to range between 0.3 and 2 pmol min(-1) kg(-1). The variability of pentane flow 1 month later seems not very important.

Oxygen toxicity: simultaneous measure of pentane and malondialdehyde in humans exposed to hyperoxia.

In order to estimate cell damage caused by free radicals during oxygenotherapy, we investigated the time course of two markers of lipoperoxidation: pentane in breath and malondialdehyde (MDA) in blood during brief normobaric hyperoxia. Nine healthy subjects inhaled hydrocarbon-free air (HCFA) for 30 minutes, hydrocarbon-free 100% O2 (HCFO2) for 125 minutes and then HCFA for 70 minutes. After 15 minutes of washout with HCFA, ambient pentane was eliminated. After HCFO2, at T175 versus T30 (i.e., 145 min from the start of 100% HCFO2), pentane production increased (P< 0.05). MDA rose significantly at T155 min (i.e., 125 min from the start of HCFO2), versus T30 (P< 0.01). These results suggest that acute hyperoxia causes a moderate increase in lipid peroxidation in healthy subjects. The increase of pentane and MDA confirms that acute hyperoxia induces lipid peroxidation in healthy subjects.