Hemodynamic Disorders in Alcohol Withdrawal Syndrome

Abstract

INTRODUCTION: The introduction of the study is determined by a high prevalence of alcoholism and a high incidence of complications from the cardiovascular system.

AIM: To study the features of hemodynamics in patients with uncomplicated alcohol withdrawal syndrome (AWS) and in those with alcohol withdrawal delirium (delirium tremens).

MATERIALS AND METHODS: The study enrolled 116 men, 58 of them with uncomplicated AWS, 78 with AWS and delirium. Basic hemodynamic parameters were studied: heart rate (HR), blood pressure (BP), and integral parameters — cardiac index (CI), total peripheral resistance (TPR), shock index (SI). Comparisons between the groups and correlation analysis were conducted to find relationships between hemodynamic parameters and clinical data.

RESULTS: In patients with alcoholic delirium, hemodynamic parameters were statistically significantly higher than in patients with uncomplicated AWS: HR (р = 0.003), systolic BP (р = 0.02) and diastolic BP (р = 0.04), while no statistically significant differences in the integral parameters (CI, TPR, SI) were found between the groups. In patients of both groups, CI linearly decreased with age (p < 0.0001). The same linearly CI decreased with increase in the duration of alcoholism (p = 0.02). With an increase in the amount of consumed alcohol during the binge period, a linear growth of CI was observed in withdrawal state (p = 0.001). The value of TPR increased with age (p = 0.005). Only in patients with delirium tremens, there was an inverse relationship between SI and partial tension of carbon dioxide in venous blood (r = -0.4; p = 0.014). Besides, only in patients with delirium tremens, by the 7^th day of withdrawal, a direct relationship was established between the cardiac index and blood potassium level (r = 0.36; p = 0.03).

CONCLUSIONS: There was no significant difference between hemodynamic parameters in uncomplicated AWS and in delirium tremens. CI in patients with uncomplicated AWS and in those with DT decreased with age and with increase in the alcohol load. The vessel tone was inversely proportional to CI throughout the entire period of observation. With the development of delirium, a correlation was noted between a decrease in the level of energy metabolism and the probability for decompensation of systemic circulation. At the stage of reduction of delirium tremens, a correlation was noted between CI and the blood potassium level that reflected the exhaustion of the cardiovascular system and reduction of its compensatory capacities.

Keywords

alcohol withdrawal syndrome / delirium tremens / tachycardia / blood pressure / hemodynamics / hypokalemia / gas composition of blood

References

[1] Howes LG, Reid JL. The effects of alcohol on local, neural and humoral cardiovascular regulation. Clin Sci (Lond). 1986;71(1):9–15. doi: 10.1042/cs0710009

[2] Howes L.G., Reid J.L. The effects of alcohol on local, neural and humoral cardiovascular regulation // Clin. Sci. (Lond.). 1986. Vol. 71, No. 1. P. 9–15. doi: 10.1042/cs0710009

[3] Ivanets NN, Vinnikova MA, editors. Narkologiya. Moscow: GEOTAR-Media; 2020. (In Russ).

[4] Иванец Н.Н., Винникова М.А., ред. Наркология. М.: ГЭОТАРМедиа; 2020.

[5] Soardo G, Donnini D, Varutti R, et al. Effects of alcohol withdrawal on blood pressure in hypertensive heavy drinkers. J Hypertens. 2006; 24(8):1493–8. doi: 10.1097/01.hjh.0000239283.35562.15

[6] Soardo G., Donnini D., Varutti R., et al. Effects of alcohol withdrawal on blood pressure in hypertensive heavy drinkers // J. Hypertens. 2006. Vol. 24, No. 8. P. 1493–1498. doi: 10.1097/01.hjh.0000239283.35562.15

[7] Kähkönen S, Zvartau E, Lipsanen J, et al. Effects of alcohol withdrawal on cardiovascular system. Prog Neuropsychopharmacol Biol Psychiatry. 2011;35(2):550–3. doi: 10.1016/j.pnpbp.2010.12.015

[8] Kähkönen S., Zvartau E., Lipsanen J., et al. Effects of alcohol withdrawal on cardiovascular system // Prog. Neuropsychopharmacol. Biol. Psychiatry. 2011. Vol. 35, No. 2. P. 550–553. doi: 10.1016/j.pnpbp.2010.12.015

[9] Regan TJ. Alcohol and the cardiovascular system. JAMA. 1990; 264(3):377–81.

[10] Regan T.J. Alcohol and the cardiovascular system // JAMA. 1990. Vol. 264, No. 3. P. 377–381.

