Disulfiram-like reaction, also known as withdrawal sulfur-like reaction, is a toxic reaction caused by the accumulation of acetaldehyde in the body due to the consumption of alcoholic beverages (or exposure to alcohol) after the application of drugs (cephalosporins). After alcohol enters the body, it is first oxidized to acetaldehyde by the action of “ethanol dehydrogenase” in the liver cells, and acetaldehyde is oxidized to “acetic acid and acetaldehyde” by the action of “acetaldehyde dehydrogenase” in the mitochondria of liver cells. Acetaldehyde is oxidized to “acetic acid and acetalase A” in the mitochondria of hepatocytes, and acetic acid is further metabolized to carbon dioxide and water and excreted from the body. Due to the presence of “methylthiotetrazolium side chain” in some chemical structures, the activity of acetaldehyde dehydrogenase in the mitochondria of hepatocytes is inhibited, which prevents further oxidation and metabolism of acetaldehyde after it is produced, resulting in the accumulation of acetaldehyde in the body and disulfiram-like reactions. Clinical manifestations: Drinking alcohol (or exposure to alcohol) during drug administration, manifested as chest tightness, shortness of breath, laryngeal edema, cyanosis of lips and mouth, dyspnea, increased heart rate, decreased blood pressure, weakness of limbs, facial flushing, excessive sweating, insomnia, headache, nausea, vomiting, blurred vision, drowsiness, hallucinations, trance, and even anaphylactic shock, with blood pressure dropping to 60-70/30-40 mmHg with loss of consciousness. It is easily misdiagnosed as acute coronary syndrome, heart failure, etc. In addition, the severity of disulfiram-like reactions is directly proportional to the dose of applied drugs and the amount of alcohol consumed. Drinking liquor is more severe than beer and alcoholic beverages, and drinking alcohol during drug administration is more severe than drinking alcohol after drug discontinuation. Drugs: drugs that cause disulfiram-like reactions include cephalosporins and imidazole derivatives, such as ceftriaxone sodium, cefoperazone, cefotaxime, etc.; in addition, metronidazole, tinidazole, ketoconazole, furazolidone, chloramphenicol, methanesulfonylurea, glibenclamide, phenelzine, etc. can cause disulfiram-like reactions. Clinical care: The following care measures should be taken for patients with disulfiram-like reactions and anaphylaxis: (1) Rest in bed and adopt a “V” position for those in shock. (2) Keep the airway open and give oxygen inhalation 4-6L/min to improve tissue hypoxia. (3) Establish intravenous access, give dexamethasone 5-10mg in glucose solution by static drip or push, rehydration and diuresis, and give vasoactive drugs according to the condition. (4) Symptomatic treatment. If nausea, vomiting can be given gastric complex 10mg intramuscularly; if drowsiness, unconsciousness can be given naloxone antagonistic treatment. (5) Have all the first aid equipment and drugs available at the bedside, such as defibrillator, aspirator, tracheotomy and intravenous incision kit, respiratory stimulants, diuretics and other resuscitation drugs. (6) Closely observe the patient’s consciousness, body temperature, pulse, respiration, heart rate, heart rhythm, blood pressure, urine output and other clinical changes, and make nursing records of the dynamics of the condition. Note: Health care workers should remind patients and their families that alcohol (and drinks containing alcohol) is prohibited when cephalosporins and imidazole derivatives are used for treatment and within 7 days of discontinuation.