The Many Facets of Chronic Alcohol Abuse

  • Chronic alcohol abuse

The Many Facets of Chronic Alcohol Abuse

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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. 

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. 

 


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By | 2017-07-19T10:31:51+00:00 July 18th, 2017|Clinical Practice, Patient Care|0 Comments

About the Author:

John Svirbely, MD is a founder and Chief Medical Officer of The Medical Algorithms Company and the primary author of its medical algorithms. John is a co-founder of the Medical Algorithms Project and has developed its medical content for nearly 20 years. He has a BA degree from the Johns Hopkins University and his MD from the University of Maryland. He is a board-certified pathologist with a fellowship in medical microbiology and biomedical computing at Ohio State University. Dr. Svirbely recently retired from private practice and resides near Austin, TX. He has authored multiple books and articles on medical algorithms & medical calculators.