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Recognition of a disulfiram ethanol reaction in the emergency department is not always straightforward

(2020) PLOS ONE. 15(12).
Author
Organization
Abstract
Objectives Disulfiram is an adjunct in the treatment of alcohol use disorders, but case reports indicate that disulfiram ethanol reactions are not always recognized in the emergency department. Our first aim is to remind of this risk with two case reports of life-threatening reactions not immediately considered by the emergency physician. The second aim is to estimate the probability that a disulfiram reaction goes unrecognized with the use of a retrospective study of patients admitted to the emergency department. Methods Clinical files of patients admitted between October 1, 2010 and September 30, 2014 to the emergency department were retrospectively screened for the key words "ethanol use" and "disulfiram". Their diagnoses were then scored by a panel regarding the probability of an interaction. Results Seventy-nine patients were included, and a disulfiram-ethanol reaction was scored as either 'highly likely', 'likely' or 'possible' in 54.4% and as 'doubtful' or 'certainly not present' in 45.6% of the patients. The interrater agreement was 0.71 (95% CI: 0.64-0.79). The diagnosis was not considered or only after a delay in 44.2% of the patients with a 'possible' to 'highly likely' disulfiram interaction. One patient with a disulfiram overdose died and was considered as a 'possible' interaction. Discussion and conclusions A disulfiram ethanol interaction can be life threatening and failure to consider the diagnosis in the emergency department seems frequent. Prospective studies with documentation of the intake of disulfiram and evaluation of the value of acetaldehyde as a biomarker are needed to determine the precise incidence. Improving knowledge of disulfiram interactions and adequate history taking of disulfiram intake may improve the care for patients.
Keywords
Multidisciplinary, ALCOHOL-USE DISORDER, ACUTE MYOCARDIAL-INFARCTION, ACETALDEHYDE, PHARMACOTHERAPY, HYPOTENSION, METABOLITE, PLASMA

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Citation

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MLA
Segher, Kristof, et al. “Recognition of a Disulfiram Ethanol Reaction in the Emergency Department Is Not Always Straightforward.” PLOS ONE, edited by Steve Lin, vol. 15, no. 12, 2020, doi:10.1371/journal.pone.0243222.
APA
Segher, K., Huys, L., Desmet, T., Steen, E., Chys, S., Buylaert, W., & De Paepe, P. (2020). Recognition of a disulfiram ethanol reaction in the emergency department is not always straightforward. PLOS ONE, 15(12). https://doi.org/10.1371/journal.pone.0243222
Chicago author-date
Segher, Kristof, Liesbeth Huys, Tania Desmet, Evi Steen, Stefanie Chys, Walter Buylaert, and Peter De Paepe. 2020. “Recognition of a Disulfiram Ethanol Reaction in the Emergency Department Is Not Always Straightforward.” Edited by Steve Lin. PLOS ONE 15 (12). https://doi.org/10.1371/journal.pone.0243222.
Chicago author-date (all authors)
Segher, Kristof, Liesbeth Huys, Tania Desmet, Evi Steen, Stefanie Chys, Walter Buylaert, and Peter De Paepe. 2020. “Recognition of a Disulfiram Ethanol Reaction in the Emergency Department Is Not Always Straightforward.” Ed by. Steve Lin. PLOS ONE 15 (12). doi:10.1371/journal.pone.0243222.
Vancouver
1.
Segher K, Huys L, Desmet T, Steen E, Chys S, Buylaert W, et al. Recognition of a disulfiram ethanol reaction in the emergency department is not always straightforward. Lin S, editor. PLOS ONE. 2020;15(12).
IEEE
[1]
K. Segher et al., “Recognition of a disulfiram ethanol reaction in the emergency department is not always straightforward,” PLOS ONE, vol. 15, no. 12, 2020.
@article{8729479,
  abstract     = {{Objectives

Disulfiram is an adjunct in the treatment of alcohol use disorders, but case reports indicate that disulfiram ethanol reactions are not always recognized in the emergency department. Our first aim is to remind of this risk with two case reports of life-threatening reactions not immediately considered by the emergency physician. The second aim is to estimate the probability that a disulfiram reaction goes unrecognized with the use of a retrospective study of patients admitted to the emergency department.

Methods

Clinical files of patients admitted between October 1, 2010 and September 30, 2014 to the emergency department were retrospectively screened for the key words "ethanol use" and "disulfiram". Their diagnoses were then scored by a panel regarding the probability of an interaction.

Results

Seventy-nine patients were included, and a disulfiram-ethanol reaction was scored as either 'highly likely', 'likely' or 'possible' in 54.4% and as 'doubtful' or 'certainly not present' in 45.6% of the patients. The interrater agreement was 0.71 (95% CI: 0.64-0.79). The diagnosis was not considered or only after a delay in 44.2% of the patients with a 'possible' to 'highly likely' disulfiram interaction. One patient with a disulfiram overdose died and was considered as a 'possible' interaction.

Discussion and conclusions

A disulfiram ethanol interaction can be life threatening and failure to consider the diagnosis in the emergency department seems frequent. Prospective studies with documentation of the intake of disulfiram and evaluation of the value of acetaldehyde as a biomarker are needed to determine the precise incidence. Improving knowledge of disulfiram interactions and adequate history taking of disulfiram intake may improve the care for patients.}},
  articleno    = {{e0243222}},
  author       = {{Segher, Kristof and Huys, Liesbeth and Desmet, Tania and Steen, Evi and Chys, Stefanie and Buylaert, Walter and De Paepe, Peter}},
  editor       = {{Lin, Steve}},
  issn         = {{1932-6203}},
  journal      = {{PLOS ONE}},
  keywords     = {{Multidisciplinary,ALCOHOL-USE DISORDER,ACUTE MYOCARDIAL-INFARCTION,ACETALDEHYDE,PHARMACOTHERAPY,HYPOTENSION,METABOLITE,PLASMA}},
  language     = {{eng}},
  number       = {{12}},
  pages        = {{13}},
  title        = {{Recognition of a disulfiram ethanol reaction in the emergency department is not always straightforward}},
  url          = {{http://doi.org/10.1371/journal.pone.0243222}},
  volume       = {{15}},
  year         = {{2020}},
}

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