Intensivist Interview: Chronic diseases and conditions related to alcohol use

Classic presentation of patients with long-term heavy alcohol consumption:

• Ataxia: loss of balance, tremors
• Dilated cardiomyopathy that ultimately leads to a decrease in ejection fraction
• Hypotension
• Weakness
• Beer potomania: expect all electrolytes, especially Na+, to be low
• Renal failure
• Jaundice, bruising, coagulopathies
• Ascites, gastritis
• Shortness of breath when sitting or standing-up due to hepatopulmonary syndrome

Keep an eye out for the following potential disasters:

• Subdural hematoma. Patients may have an undiagnosed head bleed due a forgotten fall. Remember: a headache is never just a headache for an alcoholic patient
• Aspiration pneumonia due to an impaired gag reflex (among other reasons)
• Upper GI bleed. An esophageal variceal rupture can cause life-threatening bleeding
• Lower GI bleed: hemorrhoids

Long Term Management of Chronic Alcoholic Cirrhosis

The Liver Transplant Route

• Calculate the Model For End-Stage Liver Disease (MELD score) to determine the level of liver disease
• Frequent paracentesis to decompress ascites
• The Molecular Adsorbent Recirculating System (MARS^®), aka liver dialysis, can serve as a bridge to transplant

The Palliative Route

• Indwelling peritoneal catheter to decompress ascites
• Transjugular intrahepatic portosystemic shunt (TIPS) procedure to decrease the amount of fluid that accumulates in the abdomen