Disease alcoholism

Liver diseases Alcoholic hepatitis (A), hepatitis B and C (A), non-alcoholic steatohepatitis (A), liver transplantation (A), Wilson s disease (A)... 

Under certain circumstances, and very rarely, the inhibition of gluconeogenesis by metformin may suppress lactic acid metabolism and precipitate a potentially fatal lactic acidosis. Impairment of renal function, liver disease, alcoholism, conditions that give rise to increased lactate production (e.g. congestive heart failure, infections) are therefore contraindications for the application of metformin. 

Another common liver disease, alcoholic liver damage produced by moderate to heavy alcoholic intake, is also reflected by an elevation of the serum GOT and GPT activities. The serim glutamyl transferase activity is reported to be a sensitive index of alcoholic intake and can serve to monitor persons on alcoholic withdrawal programs (60). The LD-5 isoenzyme arises mainly from liver tissue, but has a short half-life (61), which is about 1/5 and 1/2 of the half life of the transaminases, GPT and GOT respectively. Some authors consider that a normal LD-5 isoenzyme activity in a jaundiced patient is sufficient evidence to exclude primary liver disease and that obstruction is probably responsible for the jaundice (62). In hemolytic jaundice the LDH-1 and 2 isoenzymes are elevated. 

Martin, F. and Peters, T.H. (1985). Alcoholic muscle disease. Alcohol Alcoholism 20, 125-136. 

Immunosuppression—anatomic or functional asplenia, sickle cell disease, alcoholism, cirrhosis, immunoglobulin or complement deficiency cancer, HIV/AIDS, debilitated state of health... 

Whitfield JB. Meta-analysis of the effects of alcohol dependence and alcoholic liver disease. Alcohol Alcohol 1997 32 613-619. 

Mayo O. Genetic analysis of a complex disease. Alcohol Alcoholism. 1994 Suppl. 2 918. 

The main causes are hepatitis B and C, drug induced damage, metabolic disease (alcohol, haemochro-matosis and Wilsons disease) and autoimmune disease. Management depends upon the diagnosis. 

Liver disease is the most common medical complication of alcohol abuse an estimated 15-30% of chronic heavy drinkers eventually develop severe liver disease. Alcoholic fatty liver, a reversible condition, may progress to alcoholic hepatitis and finally to cirrhosis and liver failure. In the United States, chronic alcohol abuse is the leading cause of liver cirrhosis and of the need for liver transplantation. The risk of developing liver disease is related both to the average amount of daily consumption and to the duration of alcohol abuse. Women appear to be more susceptible to alcohol hepatotoxicity than men. Concurrent infection with hepatitis or C virus increases the risk of severe liver disease. 

Biguanide drugs are contraindicated in patients with renal disease, alcoholism, hepatic disease, or conditions predisposing to tissue anoxia (eg, chronic cardiopulmonary dysfunction) because of an increased risk of lactic acidosis induced by biguanide drugs. 

Hoyumpa AM, Schenker S. Major drug interactions effect of liver disease, alcohol and malnutrition. Annu Rev Med 1982 33 113. 

Alcohol can suppress the immune system, making people more susceptible to infections. Because alcohol reduces inhibitions and impairs judgment, those under its influence may be prone to engage in unsafe sexual activity, raising the risks of HIV infection and sexually transmitted diseases. Alcohol use can interfere with a woman s ability to become pregnant. It can lower a man s sperm count and reduce his sexual drive. 

Adverse effects Adverse effects are a minor problem with rifampin, but can include nausea and vomiting, rash, and fever. The drug should be used judiciously in patients with hepatic failure because of the jaundice that occurs in patients with chronic liver disease, alcoholics, or in the elderly. 

ITie second stage of alcoholic liver disease, alcoholic hepatitis, is characterized by the death of a number of liver cell and inflammation of the affected areas. The damage in this stage sometimes proves fatal. 

Important susceptibility factors include age, endogenous coagulation defects, thrombocytopenia, hypertension, cerebrovascular disease, thyroid disease, renal insufficiency, liver disease, tumors, cerebrovascular disease, alcoholism, a history of gastrointestinal bleeding (peptic ulcer disease alone without past bleeding is not associated with an increased risk of bleeding), and an inability to adhere to the regimen. 