[11] Kähkönen S. Mechanisms of cardiovascular dysregulation during alcohol withdrawal. Prog Neuropsychopharmacol Biol Psychiatry. 2004; 28(6):937–41. doi: 10.1016/j.pnpbp.2004.05.039

[12] Kähkönen S. Mechanisms of cardiovascular dysregulation during alcohol withdrawal // Prog. Neuropsychopharmacol. Biol. Psychiatry. 2004. Vol. 28, No. 6. P. 937–941. doi: 10.1016/j.pnpbp.2004.05.039

[13] Kovács GL. Natriuretic peptides in alcohol withdrawal: central and peripheral mechanisms. Curr Med Chem. 2003;10(23):2559–76. doi: 10.2174/0929867033456459

[14] Kovács G.L. Natriuretic peptides in alcohol withdrawal: central and peripheral mechanisms // Curr. Med. Chem. 2003. Vol. 10, No. 23. P. 2559–2576. doi: 10.2174/0929867033456459

[15] Palmer BF, Clegg DJ. Electrolyte Disturbances in Patients with Chronic Alcohol-Use Disorder. N Engl J Med. 2017;377(14):1368–77. doi: 10.1056/nejmra1704724

[16] Palmer B.F., Clegg D.J. Electrolyte Disturbances in Patients with Chronic Alcohol-Use Disorder // N. Engl. J. Med. 2017. Vol. 377, No. 14. P. 1368–1377. doi: 10.1056/nejmra1704724

[17] Utkin SI. Clinical and metabolic predictors for delirium tremens. S.S. Korsakov Journal of Neurology and Psychiatry. 2021;121(7):64–9. (In Russ). doi: 10.17116/jnevro202112107164

[18] Уткин С.И. Алкогольный делирий: особенности метаболизма и предикторы развития // Журнал неврологии и психиатрии им. C.C. Корсакова. 2021. Т. 121, № 7. С. 64–69. doi: 10.17116/jnevro 202112107164

[19] Galankin LN, Livanov GA, Burov VV. Alkogol’nyy delirioznyy shok. Saint-Petersburg; 2004. (In Russ).

[20] Галанкин Л.Н., Ливанов Г.А., Буров В.В. Алкогольный делириозный шок. СПб.; 2004.

[21] Fernández–Solà J. The Effects of Ethanol on the Heart: Alcoholic Cardiomyopathy. Nutrients. 2020;12(2):572. doi: 10.3390/nu12020572

[22] Fernández–Solà J. The Effects of Ethanol on the Heart: Alcoholic Cardiomyopathy // Nutrients. 2020. Vol. 12, No. 2. P. 572. doi: 10.3390/nu12020572

[23] Antonov AA. Gemodinamika dlya klinitsista. Moscow; 2004. (In Russ).

[24] Антонов А.А. Гемодинамика для клинициста. М.; 2004.

[25] Kachaev AK, Levenets IV. Clinico-hemodynamic typification of alcoholics with various central circulatory disorders. Zh Nevrol Psikhiatr Im S S Korsakova. 1991;91(2):67–70. (In Russ).

[26] Качаев А.К., Левенец И.В. Клинико-гемодинамическая типизация больных алкоголизмом с различными нарушениями центрального кровообращения // Журнал неврологии и психиатрии им. С.С. Корсакова. 1991. Т. 91, № 2. С. 67–70.

[27] Psikhicheskiye i povedencheskiye rasstroystva, vyzvannyye upotrebleniyem alkogolya. Sindrom otmeny alkogolya (alkogol’noye abstinentnoye sostoyaniye) [Internet]. Available at: https://cr.minzdrav.gov.ru/recomend/784. Accessed: 2023 November 07. (In Russ).

[28] Психические и поведенческие расстройства, вызванные употреблением алкоголя. Синдром отмены алкоголя (алкогольное абстинентное состояние) [Интернет]. Доступно по: https://cr.minzdrav.gov.ru/recomend/784. Ссылка активна на 07.11.2023.

[29] Psikhicheskiye i povedencheskiye rasstroystva, vyzvannyye upotrebleniyem psikhoaktivnykh veshchestv. Abstinentnoye sostoyaniye (sindrom otmeny) s deliriyem [Internet]. Available at: https://cr.minzdrav.gov.ru/recomend/590. Accessed: 2023 November 07. (In Russ).

[30] Психические и поведенческие расстройства, вызванные употреблением психоактивных веществ. Абстинентное состояние (синдром отмены) с делирием [Интернет]. Доступно по: https://cr.minzdrav.gov.ru/recomend/590. Ссылка активна на 07.11.2023.

[31] Vensan Zh–L, Abrakham E, Mur F, et al., editors. Rukovodstvo po kriticheskoy meditsine. 7th ed. Saint-Petersburg: Chelovek; 2019. Vol. 1, 2. (In Russ).

[32] Венсан Ж.–Л., Абрахам Э., Мур Ф., и др., ред. Руководство по критической медицине. 7-е изд. СПб.: Человек; 2019. Т. 1, 2.

[33] Zabolotskikh IB, Grigor’yev SV, Danilyuk PI, et al. Sposob opredeleniya udarnogo ob”yema serdtsa u bol’nykh bez porokov serdtsa. Patent RU No. 2008136301/14. 08/09/2008. (In Russ).

[34] Заболотских И.Б., Григорьев С.В., Данилюк П.И., и др. Способ определения ударного объема сердца у больных без пороков сердца. Патент РФ № 2008136301/14. 08.09.2008.

[35] Du Bois D, Du Bois EF. A formula to estimate the approximate surface area if height and weight be known. Nutrition. 1989;5(5): 303–13.

