Influence of increased adrenergic activity and magnesium depletion on cardiac rhythm in alcohol withdrawal.
OBJECTIVE
To investigate the prevalence of arrhythmias in alcoholic men during detoxification and its relation to neuroendocrine activation and electrolyte disturbances.


METHODS
Consecutive case-control study.


METHODS
Primary and secondary care, detoxification ward.


METHODS
19 otherwise healthy alcoholic men (DSM-III-R) with withdrawal symptoms necessitating detoxification in hospital. 19 age matched, healthy non-alcoholic men as controls for Holter recordings.


METHODS
Treatment with chlomethiazole; additional treatment with carbamazepine in patients with previous seizures.


METHODS
Computer based analyses of mean heart rate and arrhythmias from 24 hour Holter recordings, 24 hour urinary excretion of adrenaline and noradrenaline, magnesium retention measured by means of intravenous loading test, and serum concentrations of electrolytes.


RESULTS
The 24 hour mean heart rate was higher in the alcoholic men (97.4 beats/minute, 95% confidence interval (CI) 91.2 to 103.6) than in the controls (69.6 beats/minute, 95% CI 65.4 to 73.8, P < 0.001). However, there was no difference in diurnal heart rate variation. The prevalence of premature supraventricular depolarisations was lower in the alcoholic men (P < 0.05). Neither atrial fibrillation nor malignant ventricular arrhythmias occurred. The sinus tachycardia in the alcoholic men correlated with the concomitant urinary excretion of catecholamines (P < 0.05). The mean serum magnesium concentration was 0.78 mmol/l (95% CI 0.73 to 0.83) in the alcoholic men and 0.83 mmol/l (95% CI 0.81 to 0.85) in a reference population of 55 men aged 40. Magnesium depletion (defined as magnesium retention > 30%) was detected in 10 alcoholic men (53%). Three alcoholic men had serum potassium concentrations < or = 3.3 mmol/l on admission.


CONCLUSIONS
Increased adrenergic activity, magnesium depletion, and hypokalaemia are often seen after heavy drinking, but in alcoholic men without clinical heart disease these changes were not accompanied by arrhythmias other than sinus tachycardia during detoxification in hospital.
Denison
H
H
Department of Medicine, Ostra Hospital, University of Gothenburg, Sweden.
Jern
S
S
Jagenburg
R
R
Wendestam
C
C
Wallerstedt
S
S
D000328:Adult; D002395:Catecholamines / Q000378:metabolism*; D015716:Electrocardiography, Ambulatory; D004837:Epinephrine / Q000652:urine; D000431:Ethanol / Q000009:adverse effects*; D006321:Heart / Q000503:physiopathology*; D006801:Humans; D008274:Magnesium / Q000097:blood / Q000378:metabolism* / Q000652:urine; D008297:Male; D008875:Middle Aged; D009638:Norepinephrine / Q000652:urine; D011188:Potassium / Q000097:blood; D013375:Substance Withdrawal Syndrome / Q000097:blood / Q000503:physiopathology* / Q000652:urine
D002395:Catecholamines; D000431:Ethanol; D008274:Magnesium; D011188:Potassium; D009638:Norepinephrine; D004837:Epinephrine