Alcohol use is prevalent in many parts of the world and for some people alcohol misuse and chronic alcohol abuse is a serious health issue. We all know that alcohol can be bad for us, but few of us are familiar with all of the reasons why. Few conditions have as many or as diverse a body of knowledge as alcohol misuse, and this is reflected in the large number of algorithms that are available.
The algorithms that deal with alcohol can be subdivided into 4 categories:
Organ-Specific Damage Caused by Alcohol
- Amblyopia
- Cardiomyopathy (including cobalt cardiomyopathy)
- Cholestasis
- Gastritis
- Hemolytic anemia (Zieve syndrome)
- Myopathy and rhabdomyolysis
- Pancreatitis
- Renal injury
- Steatohepatitis and cirrhosis
- Teratogenicity (fetal alcohol syndrome)
Toxic and Metabolic Effects
- Acetaldehyde syndrome
- Addiction
- Disulfiram-like reaction
- Hangover
- Ingestion of methanol and other alcohols
- Ketoacidosis
- Mixing with NSAIDs
- Other toxins in the beverage (lead, methanol, congeners, cobalt, etc)
- Overdose (acute poisoning)
- Potomania
- Withdrawal and delirium tremens
Psychological and Neurological Effects
- Blackout
- Cerebellar degeneration
- Depression and suicide
- Marchiafava-Bignoni syndrome
- Psychosis/hallucinations
- Subacute encephalopathy with seizures in alcoholism (SESA)
- Subdural hematoma
- Wernicke’s encephalopathy
Secondary Complications of Alcohol Misuse
- Abuse, physical and psychological
- Aspiration pneumonia
- Coagulopathy
- Erectile dysfunction
- Homelessness
- Infection, including STDs, Vibrio, etc
- Job loss and poverty
- Malnutrition (protein, scurvy, etc)
- Noncompliance with therapy
- Obesity
- Pain (hyperalgesia)
- Periodontitis
- Smoking and other substance abuse
- Splenomegaly
- Transplant failure
- Trauma, assaults and accidents
Here are some representative examples of relevant algorithms that deal with alcohol. Usage of medical algorithms can help clinicians manage patients with alcohol problems, not only to aid in decision making, but also to explain dangers and risks directly to patients.
- Recognition of Acetaminophen Hepatotoxicity in Chronic Alcoholics
- Prognostic Score for a Patient with Alcoholic Hepatitis (ABIC Score)
- Glasgow Alcoholic Hepatitis Score (GAHS)
- Screening Pregnant Women for Significant Alcohol Consumption Using a Metabolic Panel
- High Risk Alcohol Relapse (HAR) Model
- Estimated Blood Ethanol Level from Body Weight and Number of Drinks
- Disulfiram-Like Reaction to Alcohol Ingestion (Antabuse Reaction, Acetaldehyde Syndrome)
- Equation for Evaluating Ethanol Intoxication in Children
- Alcohol-Induced Hangover Symptoms
- Grading Delirium Tremens (DTs) During Ethanol Withdrawal
- Respiratory Depression Due to Co-Ingestion of Two or More CNS Depressants (Ethanol and Benzodiazepines, Opiates and Muscle Relaxants, Other)
- Reasons for Impaired Mobility in an Alcoholic
- Hyperalgesia Associated with Alcohol or Opioid Withdrawal
- Symptom Score in Alcohol Embryopathy (AE)
Conclusion
What does this all mean for clinicians? When there are so many potential problems, clinicians tend to focus on what they are familiar with or what is obvious. Many other problems may go unrecognized, or are recognized too late. With the exponential pace of growth of medical knowledge–it’s now estimated to double every couple of years and that time frame will be reduced to 73 days by 2020, there’s no way clinicians can rely only on our experience and our continuing medical education to effectively treat our patients. We need to have instant, easy access to clinical knowledge at the precise time when it’s relevant to us–when treating our patients. What’s required is automatic execution of medical algorithms within the electronic health record (EHR). If the algorithms are running in the background, and they can pull data available in the EHR, the clinician can conveniently review all of the possible diverse aspects of the disease, and in turn can diagnose and address issues that they might have overlooked without the aid of robust clinical decision making tools at their fingertips. This approach is relevant not only for the many aspects of alcoholism, but nearly every other condition as well.