[36] Du Bois D., Du Bois E.F. A formula to estimate the approximate surface area if height and weight be known // Nutrition. 1989. Vol. 5, No. 5. P. 303–313.

[37] Starr I. Clinical tests of the simple method of estimating cardiac stroke volume from blood pressure and age. Circulation. 1954;9(5): 664–81. doi: 10.1161/01.cir.9.5.664

[38] Starr I. Clinical tests of the simple method of estimating cardiac stroke volume from blood pressure and age // Circulation. 1954. Vol. 9, No. 5. P. 664–681. doi: 10.1161/01.cir.9.5.664

[39] Tkachenko BI, editor. Osnovy fiziologii cheloveka. Saint-Petersburg: Mezhdunarodnyy fond istorii nauki; 1994. Vol. 1. (In Russ).

[40] Ткаченко Б.И., ред. Основы физиологии человека. СПб.: Международный фонд истории науки; 1994. T. 2.

[41] Bisyarina VP, Yakovlev VM, Kuksa PYa. Arterial’nyye sosudy i vozrast. Moscow: Meditsina; 1986. (In Russ).

[42] Бисярина В.П., Яковлев В.М., Кукса П.Я. Артериальные сосуды и возраст. М.: Медицина; 1986.

[43] Koch E, Lovett S, Nghiem T, et al. Shock index in the emergency department: utility and limitations. Open Access Emerg Med. 2019;11: 179–99. doi: 10.2147/oaem.s178358

[44] Koch E., Lovett S., Nghiem T., et al. Shock index in the emergency department: utility and limitations // Open Access Emerg. Med. 2019. Vol. 11. P. 179–199. doi: 10.2147/oaem.s178358

[45] Allgöwer M, Burri C. Shock index. Dtsch Med Wochenschr. 1967;92(43):1947–50. doi: 10.1055/s-0028-1106070

[46] Allgöwer M., Burri C. Shock index // Dtsch. Med. Wochenschr. 1967. Vol. 92, No. 43. Р. 1947–1950. doi: 10.1055/s-0028-1106070

[47] Sullivan JT, Sykora K, Schneiderman J, et al. Assessment of alcohol withdrawal: the revised clinical institute withdrawal assessment for alcohol scale (CIWA-Ar). Br J Addict. 1989;84(11):1353–7. doi: 10.1111/j.1360-0443.1989.tb00737.x

[48] Sullivan J.T., Sykora K., Schneiderman J., et al. Assessment of alcohol withdrawal: the revised clinical institute withdrawal assess-ment for alcohol scale (CIWA-Ar) // Br. J. Addict. 1989. Vol. 84, No. 11. P. 1353–1357. doi: 10.1111/j.1360-0443.1989.tb00737.x

[49] Ablyaminov RF. Primeneniye korrelyatsionnogo i regressionnogo analiza v sisteme prognozirovaniya tekhnologicheskogo protsessa. Nauchnyye Vyskazyvaniya. 2023;(21):24–8. Available at: https://nvjournal.ru/article/Primenenie_korreljatsionnogo_i_regressionnogo_analiza_v_sisteme_prognozirovanija_tehnologicheskogo_protsessa/. Accessed: 2023 November 07. (In Russ).

[50] Абляминов Р.Ф. Применение корреляционного и регрессионного анализа в системе прогнозирования технологического процесса // Научные высказывания. 2023. № 21 (45). С. 24–28. Доступно по: https://nvjournal.ru/article/Primenenie_korreljatsionnogo_i_regres sionnogo_analiza_v_sisteme_prognozirovanija_tehnologicheskogo_protsessa/. Ссылка активна на 07.11.2023.

[51] Khasan A; Ivanov AM, Pikalov IV, editors. Spravochnik po interpretatsii gazovogo sostava krovi i kislotno-shchelochnogo balansa. Moscow: GEOTAR-Media; 2023. (In Russ).

[52] Хасан А.; Иванов А.М., Пикалов И.В., ред. Справочник по интерпретации газового состава крови и кислотно-щелочного баланса. M.: ГЭОТАР-Медиа; 2023.

[53] Pavlova VA, Les’ko AYu. Myocardial structural and functional indicators based on the results of echocardiography in the age aspect. Vestnik NovSU. Issue: Medical Sciences. 2021;(3):124–6. (In Russ). doi: 10.34680/2076-8052.2021.3(124).124-126

[54] Павлова В.А., Лесько А.Ю. Структурно-функциональные показатели миокарда по результатам эхокардиографии в возрастном аспекте // Вестник НовГУ. Сер.: Медицинские науки. 2021. № 3 (124). С. 124–126. doi: 10.34680/2076-8052.2021.3(124).124-126

[55] Utkin SI, Buzik OZh, Dyuzhev DV. Objective predictors for delirium tremens based on physiological and metabolic indicators. Voprosy Narkologii. 2021;(12):17–30. (In Russ).

[56] Уткин С.И., Бузик О.Ж., Дюжев Д.В. Объективные предикторы развития алкогольного делирия на основе физиологических и метаболических показателей // Вопросы наркологии. 2021. № 12 (207). С. 17–30.

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