Alcoholism Patients

  1. We received many alcoholism in emergency department whose came with loose of consciousness ,sweating and their HGT 1or2 m mol/l ,my question does all alcoholism develop hypoglycemia ? next Why the nurse should assess the patient for pneumonia and head injury.

    THANKS!
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  2. 11 Comments

  3. by   CEN35
    not all alcoholics develop hypoglycemia. they can develop hyperglycemia (if not already a diabteic), secondary to pancreatitis. the hypoglycemia usually occurs, because most alcoholics eat very little. their body essentially relies on the carbs in etoh and their body stores.

    as far as head injury? there are two reasons.

    1st - anytime a patient presents to the er with an altered mental status, head injury needs to be suspected. you can look at the labs and say, .356 etoh, or positive tox screen, and say......oh it's because he was drinking or using.

    however, how do you know he didn't fall down while intoxicated, and smack his head? this could have led to a sub-dural/epi-dural, and although rare from trauma a sub-arachonoid bleed. how do you know it's not because the patient stroked out, or had a spontaneous bleed?
    if you assume it's the alcohol, and it's not? that could lead to a huge problem. never assume one thing, unless evrything else can be ruled out.

    2nd - i can't remember the specifics, or technical stuff to this one, but will do my best to explain it.
    alcoholics, or long term drinking binges can cause an encepholopathy. thiamine, is used by the body excessively in alcoholics, and/or long term binges. thiamine contains something that your body needs, to produce a co-enzyme. this co-enzyme is necessary for your brain to be able to convert and use glucose. if you deplete this co-enzyme (thiamine stores), it's almost the same as letting the serum glucose, drop to less than 10, or even 0.
    the only difference is, the remainder of your body functions because only the brain requires that co-enzyme converted from thiamine.
    pneumonia? i'm not sure about that one, or why you even asked?


    me
  4. by   Level2Trauma
    Unless it is perhaps the fact that a high number of alcoholics aspirate on their vomit.
  5. by   Squirrel
    Because of the liver damage, alcoholics are not able to store glycogen properly, and that is another reason they become hypoglycemic
  6. by   debbyed
    We had a pair of cousins from one of the lower South American countries that we would get in the ER every Friday night without fail. They were always brought in unresponsive with Blood etoh levels of >400, occasionally the younger one would be >500.

    They died within 2 weeks of each other.

    They younger one had a massive sub-dural that was discovered on the last of many, many CT Scans he had had done over the 6 or so months we treated them.

    The older one was found dead in the median strip of the highway they had to cross to get home. No physical signs of trauma, but we never heard the M.E.'s report.

    Each time these boys ( 21 & 23) came in they received IV fluids (banana bag), foleys and CT Scans because they were always unresponsive.

    Of course they had no insurance and drank any money they made.

    Now I firmly believe that every person is entitled to emergency care regardless of their ability to pay, but we couldn't help but feel anger that we were all working hard to take care of our own families and that there would never be reinbursement for the care given these cousins. They lived a sad and unproductive life that was not only a drain on society but they were also a danger to society as well.

    There needs to be a middle ground somewhere.

    Sorry...Guess I got up on one of my soap boxes again. I only started out to point out why it is necessary to CT Scan unresponsive intoxicated patients.
  7. by   kaycee
    I hear ya Debbye!
  8. by   Level2Trauma
    When you see one of these individuals, i suggest......You repeat the phrase.....BUT BY THE GRACE OF GOES ME!!!! By the way.......It is hard to dismount gracefully when you are sitting on a "HIGH HORSE".
  9. by   teeituptom
    Howdy Yall
    From deep in the heary of Texas

    Well sweetnurse11, You always worry about severel intoxicated patients with the problems of aspiration pneumonia, have see this a few times. Also with the chronic alcoholics their immune system is depressed and they are at risk of catching anything they get exposed to. Then there are those who will do anything for a drink, and they are at risk for all sorts social exposure maladies, Ive een a few of those also.

    keep it in the short grass yalll
    teeituptom
  10. by   shootemrn
    By the Grace of God goes me?
    Yes... for a person that is suffering from a medical ailment absolutely. You should be thankful that you have your health and not be suffering their fate.
    But chronic alcoholics..They have a choice. Our hospital has a detox and I admit people to it every day. I like helping people try to beat their addiction..BUT you also get people who refuse detox and just want a bed and a sandwich and to urinate on my floors. Then they sign out AMA...then there back again and again and again...rinse repeat ...rinse repeat.

    They are a drain on the department and occupy alot of time of staff. And their ailment is self inflicted...they chose that ailment. I have very little compassion for repeat drunks.
  11. by   Level2Trauma
    From my experience in the ER, the alcoholics don't drain the system 1/2 as much as the hyperchondriacs. At least with the alcoholic there is a problem. Some words to chew on....Don't climb too high on that pedastool......you never know who, in your family might succumb to the disease you most despise. I have very little compassion for uncompassionate nurses.
  12. by   MollyJ
    As a former ED nurse there was more than a little irony when I went into drug prevention.

    Drunks are time consuming, prone to explosions of anger, can have a bevy of true maladies or alternately can just be bs'ing and using up your time and energies. I would rate my compassion LOW.

    However, I read somewhere that alcoholics are often seen at their absolute worst by nurses and we tend to have pretty negative perspectives on them.

    I absolutely agree with Level2 that the mantra should be, "There but for the grace of god go us." Just about anyone can slip into maladaptive drinking patterns given the right circumstances. Alcoholics who have been in sobriety for a while will tell you that they were terrified by what was happening but more terrified of sobriety (at least for a time). what a horrible position to be in.

    Anyhow, drunks are part of the scenery in the ED. There are some indications that simple expressions of concern about a patient's pattern of drinking may help move some problem drinkers toward changing their behavior. ED nurses know they are sometimes THE hcp that drunks see...so don't forget your simple expression of concern for you drunk clients.
  13. by   traumajunkee
    I really really hate nurses on their high horses that tell other nurses how they should feel.
    Where is your compassion for your fellow co-workers? Do they not have a right to express their frustration here on an anonymous bullentin board without someone getting all santimonious? I lived with an alcoholic that when sober was a really nice guy but when drunk used me as a punching bag. It really irked me to have to go to work and put up with the behavior of these people but I did and probably treated them better than any of the other nurses, encouraging them to seek treatment and using alot of patience. I had learned at the expense of getting a punch that patience works alot better with these people. But inside I did not like who and what they were.
    That is my right. I earned it the hard way. Try being a little sympathetic and realize even nurses have feelings and deserve your compassion. Thank you very much!:

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