Abstract
Disulfiram (tetraethylthiuram disulfide) has been used since decades in the treatment of alcohol addiction. It causes aversive behaviour towards alcohol due to Disulfiram Ethanol Reaction (DER). The classical DER includes flushing, sweating, tremors, nausea, vomiting, tachycardia, hypotension and restlessness. Complete recovery is the usual outcome in clinical settings. Life threatening reactions are rare but sometimes occur. Rare complications include shock, myocardial ischemia, hypertension, bronchospasm and methemoglobinemia. We present here a very rare case of ischemic stroke in a hemodynamically stable patient, which developed secondary to disulfiram–ethanol reaction. To the best of our knowledge, this is the first such reported case in literature.
Highlights
Disulfiram was first used for the treatment of alcohol dependency in 1940
Disulfiram Ethanol Reaction with Ischemic stroke investigations, complete hemogram, biochemical parameters like blood sugar, blood urea, serum creatinine, liver function tests, lipid profile, serum calcium, magnesium, electrolytes and ABG were within normal limits
The inhibition by disulfiram of aldehyde dehydrogenase-2 (ALDH2) leads to a rise of acetaldehyde levels 5 to 10 times above baseline levels and a few days of treatment with disulfiram can reduce
Summary
Disulfiram was first used for the treatment of alcohol dependency in 1940. The effectiveness of disulfiram in discouraging alcohol consumption is aversive in nature as it is dependent on the patient’s fear of developing a disulfiram – ethanol reaction and does not produce central nervous system effects that alter an alcoholic’s drinking behaviour [1]. A 35 year old man who was a chronic alcoholic and smoker was on treatment with T.Disulfiram 250mg once daily for about 3 months. 10 to 15 minutes after the alcoholic drink, patient became unwell with sweating, giddiness, disturbed vision and tremors of extremities. Later he developed drowsiness and lost consciousness. There was paucity of movements of the left half of the body. He was admitted to our hospital for further evaluation and management. Correspondence: Dr.M.Suresh Babu, Associate Professor of Medicine, JSS Medical College, JSS University, Mysore, Karnataka, India
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