Question

J.G., a 49-year-old man, was assessed in the emergency department (ED) 4 days ago’ He was diagnosed with alcohol intoxication, and released after 8 hours to his brother’s care. He was readmitted to the ED 12 hours ago with a gastrointestinal (GI) bleed and is being transferred to the intensive care unit (ICU). His diagnosis is upper GI bleed and alcohol intoxication.

You are assigned to J.G. for the remainder of your shift. According to the ED notes, his admission vital signs (VS) were 84/56, 110, 26, and he was vomiting bright red blood. He was given IV fluids and transfused 6 units of packed red blood cells (PRBCs) in the ED. On initial assessment, you note that J.G.’s VS are 102.2° F (39°C), 174/98, 110, 24. He has a slight tremor in his hands, is diaphoretic, and he appears anxious. He reports a headache and appears flushed. No report of vomiting, frank red blood or melena in the stools, according to the chart, for the past 5 hours. In response to your questions, J.G. denies he has an alcohol problem but later on admits to drinking approximately a fifth of vodka daily for the past 2 months. He admits to having seizures while withdrawing from alcohol in the past. He tells you that he “just can’t help it” and has strong urges to drink, but that he never means “to drink very much.” He has had trouble keeping a job over the past several months.

Chart View

Admission Laboratory Work

Hgb	10.9 g/dL (109 g/L)
Hct	23%
ALT (formerly SGPT)	69 units/L
AST (formerly SGOT)	111 units/L
GGT	75 units/L
ETOH	291 mg/dL (63 mmol/L)
aPTT	35 seconds
PT/INR	12 seconds/1
Hepatitis C Screening	Negative

1. Which data from your assessment of J.G. are of concern to you?

2. What do the admission laboratory results indicate?

3. Which of the previous laboratory results specifically reflects chronic alcohol ingestion?

4. What are the 2 most likely causes of J.G.’s symptoms?

5. What is the most likely time frame for someone to have withdrawal symptoms after abrupt cessation of alcohol?

Answer 1

Alcoholism: A chronic disease caused by compulsive and uncontrollable consumption of alcoholic beverages, leading to addiction and deterioration in health and social functioning.

1. His vital signs are not normal indicating the variation from normal health in following areas:

Nurse can have concern over the patient data,such as :

Temperature: 102.2 degree F. - Fever

Blood pressure: 174/ 98- Hypertension

Pulse : 110 bpm- Tachycardia.

Mr. JG has the symptoms of Alcoholic withdrawal such as tremors, diaphoresis, anxiety, headache etc.

2. Admission laboratory results indicates

* low haemoglobin count : Adult male need a minimum of 13.5 g/ dL

* Low Heamatocrit value ( 23 %) , indicates the size of RBC/ package of Red blood cells.

* Aspartate amino transferace ( normal 10 to 40 ), Alanine Amino transferace ( 7 to 56) and GGT ( 9 to 48 ) are high , it indicates the inability of liver to function properly.

* ETOH- Ethyl alcohol ( 0 to 50 normal). Mr JG has a level of 291 mg/ dL.

Activated partial thromboplastin time ( aPTT) is normal and Prothrombin time also normal.

3. Previous laboratory results:

In the first admission he had Gastrointestinal bleeding and vomiting in bright red colour. He received 6 units of Packed Red blood cells , may be due to anemia.( Previous lab result has not provided. )

4. Mr. JG symptoms: 2 most likely causes

* Alcohol withdrawal symptoms : A wide range of symptoms associated with the discontinuance of Alcohol by a person who has become addicted to it. Symptoms include tremors, headache, diaphoresis , diarrhoea, etc

* Hypertension: The state of being abnormally high blood pressure. The symptoms of include severe headache, vision problems, fatigue, confusion and chest pain.

6. Time frame:

After abrupt cessation of Alcohol, withdrawal symptoms start at 8 hrs after the last drink, it may extend upto 4 days .

From 8 hrs to 1 day: abdominal pain , nausea and vomiting.

24 to 72 hrs ( after last drink : High Blood pressure, fever, increased heart rate .

2 to 4 days : hallucinations, seizures and agitation.