All of 10 patients taking mitotane for Cushing s syndrome had rises in either gamma-glutamyl transpeptidase or alanine transaminase, with a maximum increase six times basal value (7). The only variable that correlated with hepatic increase was the body mass index. In contrast, the severity of the disease, alcohol intake, and other biological characteristics did not correlate with transaminase rises. 

Mann RE, Smart RG, and Govoni R (2003) The epidemiology of alcoholic liver disease. Alcohol Research Health 27(3) 209-219. 

Folic acid is a nutritional supplement frequently used during periods of deficiency. Folic acid needs increase during chronic diseases, such as malabsorption liver disease, alcoholism, and anticonvulsant or oral contraceptive use. Folic acid supplementation during pregnancy is strongly recommended to prevent neural tube defects to the unborn child. The active form of folic acid, folinic acid, is used in the management of certain medical diseases (e.g., patients taking methotrexate, and 5-fluorouracil). 

Thiamine is a nutritional supplement used during periods of deficiency known as beriberi and its manifestations such as Wernicke-Korsakoff syndrome. Thiamine needs increase during diseases of the small intestine, malabsorption, congenital metabolic dysfunction, liver disease, alcoholism, and during pregnancy and lactation. Supplementation of thiamine for treatment of Alzheimer s disease, congestive heart failure, and cataracts has been investigated however, evidence is unclear as to its benefits at this time. 

Other Conditions. Other groups of individuals are considered to be at risk either from a marginal dietary deficiency or from an acquired deficiency secondary to disease. These groups would include female adolescents during pregnancy and lactation. Also affected may be patients with malabsorption syndrome, inflammatory bowel disease, alcoholic liver disease, and anorexia nervosa. A significant proportion of cases of sickle cell anemia have clinical signs and symptoms and some laboratory abnormalities of zinc deficiency. These patients respond well to zinc supplementation. ... 

Teare J, Carmichael A, Burnett F, Rake M. Detection of antibodies to acetaldehyde-albumin conjugates in alcoholic liver disease. Alcohol Alcohol 1993 28 11-6. 

Chronic conditions, i.e., HIV, renal failure, diabetes mellitus, chronic lung disease, alcohol excess... 

The prevalence of pancreatitis varies widely with geographic area, etiologic factors (e.g., alcohol consumption), and environmental or hereditary factors. The overall prevalence of AP in males and females in the United States is estimated to be less than 1%, whereas the prevalence of CP is 0.05% in males and 0.01% in females. The reported prevalence of AP and CP most likely underestimates the true spectrum of these diseases. Alcoholic CP is more common in men and has a peak incidence between 35 and 45 years of age. Blacks are two to... 

AZRI, S. and RENTON, K.W. (1991) Factors involved in the depression of hepatic mixed function oxidase during infection with Listeria monocytogenes. Int. J.Immunopharmacol., 13, 197. HOYIJMPA, A.M. and SCHENKER, S. (1982) Major drug interactions effect of liver disease, alcohol and malnutrition. Rev. Med., 33, 113. 

The dibenzapine derivatives are called tricyclic antidepressants and include imipramine (Tofranil), desipramine (Norpramin), amitriptyline (Elavil), nortriptyline (Aventyl), protriptyline (Vivactil), and doxepin (Adapin). Amitriptyline is indicated in depression major depression with melancholia or psychotic symptoms depressive phase of bipolar disorder depression associated with organic disease, alcoholism, schizophrenia, or mental retardation anorexia or bulimia associated with depression (see Figure 20). 

Desipramine is a tricyclic antidepressant, inhibits reuptake of norepinephrine and serotonin in CNS, and is indicated in relief of symptoms of depression. Desipramine (75 to 150 mg p.o./day in divided doses) is indicated in endogenous depression major depression with melancholia or psychotic symptoms depression associated with organic brain disease, alcoholism, schizophrenia, or mental retardation and the depressive phase of manic-depressive disorder. Desipramine is absorbed rapidly from the GI tract, distributed widely in the body, and appears also in breast miUc. It is bound to plasma proteins to the extent of 90%, undergoes extensive first-pass metabolism, and its metabolites are excreted in urine. Desipramine strongly blocks the norepinephrine uptake mechanism and has no effect on the uptake of serotonin. Desipramine has weak alpha -adrenergic and... 

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