Electrolyte abnormalities in the alcoholic patient

The acute effect of ethyl alcohol ingestion is to induce diuresis with excretion of free water and preservation of electrolytes. This occurs as the blood alcohol concentration increases and is due to the suppression of endogenous release of ADH by alcohol. During a steady state blood alcohol concentration, alcohol acts as an antidiuretic and induces water and electrolyte retention.

In steady state, additional doses of alcohol result in progressively lower and eventually absent diuretic responses. The chronic effect of alcohol is to promote isosmotic storage of water and electrolytes due to increased ADH levels. Excess water and electrolytes are acutely excreted in response to additional alcohol ingestion. With cessation of alcohol consumption, this excess is excreted over several days.

Routine parenteral fluid administration in chronic and withdrawing alcoholics should be avoided. The role of potassium and magnesium in the development of specific manifestations of the alcohol withdrawal syndrome is unclear. Alcoholics may have electrolyte abnormalities due to alcohol-induced illness, poor nutrition, or vomiting and diarrhea. Each case must be assessed individually.


Emerg Med Clin North Am.: Electrolyte abnormalities in the alcoholic patient

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