Does Alcohol affect hemodynamics?

We are frequently faced with an intoxicated patient after trauma.  How does the alcohol affect their hemodynamics?

A group in Fresno attempts to answer this question. 

• A retrospective study identified 569 patients with blunt liver injuries and a BAL drawn on admission
• 420 patients with BAL <0.08% were compared to 149 patients with BAL >0.08% (legal limit)
• The intoxicated patients had a lower average grade of liver injury (grade 2) vs. the non-intoxicated patient (grade 3), but were more likely to be hypotensive and have a worse base deficit
• Intoxicated patients who were transfused required more blood (14 units pRBC's) than non-intoxicated patients who required transfusion (7.6 units pRBC's), as well as more crystalloid (9.5 liters vs. 6.7 liters in 24 hours)
• There was no difference in INR or FFP requirements between the groups



World J Surg. 2011 Sep;35(9):2149-53.

Acute ethanol intoxication and the trauma patient: hemodynamic pitfalls.

Bilello J, McCray V, Davis J, Jackson L, Danos LA.

Source

Department of Surgery, University of California San Francisco - Fresno Campus, Fresno, CA, USA, jbilellomd@communitymedical.org.

Abstract

Many trauma patients are acutely intoxicated with alcohol. Animal studies have demonstrated that acute alcohol intoxication inhibits the normal release of epinephrine, norepinephrine, and vasopressin in response to acute hemorrhage. Ethanol also increases nitric oxide release and inhibits antidiuretic hormone secretion. This article studies the effects of alcohol intoxication (measured by blood alcohol level, BAL) on the presentation and resuscitation of trauma patients with blunt hepatic injuries. A retrospective registry and chart review was conducted of all patients who presented with blunt liver injuries at an ACS-verified, level I trauma center. Data collected included admission BAL, systolic blood pressure, hematocrit, International Normalized Ratio (INR), liver injury grade, Injury Severity Score (ISS), intravenous fluid and blood product requirements, base deficit, and mortality. From September 2002 to May 2008, 723 patients were admitted with blunt hepatic injuries. Admission BAL was obtained in 569 patients, with 149 having levels >0.08%. Intoxicated patients were more likely to be hypotensive on admission (p = 0.01) despite a lower liver injury grade and no significant difference in ISS. There was no significant difference in the percent of intoxicated patients requiring blood transfusion. However, when blood was given, intoxicated patients required significantly more units of packed red blood cells (PRBC) than their nonintoxicated counterparts (p = 0.01). Intoxicated patients also required more intravenous fluid during their resuscitation (p = 0.002). Alcohol intoxication may impair the ability of blunt trauma patients to compensate for acute blood loss, making them more likely to be hypotensive on admission and increasing their PRBC and intravenous fluid requirements. All trauma patients should have BAL drawn upon admission and their resuscitation should be performed with an understanding of the physiologic alterations associated with acute alcohol intoxication.