Inter-relationship between serum potassium and plasma catecholamines and 3′:5′ cyclic monophosphate in alcohol withdrawal

Abstract

Serial analyses of serum potassium and plasma epinephrine, norepinephrine and adenosine 3′:5′-cyclic monophosphate (cyclic AMP) concentrations were measured in 13 patients with alcohol withdrawal, six of whom presented delirium tremens. Patients with delirium showed at admission levels of potassium (3.45 ± 0.45 mmol/l) lower ( P < 0.02) than patients without delirium (3.81 ± 0.14 mmol/l). Three patients were hypokalemic, all of them with delirium. Serum potassium increased significantly in all the patients during evolution. A close negative correlation ( r = − 0.751) between the intensity of withdrawal and serum potassium was observed. Plasma epinephrine concentrations were increased at admission (623 ± 192 pmol/l), patients with delirium showing greater values (705 ± 137 pmol/l). As the alcohol withdrawal improved, plasma epinephrine concentration decreased. Plasma norepinephrine concentrations were also increased at admission (3422 ± 1451pmol/l), but did not change significantly during evolution, being similar in patients with and without delirium. Plasma cyclic AMP levels were high at admission (40.4 ± 24.3 nmol/l) and increased significantly ( P < 0.05) during evolution. The data obtained suggest that in patients with alcohol withdrawal, as symptomatology improves, plasma epinephrine decreases, while plasma norepinephrine remains increased. The combined actions of the two facts — less β-stimulus, maintaining of α-stimulus — would comprise a significant increase of kalemia, that in cases of initial hypokalemia would lead to normal values of serum potassium.