title: Refractive hypotension in a patient with disulfiram-ethanol reaction.
abstract: Disulfiram (Antabuse) is used for aversive treatment of alcohol dependence with good effects. Through inhibition of aldehyde dehydrogenase, disulfiram heightens serum aldehyde concentration after alcohol ingestion and causes aversive disulfiram-ethanol reaction. Typical symptoms of this reaction include flushing, nausea, dyspnea, tremor, and confusion, which are usually self-limiting. However, severe life-threatening arterial hypotension sometimes develops. We report here a patient with generalized flushing, tremor, and refractive hypotension after ingestion of alcohol 18 hours after disulfiram treatment. Initial volume resuscitation and dopamine infusion failed to restore the blood pressure. Noradrenaline was given and the blood pressure returned to normal range. This case illustrates the intensity of disulfiram-ethanol reaction and underscores the advantageous use of noradrenaline in patients in such a critical condition.
authors.affiliation: Department of Emergency Medicine, Far Eastern Memorial Hospital, Taipei, Taiwan.
authors.forename: Min-Po
authors.initials: MP
authors.lastname: Ho
authors.forename: Chia-Hung
authors.initials: CH
authors.lastname: Yo
authors.forename: Chang-Ming
authors.initials: CM
authors.lastname: Liu
authors.forename: Chun-Lin
authors.initials: CL
authors.lastname: Chen
authors.forename: Chien-Chang
authors.initials: CC
authors.lastname: Lee
mesh_terms: D000328:Adult; D000427:Alcohol Deterrents / Q000008:administration & dosage / Q000009:adverse effects*; D004221:Disulfiram / Q000008:administration & dosage / Q000009:adverse effects*; D000431:Ethanol / Q000008:administration & dosage / Q000009:adverse effects*; D006801:Humans; D007022:Hypotension / Q000139:chemically induced* / Q000188:drug therapy; D008297:Male; D009638:Norepinephrine / Q000627:therapeutic use; D014662:Vasoconstrictor Agents / Q000627:therapeutic use
chemical_list: D000427:Alcohol Deterrents; D014662:Vasoconstrictor Agents; D000431:Ethanol; D004221:Disulfiram; D009638:Norepinephrine