Determining Alcohol Elimination Rates in Chronic Alcoholics Presenting in the ED

Abstract

Objective: Chronic alcoholics eliminate ethanol at higher rates than non-alcoholics. The exact rate of increase in elimination is unknown. Certain alcoholics may eliminate ethanol at much greater rates than the textbook estimated 20–25mg/dL/hr for alcohol-tolerant individuals. A case report has suggested that first order elimination kinetics may occur in certain patients presenting with extremely high ethanol levels. The purpose of the study is to evaluate ethanol elimination rates among chronic alcoholics presenting to the emergency department with extremely high serum ethanol levels. Methods: The study design was a prospective, convenience sample of alcohol-intoxicated patients presenting to the ED with an initial serum ethanol 400 mg/dL. Serial serum ethanol measurements were obtained over 4 hours on a predetermined schedule. Informed written consent was obtained during a prior ED visit when the patient’s initial blood alcohol level was measured 400 mg/dl and the patient (when sober) agreed to enroll in the study if he/she returned on a future ED visit for the same presentation. Demographic data (ethnicity, gender, age) and serum ethanol level and time sampling was recorded. Elimination rates were calculated for each patient. Results: 9 male patients enrolled into the study. Mean initial serum ethanol level was 471.53 mg/dL. (range: 405.1–602.7 mg/dL). Mean elimination rate 28 5 mg/dL/hr (range 21–36). Mean correlation coefficient 0.97 0.03. (range 0.92–0.99) No evidence of first-order kinetic metabolism was noted for any patient. Conclusion: Chronic alcoholics with high serum ethanol levels greater than 400 mg/dL appear to eliminate alcohol using zero kinetics at a mean rate of 28 mg/dL/hr.