J.G., a 49-year-old man, was a
J.G., a 49-year-old man, was assessed in the emergencydepartment (ED) 4 days ago’ He was diagnosed with alcoholintoxication, and released after 8 hours to his brother’s care. Hewas 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) were84/56, 110, 26, and he was vomiting bright red blood. He was givenIV fluids and transfused 6 units of packed red blood cells (PRBCs)in the ED. On initial assessment, you note that J.G.’s VS are102.2° F (39°C), 174/98, 110, 24. He has a slight tremor in hishands, is diaphoretic, and he appears anxious. He reports aheadache and appears flushed. No report of vomiting, frank redblood or melena in the stools, according to the chart, for the past5 hours. In response to your questions, J.G. denies he has analcohol problem but later on admits to drinking approximately afifth of vodka daily for the past 2 months. He admits to havingseizures while withdrawing from alcohol in the past. He tells youthat he “just can’t help it” and has strong urges to drink, butthat he never means “to drink very much.” He has had troublekeeping 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 toyou?
2. What do the admission laboratory results indicate?
3. Which of the previous laboratory results specificallyreflects 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 havewithdrawal symptoms after abrupt cessation of alcohol?
Answer:
Alcoholism: A chronic disease caused by compulsive anduncontrollable consumption of alcoholic beverages, leading toaddiction and deterioration in health and social functioning.
1. His vital signs are not normal indicating the variation fromnormal 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 Aminotransferace ( 7 to 56) and GGT ( 9 to 48 ) are high , it indicatesthe inability of liver to function properly.
* ETOH- Ethyl alcohol ( 0 to 50 normal). Mr JG has a level of291 mg/ dL.
Activated partial thromboplastin time ( aPTT) is normal andProthrombin time also normal.
3. Previous laboratory results:
In the first admission he had Gastrointestinal bleeding andvomiting in bright red colour. He received 6 units of Packed Redblood cells , may be due to anemia.( Previous lab result has notprovided. )
4. Mr. JG symptoms: 2 most likely causes
* Alcohol withdrawal symptoms : A wide range of symptomsassociated with the discontinuance of Alcohol by a person who hasbecome addicted to it. Symptoms include tremors, headache,diaphoresis , diarrhoea, etc
* Hypertension: The state of being abnormally high bloodpressure. The symptoms of include severe headache, vision problems,fatigue, confusion and chest pain.
6. Time frame:
After abrupt cessation of Alcohol, withdrawal symptoms start at8 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.
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