Complications of chronic alcoholism that affect critical illness
The worldwide consumption of alcohol is increasing. For uniformity, the consumption of alcohol often is expressed in terms of units of ethanol ingested. Table 14-1 shows how units of alcohol routinely are calculated. Not everyone who abuses alcohol develops liver damage, however. It is estimated that at least 80% of heavy drinkers show some features of fatty liver, 10% to 35% develop alcoholic hepatitis, and 10% develop cirrhosis. A retrospective study in men showed that 50% of men with an average intake of alcohol of greater than 160 g (15 to 16 units) per day for 20 years developed cirrhosis. Later studies showed risk levels with alcohol consumption of 40 g (7 units) per day for men. The duration of alcohol abuse seems important because neither cirrhosis nor alcoholic hepatitis was seen in patients who consumed 160 g (28 units) of ethanol per day for less than 5 years, whereas 50% of patients consuming these levels for an average of 21 years developed cirrhosis.
In many parts of the world, alcoholism is increasing among women as the social stigma surrounding drinking declines and the access to alcohol becomes easier. Women are less likely to be suspected of alcohol abuse, present at more advanced stage of disease, and are more likely to relapse after treatment. The increased vulnerability of women to alcohol-induced liver injury has been attributed to significantly higher alcohol concentrations and area under the concentration-time curve compared with men. In addition, women often weigh less than men and have a lower volume of distribution for alcohol. Following a brief description of the pathophysiology and clinical features of liver injury due to alcohol, this chapter reviews the major syndromes in ethanol abusers that may precipitate or complicate an intensive care unit admission.
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