Serum lipase: a better test to diagnose acute alcoholic pancreatitis.

OBJECTIVE: To determine whether serum lipase is a better test than serum amylase to diagnose acute alcoholic pancreatitis. PATIENTS: Two hundred two asymptomatic chronic alcoholics (Group A) and 29 patients with image-proven pancreatitis (Group P). MEASUREMENTS: Serum lipase was measured using the Kodak Ektachem clinical chemistry slide. Serum amylase was estimated using the Kodak Ektachem clinical chemistry slide or the Beckman Astra amylase chemistry module. RESULTS: The level of serum amylase in Group A ranged from 17 to 347 U/L (mean 71, SD +/- 36 U/L) and in Group P from 180 to 2,985 U/L (mean 722, SD +/- 663 U/L). Thirteen of 29 patients (45%) with image-proven pancreatitis had levels that overlapped those found in asymptomatic alcoholics. The serum lipase levels in Group A ranged from 34 to 600 U/L (mean 186, SD +/- 111 U/L), while in Group P, the corresponding figures were 1,011 to 25,706 U/L (mean 5,822, SD +/- 5,664 U/L). None of the 29 patients with image-proven pancreatitis had levels that overlapped those found in asymptomatic alcoholics. CONCLUSIONS: Serum lipase is a better test that serum amylase to diagnose acute alcoholic pancreatitis.

Serum lipase levels in chronic alcoholics.

Using an elevated serum amylase level to diagnose acute pancreatitis in an alcoholic patient with abdominal pain may not be appropriate, because hyperamylesemia is common in asymptomatic alcoholics without acute pancreatitis. To determine whether serum lipase also suffers from the same drawback, we undertook a prospective study involving 202 asymptomatic alcoholics admitted to the detoxification unit of our hospital. Sixty-six of the 202 patients had serum lipase levels above the normal range (0-213 U/L). Of these 66, 55 (83%) had levels that were one to two times normal, while 11 patients had levels ranging between two and three times normal. No patient exceeded three times the normal level. This background information is important in the interpretation of serum lipase levels in alcoholic patients with abdominal pain.

Drug use among alcoholism detoxification patients: prevalence and impact on alcoholism treatment.

We collected urine specimens for toxicology from 266 patients consecutively admitted for alcoholism detoxification. We compared these results to patient's self reports of drug use and attempted to determine whether drug use adversely impacted the course of alcoholism treatment.

Mandatory supervised antabuse therapy in an outpatient alcoholism program: a pilot study.

We instituted a program of mandatory supervised antabuse therapy in an outpatient alcoholism clinic for patients who wish to remain connected to the clinic but who have continued to drink repeatedly. Almost 60% of 68 patients who agreed to this regimen achieved significant periods of sobriety. These preliminary findings suggest that a controlled trial of this approach is warranted.

Chronic alcoholism and myocardial disease.

Myocardial function was determined by echocardiographic and systolic time interval measurements in 24 abstinent chronic alcoholics and matched non-alcoholic controls. In the patients, the measurements were taken sequentially 24-48 h after their last drink, 5-7 days later and 14-21 days after the second testing. All measurements were done without the investigators' knowledge of whose tracing he was evaluating. The results showed no significant deviation from normal values in any of the patients at any time and are in keeping with the assumption that chronic, excessive alcohol use by itself has no toxic effect on a healthy myocardium; excessive alcohol use probably plays a role by further impairing myocardial function in an already diseased heart.

Effect of prior narcotic addiction on response to treatment of alcoholism.

We studied the effect of prior narcotic addiction on response to treatment of alcoholism. Patients in the Elmhurst Alcoholism Treatment Program are offered medical care, counseling, disulfiram, and close affiliation with Alcoholics Anonymous. We compared 85 alcoholics who had a history of narcotic use with a control group of 85 alcoholics matched for age, sex, and race who had never used narcotics. Among controls, 30 (35%) became abstinent from alcohol for at least half the time that they were known to us. Of the former narcotic users, only 8 (9%) became abstinent for at least half the time they were known to us. Former narcotic users did poorly in alcoholism treatment, whether or not they had ever been treated with methadone maintenance. Alcohol use, often heavy, began before heroin use in at least half the narcotic group. We conclude that a history of narcotic use reduces markedly the chance of success in conventional alcoholism treatment, and that alcoholism and narcotic addiction develop independently.

Chronic alcoholic cardiomyopathy: fact or fiction?

This study was designed to ascertain whether excessive prolonged alcohol intake itself may produce chronic cardiomyopathy. We reasoned that, since alcoholic cardiomyopathy is allegedly a chronic condition, asymptomatic or early symptomatic cases should be found in a large hospitalized alcoholic population. Two groups of patients were studied. The first group consisted of 292 chronic alcoholics whose hospital records were examined for evidence of early cardiomyopathy, according to predetermined criteria. The second group consisted of eight patients who died on the medical service ward and in whom one of the diagnoses listed in the autopsy report was alcoholic cardiomyopathy. In the first group hepatic and neurological complications of alcoholism were frequent; no patient was found to have early cardiomyopathy. In the second group the post-mortem records indicated that all eight patients had other illnesses causing the abnormal findings on which the diagnosis of alcoholic cardiomyopathy was made. We conclude that the concept of chronic alcoholic cardiomyopathy caused by the direct toxic effect of alcohol may not be valid.

Mechanism and significance of carbohydrate intolerance in chronic alcoholism.

Intravenous glucose tolerance tests were carried out in 61 chronic alcoholic patients, divided into two groups, and in a third group consisting of healthy, nonalcoholic volunteers. Members of one experimental group were drinking alcohol throughout the study. The patients of the other experimental group received no alcohol and were in withdrawal from alcohol. The glucose tolerance tests were carried out on each patient on admission to the hospital and 1 wk later. During the test, blood was drawn at 10 min intervals for glucose, immunoreactive insulin, and glucagon determinations. The results indicated that there was transient carbohydrate intolerance in the great majority of both patient groups, and it became evident that the carbohydrate intolerance was the result of continuous alcohol consumption and was not part of the withdrawal syndrome. Significant decrease in insulin secretion was found in the early part of the glucose tolerance tests in the majority of the patients in both alcohol and withdrawal groups. Based on results of this study and evidence from the literature, it is suggested that chronic alcoholism is dabetogenic in susceptible individuals and that the transient carbohydrate intolerance found in our study represents and early step in the development of adult-onset diabetes eventually developing in a significant number of chronic alcoholics.

Glucose intolerance in alcoholism.

Intravenous glucose tolerance tests were given to 31 nondiabetic alcoholics and 11 healthy nonalcoholic controls. In almost half of the alcoholics peak glucose concentration was higher and glucose elimination from the plasma was slower than in the controls.