J.G., a 49-year-old man, was seen in the emergency department 4 days ago, diagnosed with alcohol intox-ication, and released after 8 hours to his brother's care

Question

He was brought back to the ed12 hours ago with
an active gastrointestinal (GI) bleed and is being admitted to the intensive care unit (ICu); his diagnosis is
upper GI bleed and alcohol intoxication.
you are assigned to admit and care for J.G. for the remainder of your shift. according to the ednotes,
his admission vital signs (Vs) were 84/56, 110, 26, and he was vomiting bright red blood. He was given IV
fluids and transfused 6 units of packed red blood cells (PRBCs) in the ed. On initial assessment, you note
that J.G.'s Vsare blood pressure 154/90, 110, 24; he has a slight tremor in his hands, and he appears anx-ious. He complains of a headache and appears flushed. you note that he has not had any emesis and has
not had any frank red blood in his stool or melena (black tarry stools) over the past 5 hours. In response
to your questions, J.G. denies that he has an alcohol problem but later admits to drinking approximately a
fifth of vodka daily for the past 2 months. He reports that he was drinking vodka when he got home from
the edthe first time. He admits to having had seizures while withdrawing from alcohol in the past. He tells
you that he "just can't help it" and has strong urges to drink, but that he never means "to drink very much."
He has had trouble keeping a job over the past several months.

Admission Lab Work
Hgb 10.9?g/dL
Hct 23%
ALT?(formerly?SGPT) 69?units/L
AST?(formerly?SGOT) 111?units/L
GGT 75?units/L
ETOH 291?mg/dL

Which data from your assessment of J.G. are of concern to you?

What do the admission laboratory results indicate?

Which of the previous laboratory results specifically reflects chronic alcohol ingestion?

What are the two most likely causes of J.G.'s symptoms?

What is the most likely time frame for someone to have withdrawal symptoms after abrupt
cessation of alcohol?

Answer 1

Elevated BP and heart rate, tremor, anxious and flushed appearance, headache, amount and
frequency of alcohol use, and history of seizures with withdrawal from alcohol.

The Hgb and Hct indicate blood loss from the GI bleed. The ALT, AST, and GGT results indicate liver
disease or damage. Last, the blood alcohol level is dangerously high.

The GGT can reflect chronic alcohol ingestion and is elevated in almost 75% of patients who are
long-term alcohol users.

Active GI bleed and alcohol withdrawal

Early signs of withdrawal after cessation of alcohol intake start to develop within a few hours. They
peak after 24 to 48 hours, then disappear rapidly unless the person's withdrawal progresses to
alcohol withdrawal delirium. This delirium will peak 48 to 72 hours after alcohol intake stops and
lasts 2 to 3 days or longer.