Alcoholism

Last updated: Wednesday, 27, October, 2010
PresentationAppropriate Tests

Diagnosis is based on clinical assessment.

Laboratory tests include: FBC, blood film; PT; GGT, urate, triglycerides, as appropriate; ethanol is helpful in detecting recent alcohol ingestion.

In chronic alcoholism, macrocytosis, thrombocytopenia, prolonged PT, elevated GGT, hyperuricaemia or hypertriglyceridaemia may be found. The most specific indicator of chronic excessive alcohol ingestion is carbohydrate-deficient transferrin but it has a low sensitivity.

Alcoholic liver disease

AST, ALT, ALP, bilirubin, albumin, protein (total), PT. An AST/ALT ratio of >1 suggests liver disease is due to alcohol. Protein electrophoresis or immunoglobulin quantitation may assist in establishing chronicity. Liver biopsy, if indicated.

Fatty liver

Alcoholic Hepatitis

See Hepatitis

Cirrhosis

Hepatic failure

Hepatocellular carcinoma

Portal hypertension

Pancreatitis

Acute metabolic disorders

Hypoglycaemia

Glucose.

Ketoacidosis

Electrolytes, hydroxybutyrate.

Lactic acidosis

Electrolytes, lactate.

Hypoalbuminaemia

Hyperlipidaemia

Malnutrition

Wernicke-Korsakoff syndrome

If confirmation is required, blood must be collected for vitamin B1 assay prior to therapy.

Central pontine myelinolysis 

A demyelinating syndrome associated with rapid sodium fluxes. Electrolytes.

Peripheral Neuropathy

Cardiomyopathy

Infection

Pneumonia

Aspiration of upper respiratory tract bacteria esp Streptococcus pneumoniae and Klebsiella pneumoniae. Alcoholism also predisposes to infection with Legionella pneumophila.

Bacteraemia/Septicaemia

Inability of the liver to deal with bacteria coming from the gastrointestinal tract in the portal system predisposes to septicaemia caused by Gram-negative bacilli, eg Escherichia coli, Klebsiella pneumoniae.

Peritonitis

Primary infection with Streptococcus pneumoniae or Gram-negative bacilli, eg Escherichia coli. Diagnosis established by aspiration of peritoneal fluid for microscopy and culture (peritoneal fluid examination).

Tuberculosis

Pancytopenia

Multifactorial; likely cause(s) indicated by blood film findings and red cell indices. Bone marrow aspiration occasionally indicated, particularly if severe, unexplained anaemia, pancytopenia.

Anaemia

Alcohol marrow toxicity

Blood loss

Iron deficiency

Folate deficiency

Hypersplenism

Bleeding

FBC, PT, APTT, thrombin time, fibrin degradation products, fibrinogen.

Failure of coagulation factor synthesis

See coagulation disorders

Vitamin K deficiency

Hepatocellular failure

See hepatic failure

Thrombocytopenia

Bone marrow aspiration may be appropriate.

  • Alcohol marrow toxicity
  • DIC (usually low grade)

Fibrinolysis

Primary fibrinolysis may occur and is usually low grade.

Dysfibrinogenaemia 

In severe liver disease, especially with hepatocellular carcinoma. Thrombin time, reptilase time.