Disulfiram-like reactions, also known as abstinence sulfur-like reactions, are toxic reactions caused by the accumulation of acetaldehyde in the body during or shortly after the use of antimicrobial drugs with similar effects to disulfiram (an abstinence agent) (cefoperazone sodium is the most common) and the consumption of alcoholic beverages (or exposure to alcohol). Disulfiram, also known as disulfiram and disulfiram, has been included in the pharmacopoeia of the United States and Japan as a drug for alcohol withdrawal. Disulfiram mechanism of action is: ethanol into the body, first in the liver through the role of ethanol dehydrogenase into acetaldehyde, acetaldehyde and then through the aldehyde oxidoreductase (also known as acetaldehyde dehydrogenase or acetaldehyde dehydrogenase) into acetic acid, acetic acid into the raffinate cycle, and finally transformed into water and carbon dioxide excretion. Disulfiram can inhibit aldose oxidoreductase, so that acetaldehyde can not be oxidized to acetic acid, resulting in an increase in acetaldehyde concentration in the body, resulting in discomfort. When drinking alcohol within a certain period of time after taking disulfiram, facial flushing, fever, headache, nausea, vomiting, garlic-like odor in the mouth and other reactions can occur, and even shock, blood pressure drops to 60-70/30-40mmHg, accompanied by loss of consciousness, which can lead to respiratory depression, myocardial infarction, acute heart failure, convulsions and death in severe cases. This is the disulfiram (like) reaction, also known as withdrawal sulfur-like reaction, disulfiram-alcohol reaction or disulfiram wake reaction. The application of disulfiram is expected to establish the conditioned reflex of the drinker to produce an aversion to alcohol. Because disulfiram is slowly excreted from the body, disulfiram-like reactions can occur during drug administration or even when alcoholic beverages are consumed within 1 to 2 weeks after discontinuation of the drug. Therefore, disulfiram is only suitable for those who have a strong desire to quit drinking alcohol on their own. 1. The cause of disulfiram-like reaction when cefoperazone sodium is applied The chemical structure of cefoperazone sodium is characterized by the presence of a methylthiotetrazole (thiomethyltetrazole) substituent at the 3-position of the 7-amino cephalosporanic acid (7-ACA) ring in its parent nucleus, which competes with coenzyme I for the active center of acetaldehyde dehydrogenase and prevents the continued oxidation of acetaldehyde, leading to the accumulation of acetaldehyde and thus causing disulfiram-like reaction. When cefoperazone sodium is applied, there may be a decrease in blood pressure, an accelerated heart rate (up to 120 beats/min) and a normal or partially altered ECG (e.g., ST-T changes) on examination. If the patient has precordial pain with ST-T changes in the ECG, it is due to the increased sympathetic excitability caused by the substitution of methiodiazole, which results in an increased heart rate, increased myocardial oxygen consumption, shortened myocardial diastole, and reduced coronary perfusion pressure, resulting in reduced perfusion flow. 2, the occurrence of disulfiram-like reaction treatment measures Strictly grasp the indications, improve safety awareness is the premise of effective prevention of disulfiram-like reaction. Once a disulfiram-like reaction occurs, appropriate and effective first aid measures should be taken within the shortest possible time, including: (1) bed rest, “V” position for 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 IV or IV push, rehydration and diuresis, and give naloxone and vasoactive drugs according to the condition. (4) Symptomatic treatment. If nausea, vomiting can be given gastroflucan 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. 3.About naloxone Naloxone is a hydroxymorphine derivative, which is a pure opioid receptor antagonist, can block and reverse the toxic effects of endogenous opioid peptides, and can antagonize the analgesic and inhibitory effects of morphine drugs. Naloxone can not only antagonize the respiratory depression caused by opioids, but also has significant effect on non-opioid poisoning, shock and acute respiratory failure. It can effectively produce the inhibition of B-endorphin effect, release its inhibitory effect on respiratory and vascular sympathetic function, improve systemic blood circulation, inhibit the release of free radicals, reduce oxygen radical damage, and also promote the conversion of alcohol, so that the content of alcohol in the blood drops significantly, thus reversing the pathological physiological changes of alcoholic clearing. The pathological physiological changes of poisoning. Make the patient turn clear in a short period of time, respiratory blood pressure back to normal. 4, other drugs that can occur disulfiram-like reactions In addition to cefoperazone, the application of cephalosporin other antibiotics such as cefmetazole, cefminox, cefamandole, cefmenoxime, laxative cephalosporin, cefazolin, cefaclor, ceftriaxone, etc.; imidazole drugs such as metronidazole, tinidazole, ornidazole, thiacnidazole, ketoconazole, etc.; and other classes such as furazolidone, chloramphenicol, ashwagandha and other drugs during Disulfiram-like reactions may also occur if alcohol is consumed.