Disulfiram (disulfiram) is the common name of alcoholic sulphur drugs, also known as alcoholic sulphur, disulfiram wake, is a drug for the treatment of chronic ethanol intoxication and ethanol toxic psychosis, as a drug for alcohol withdrawal has been used in many countries. Application of this drug after drinking alcohol will be nausea, vomiting, fear and other serious reactions, and the alcoholic fear of drinking alcohol, so as to play a role in alcohol withdrawal. However, the chemical structure or mechanism of action of certain drugs currently used in clinical practice is similar to that of disulfiram, which can produce disulfiram-like reactions, also known as antabuse reactions.
A. Characteristics of disulfiram-like reactions
1, the clinical characteristics of thiuram-like reaction
Drinking alcohol within a week after using drugs that can cause disulfiram-like reactions, facial and general skin flushing, conjunctival redness, fever, dry mouth, dizziness, headache, dizziness, panic, chest tightness, shortness of breath, nausea and vomiting, confused speech, talkative, blurred vision, unsteady gait, frenzy, delirium, impaired consciousness, syncope, abdominal pain, diarrhea, tingling in the throat, tremor, mouth with The patient may also experience tachycardia, decreased blood pressure, irritability, panic and fear, near-death feeling, some may experience confusion, numbness of limbs, incontinence, and in severe cases, shock, convulsions, acute heart failure, acute liver damage, angina pectoris, myocardial infarction, or even death. This performance is related to the inhibition of acetaldehyde dehydrogenase and dopamine β-aldolase in the body by disulfiram, and the performance of this group of clinical syndrome is called disulfiram-like reactions.
2, the time characteristics of disulfiram-like reaction
Drinking alcohol after using drugs with disulfiram-like reactions can cause symptoms as early as 5 min, generally within 30 min, a few within lh, and rarely after 1 h. Disulfiram-like reactions can occur in children. After the application of drugs that can cause disulfiram-like reactions in pediatric patients, alcohol or food containing ethanol should be avoided for 2 to 3 weeks after the drug is discontinued, because the function of the liver in metabolizing ethanol in pediatric patients is poor, and such reactions can occur even at low ethanol concentrations. There is individual variability in disulfiram-like reactions. Xie Fang reported that disulfiram-like reactions may occur in children with a history of alcohol consumption 3 d before drug administration. Chen Ling reported a disulfiram-like reaction in a 2-year-old child 0.5 h after taking 10 mL of Huoxiang Zhengqi water.
3. Characteristics of disulfiram-like reactions and the type and amount of alcohol consumption
Disulfiram-like reaction is proportional to the dose of drugs used, the interval after stopping drugs and the amount of alcohol consumed, but the relationship with the type of alcohol consumed is not clear. There are reports of disulfiram-like reactions after drinking 50mL of beer. White wine, red wine, yellow wine, beer and beverages containing ethanol can all cause disulfiram-like reactions. When a disulfiram-like reaction occurs, it often lasts for about 2h and can be gradually relieved; in severe cases, it can last for 24h or several days before it is completely relieved.
Diagnostic criteria, classification and differential diagnosis
1.Diagnostic criteria
Clear history of the use of drugs that can cause disulfiram-like reactions; the use of ethanol and its products 0d-7d after the use of drugs, or the use of drugs that can cause disulfiram-like reactions after drinking alcohol; the simultaneous application of ethanol-based drugs and drugs that can cause disulfiram-like reactions; typical clinical manifestations of disulfiram-like reactions; the amount or degree of alcohol consumed is significantly smaller or lower than the usual amount or degree of alcohol consumed, but significantly different from The amount or degree of alcohol consumed is significantly less than or lower than the usual amount or degree of alcohol consumed, but significantly different from the usual intoxication; no history of allergy to ethanol and the use of such drugs: in the case of disulfiram-like reactions, if there are no related diseases, the blood routine, blood sugar, renal function, electrolytes, cardiac enzyme profile, chest X-ray are mostly abnormal.
2.Disulfiram-like reaction grade
Mild: flushing of skin on the face or whole body. Mild dizziness, panic, no nausea, vomiting, fever, headache, etc.; moderate: dizziness, headache, panic, nausea, vomiting, fever, but no chest pain, respiratory distress, shock: severe: chest pain, respiratory distress, shock, and even impaired consciousness, incontinence.
Third, the treatment of disulfiram-like reactions
Disulfiram-like reaction is a pharmacogenic emergency and needs to be treated actively.
1.In-situ treatment
Immediately stop drinking, induce vomiting, and gastric lavage when available. Keep the airway open, remove oral and nasal vomit and secretions. Keep the head to the side to prevent asphyxia caused by vomit blocking the respiratory tract.
2.General treatment
Administer oxygen, bed rest, observe vital signs, measure blood pressure, pulse, respiration. Check electrocardiogram or electrocardiographic monitoring and observe pulse rate and blood oxygen, and conduct necessary auxiliary examinations.
3.Medication
Establish intravenous access, give intravenous drip of 5%-10% glucose 500mL-1000mL, add vitamin C2g-4g, vitamin B6
0.2g-0.4g, dexamethasone 5mg-10mg, which can accelerate the oxidation of ethanol. Intravenous injection and drip naloxone 0.4mg-0.8mg can antagonize the effect of ethanol. H2 receptor blockers, antihistamines can improve the symptoms.
4.Symptomatic treatment
Those with chest tightness and angina should apply nitrates; those in shock should supplement fluids or use dobutamine and other antihypertensive drugs; blood-activating drugs are used; vomiting can be used for gastric reversion. If there are serious complications, active and effective resuscitation should be given to prevent more serious consequences of disulfiram-like reactions.