[Clinical and laboratory differentiation of alcohol withdrawal syndrome ("predelirium") and alcoholic delirium]. / Zur klinischen und labortechnischen Differenzierung des Alkoholentzugssyndroms ("Prädelir") und des Alkoholdelirs.

In a retrospective study, data from 99 male and female inpatients with alcohol withdrawal syndrome or alcohol withdrawal delirium, treated between 1977 and 1987, were analyzed. DSM-III criteria were used to assign the diagnosis of either withdrawal delirium (with obligatory clouding of consciousness) or alcohol withdrawal syndrome (without disturbances of consciousness and/or perception). No statistically significant differences between the two groups were found with respect to the red and white blood count, liver enzymes, and electrolytes. Significant differences were found in calcium levels, lymphocyte counts, and in electrophoresis. However, these differences are of no use for diagnostic purpose. Moreover, they are unspecific with respect to etiology. Hence, the distinction between alcohol withdrawal syndrome and alcohol withdrawal delirium can only be made clinically, i.e., it is dependent on the presence or absence of a clouded consciousness. This is in line with the findings published by other investigators. In the light of our metabolic findings, alcohol withdrawal syndrome and alcohol withdrawal delirium represent the two extremes of a continuum rather than two separate nosological entities.

Platelet monoamine oxidase, plasma dopamine beta-hydroxylase activity, dementia and family history of alcoholism in chronic alcoholics.

The authors measured platelet monoamine oxidase (MAO) activity and plasma dopamine beta-hydroxylase activity in 36 male chronic alcoholics during a period of non-abstinence, and in 29 normal controls. The influence of family history, dementia, chronicity of drinking and liver injury on the enzyme activities was also examined by multiple regression analysis. Platelet MAO was significantly lower in the alcoholic group. Both enzyme activities were negatively related to the presence of dementia, while low MAO activity was associated with positive family history (parents, sibs) of alcoholism.

Liver superoxide dismutases and catalase during ethanol inhalation and withdrawal.

Manganese superoxide dismutase (Mn-SOD) studied during ethanol vapor inhalation shows no changes during the inhalation period (4 days) and a transient increase 12 hours after ethanol withdrawal. A significant decrease in cytosolic Cu-Zn-SOD is found at the end of the inhalation period and was sustained during 48 hours following ethanol withdrawal. It is suggested that this decrease in Cu-Zn-SOD activity might be related to an inactivation of the enzyme linked to the increase in hydroxyl radical production related to ethanol metabolism. Cytosolic catalase is reduced at the end of the ethanol inhalation period. This decrease could be related to an enhanced superoxide radical concentration linked to the reduced Cu-Zn-SOD activity.

Platelet MAO during the alcohol withdrawal syndrome.

The authors explored platelet MAO activity in alcoholism and focused on the impact of the alcohol withdrawal syndrome on MAO values. They found that platelet MAO activity is relatively increased in alcoholic patients who are experiencing withdrawal symptoms from alcohol and that it does not appear to be stable during the period of withdrawal.

Delirium tremens: some clinico-chemical features. A study of alanine-aminotransferase, alcaline phosphatase, prothrombine and enolase.

The relationship between variables reflecting liver disease (serum-alanine-aminotransferase (SGPT), serum alcaline phosphatase and plasma prothrombine) and the clinical signs and symptoms during delirium tremens (DT; grade 3) and related clinical states (grade 2) was studied. Furthermore, it was investigated whether the two isoenzymes of enolase which predominante in brain tissue were present in plasma or cerebrospinal fluid (CSF) in DT patients. A correlation between SGPT and clinical state was not observed, which indicates that a causal relationship does not exist between acute liver cell damage and clinical state during DT of grade 3 or 2. In grade 2 patients, but not in grade 3 patients, both SGPT and serum alcaline phosphatase decreased between admission and recovery. This difference between the groups may be due to a higher alcohol consumption and a shorter interval between last drink and admission in grade 3. The difference in recent drinking history may also account for the finding of a higher plasma prothrombine index in grade 3 compared with grade 2, because chronic ethanol intoxication may be accompanied by enhanced hepatic protein synthesis. "Brain-enolase" was not present in detectable amounts in blood or CSF during DT thus suggesting that brain cell damage resulting in leakage of this enzyme from the cells did not prevail during DT.

Serum creatine phosphokinase activity in newly admitted chronic alcoholics.

Serum CPK activity was measured for a total of 33 cases of chronic alcoholics who were admitted to the mental hospital from April, 1975 to January, 1976. The result was examined in relation to the manifestation of the psychotic symptoms in the patients: (1) Twenty six (78.8%) out of 33 cases showed increased serum CPK activity within 48 hours of admission. (2) In most cases that showed abnormal CPK activity, CPK value was the highest at the moment of admission, and then began to fall rapidly, and after one or two weeks settled to the normal CPK level. (3) There was a positive correlation between abnormal CPK activity and the manifestation of the psychotic symptoms in the month before and after entering hospital. In this cases of those having more than 101 IU in serum CPK value, the rate of presenting the psychotic symptoms in a month before or after admission was 90.5% and 71.4%, respectively. The author has given here a report on the above-mentioned results and made some considerations as to pathogenesis of abnormal CPK activity in chronic alcoholism.

[Pathogenesis of chronic alcohosim]. / K patogenezu khronicheskogo alkogolizma

The paper is concerned with a study of the enzyme activity which reflects the functional state of the liver in 123 patients with chronic alcoholism (without clinical signs of disturbed liver function). The blood serum was studied for sorbitdehydrogenase, frutose-I-phosphataldolase, glutamino-asparagine and glutamine-alanine transamine. It was established that there is an increase in the activity of specific and nonspecific liver enzymes. This increase was in a direct correlation with the clinical expression and severity of the disease (withdrawal syndrome, delirious condition). It is being concluded that the indices of the level of enzyme activity may be used for the evaluation of the state of the patients and its change under the effect of treatment.

[Thiamine deficit in acute alcoholic psychoses]. / Defitsit tiamina pri ostrykh alkogol'nykh psikhozakh

In 35 females and 22 males with acute alcoholic disorders and in 44 individuals of a control group the author studied the indices of thiamine balance--the content of thiamine and pyruvic acid in the blood and urine, concentration of citric acid in the blood, activity of transketolase of erythrocytes and TDP-effect. The results demonstrated that a thiamide deficiency in excretion and insufficiency in coenzyme functions of oxidative decarboxylation of pyruvic acid and in the pentose cycle is seen not only in alcoholic psychoses, but in the withdrawal syndrome. Sex differences of these indices and their development were not noted. It is assumed that the clinical traits of alcoholic disorders in females are not related to changes in the thiamine metabolism.