STANDARD CALCULATION OF ETHANOL ELIMINATION RATE IS NOT SUFFICIENT TOPROVIDE ETHANOL SUBSTITUTION THERAPY IN THE POSTOPERATIVE COURSE OF ALCOHOL-DEPENDENT PATIENTS

Objective:Alcohol withdrawal syndrome (AWS) is a severe complication d uring postoperative treatment of alcohol-dependent patients. Besides t he use of clomethiazole, clonidine, and benzodiazepines, there is anot her possible way to prevent AWS by deliberate administration of ethano l. The appropriate dosage of ethanol has not been known up to now and it could be defined according to the average ethanol elimination rate (EER) which, from forensic analysis, is known to be 15 mg/dl per h in a normal population. However, it is questionable whether these data ar e suitable for the calculation of the correct dosage in alcohol-depend ent patients. Design: Preliminary retrospective descriptive study. Set ting: Intensive care unit of a university teaching hospital. Patients: 11 alcohol-dependent patients (9 males, 2 females, mean age 50.8 year s, range 33 to 60 years). Interventions: Ethanol substitution (ES) by parenteral application. Measurements and results: Ethanol kinetics wer e evaluated by repeated measurement of the blood ethanol concentration (BEC) over a period of at least 6 h parallel to the administration of ethanol. The average EER was found to be 28 mg/dl per h with a standa rd deviation of 11 mg/dl per h. The minimum value was 18 mg/dl per h a nd the maximum 50 mg/dl per h. These EERs were significantly higher th an the EERs known from forensic analysis. AWS was prevented in all 11 patients. Conclusions: Close control of BEC and precise adjustment of ethanol administration are necessary prerequisites for ES. The standar d EER is not sufficient to define the appropriate ethanol dosage due t o enormous variations in the ethanol metabolism of alcohol-dependent p atients.