The effect of alcohol withdrawal on electrolyte and acid-base balance

Abstract

A metabolic balance study of 5–7 days' duration was carried out on 8 chronic alcoholic males during alcohol withdrawal; 5 nonalcoholic patients were used as controls. Four alcoholic subjects without liver damage showed significant weight gain and Na + retention. Of 4 alcoholics with liver damage, only one showed a comparable Na + retention, and none gained weight. The 5 controls were close to Na + balance, and 4 of them lost weight. There was no significant difference between groups with respect to K + balance. Blood and plasma volume were significantly higher in the alcohol withdrawal group than in the controls, and the urine specific gravity tended to rise appreciably during the first 2 days of alcohol withdrawal. The alcohol withdrawal group, but not the controls, showed evidence of systemic alkalosis, as indicated by elevation of arterial blood pH and urine pH, decreased urinary NH 4 and titratable acidity, and reduced serum K +. These findings are consistent with the hypotheses that (1) alcohol withdrawal results in a “rebound” increase in antidiuretic hormone activity, following prolonged suppression of ADH by continuous drinking, (2) increased aldosterone activity occurs during continuous drinking but is masked by the opposing effects of ethanol; it is suggested that when alcohol is withdrawn the aldosterone effect becomes evident.