KYJ 68 Alcohol overdose
Whilst alcohol is diuretic, and causes dehydration most noticeably cerebral (hence hangover), the patient's diuresis is osmotic, so doesn't reduce blood volume.
Alcohol filtered into renal tubules causes the increase in urine output, by osmosis. It prevents reabsorption in the ascending loop and distal tubes.
The patient may be dehydrated, but they are not volume depleted.
Giving IV Normal saline in these patients who are hung over or still intoxicated, compounds their hypervolaemia, but because their blood is still full of ethanol, they continue to suck water from their interstitial space and cells.
IV fluids in the acute alcohol ingestion just worsens the need to use the bottle or pan more frequently.
Normally in sober blood, 65% of a litre of NS is shifted into the ISS within 15 mins, but in drunk folk, (because of the osmotic pull of alcohol in blood), this ISS replenishment doesn't happen and all we do is overload them.
Fine if you are 22 and full of Yagerbombs, but potentially dangerous if you have an older type with the beginnings of heart failure. That hypervolaemia can induce a hypertensive crisis, and systolic failure, not to mention a heap of unwanted preload.
No comments:
Post a Comment