What is acetaldehyde syndrome?There is talk of an acetaldehyde syndrome when symptoms of intoxication occur after drinking alcohol or certain fungi.
Acetaldehyde syndrome is also known as Antabuse Syndrome, Coprinus Syndrome or Disulfiram Syndrome. This refers to an acute poisoning after the consumption of certain substances. These include, first and foremost, alcohol, medicines or fungi such as wrinkles.
Particularly affected by an acetaldehyde syndrome are people of Asian descent. For example, they are more likely to have a genetic polymorphism of aldehyde dehydrogenase than people of European descent. This leads to a slower degradation of the aldehyde acetaldehyde. Doctors also speak of an ALDH-2 defect.
An acetaldehyde syndrome is caused by a blockade of the enzyme aldehyde dehydrogenase or ALDH-1 and ALDH-2. This in turn results in an inhibition of the oxidation of the acetaldehyde to acetic acid, resulting from the degradation of alcohol. This leads to a toxic increased formation of hydroxyl radicals, which are among the most common radicals.
There are many different substances that are considered to be responsible for the formation of acetaldehyde syndrome after consuming alcohol. These include other medicines taken at the same time as antibiotics. Specifically, these are cephalosporins having a lateral methylthiotetrazole chain such as moxalactam, cefoperazone, cefotetan, cefmenoxime and cefamandole, imidazoles effective against anaerobic agents such as tinidazole or metronidazole, antifungals such as griseofulvin and other antibiotic agents such as cotrimoxazole and chloramphenicol.
Other drugs that can cause acetaldehyde syndrome are malaria drugs such as quinacrine, antidiabetic drugs that include the sulfonylureas such as chlorpropamide, acetohexamide, glipizide, glyburide and tolbutamide, vasodilators derived from the nitrates genus, isosorbitol dinitrate or nitroglycerin. Likewise, chemicals such as pesticides used to kill pests are candidates for causing acetaldehyde syndrome.
These are primarily sulfiram and carbamates. Eponym for the antiviral syndrome or disulfiram syndrome was the medical drug disulfiram, which was used in earlier years as a sleep-prevention drug for alcoholism under the trade name Antabus.
The drug prevents alcohol from converting to acetic acid by blocking the enzyme aldehyde dehydrogenase. In this way, even small amounts of alcohol that are taken, provide for violent intolerance reactions such as palpitations, headaches and nausea. For larger amounts of alcohol, in the worst case, these reactions may even result in the death of the person concerned.
That's why disulfiram is rarely used today. Also triggering an acetaldehyde syndrome include several edible mushrooms such as the wrinkles and the Witches. In the mushrooms is the mushroom poison Coprin, which has the property to block the enzyme aldehyde dehydrogenase.
As Coprinus syndrome, this leads to the simultaneous consumption of alcohol again to poisoning symptoms. Without the compound with alcohol, the coprin, however, can develop no harmful effect.
Symptoms, complaints & signs
It takes only a few minutes, or up to 72 hours, for the first effects of acetaldehyde syndrome to appear after drinking alcohol. Already a few milliliters of alcohol can trigger noticeable redness on the face, neck, neck and chest as well as pronounced heat feelings.
In some people, redness occurs throughout the body. Patients also suffer from itching, prickling, a metallic taste in the mouth, high or low blood pressure and coldness in the arms and legs.
In addition, discomfort such as sweating, nausea, vomiting, diarrhea, headache, cramping and tremors are possible. Rarely, chest tightness, ranging as far as an attack of angina pectoris, cardiac arrhythmias, movement disorders, or ataxia, are also rare. In the worst case, the patient suffers a collapse and falls into a coma. As a rule, however, the symptoms improve again after three to six hours.
Diagnosis & History
The diagnosis of acetaldehyde syndrome or Coprinus syndrome is based on typical symptoms. In addition, the doctor interviews the patient about his alcohol consumption and whether he has eaten certain mushrooms or taken special medicines at the same time. Furthermore, a physical examination is carried out.
In most patients, the acetaldehyde syndrome takes a positive course. Thus, the unpleasant symptoms disappear after a few hours by itself. Chance, however, threaten serious complications such as a circulatory collapse or the case in a coma. However, deaths were very rare due to the acetaldehyde syndrome.
When should you go to the doctor?
Whether a medical treatment for acetaldehyde syndrome is necessary, can not be generally predicted and usually depends on the severity of the symptoms. If the symptoms only occur to a very slight extent and do not restrict the person's life too much, no treatment is necessary. The symptoms usually disappear after a few minutes or hours and lead to no further complaints. However, if alcohol dependence or drug addiction is involved, the patient should consult a consultant or withdrawal clinic.
A doctor must be consulted when, for example, heart disease occurs due to the acetaldehyde syndrome. These can in the worst case lead to the death of the person concerned. However, even in the case of vomiting or in the case of disorders of sensitivity, treatment should be given by a doctor to prevent consequential damage. If a collapse or a coma occurs, the emergency physician must be contacted in any case. The complaints usually disappear after three hours at the latest. If it does not come to an improvement after this period, as must also be a medical treatment.
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Since the effects of acetaldehyde syndrome can be very different, the prognosis of the course of the disease is important. If the symptoms are mild, no medical treatment is necessary. The symptoms disappear after a short time again. If treatment is desired or necessary, it is the symptoms that are tackled.
So far, however, there are no appropriate therapeutic measures. In the case of a severe illness, activated charcoal is prescribed in most cases. Cardiovascular symptoms, such as tachycardia, in which the heart begins to lawn, or hypotension, low blood pressure, can occur in rare cases.
With the help of beta-blockers, the tachycardia can be contained very quickly. The treatment of low blood pressure due to the acetaldehyde syndrome is performed with volume replacement, a compensation for excessive loss of body fluids. All these measures are monitored by the monitor so that there is a chance of a full recovery.
Only in isolated cases, a sedation, so a reassurance of the patient necessary. Following the treatment, a consistent alcohol abstinence is recommended.
Treatment & Therapy
If there is a slight course of acetaldehyde syndrome, usually no medical treatment is necessary. So the complaints usually last only briefly. In addition, because there are no causal therapies, symptoms are treated instead, if necessary.
If it is a severe poisoning, the patient often receives activated carbon. If cardiovascular complaints are present, the use of beta-blockers for tachycardia or volume replacement for low blood pressure (hypotension) is recommended. The patient is simultaneously monitored by screen.
Sometimes it may also be necessary to perform a drug sedation (sedation) of the patient. The person concerned must refrain from consuming any alcohol for at least five days.
Outlook & Forecast
As a rule, acetaldehyde syndrome causes various unpleasant symptoms after drinking alcohol. This causes severe redness and itching on the face. The patient feels unwell and suffers from decreased blood pressure. The low blood pressure can also lead to loss of consciousness. Often it comes with the loss of consciousness to a fall in which the person can be injured.
Furthermore, the patient suffers from cramping and tremors. In the worst case, the heart is also affected, causing a circulatory collapse. In most cases, however, no life-threatening complications occur when the acetaldehyde syndrome is treated. The symptoms disappear after a few hours.
The treatment uses medication. In severe cases, the person has to spend a few days in the hospital until the symptoms have improved. Even after treatment, it is necessary to abstain from alcohol for a period of one week. It can not be excluded that it will come again to the acetaldehyde syndrome when consuming alcohol. As a rule, the life expectancy is not reduced by the syndrome.
The best way to prevent acetaldehyde syndrome is to avoid the simultaneous consumption of alcohol, mushrooms such as wrinkles and witch's cancers, and certain medications that can trigger poisoning. So usually only the interaction of the individual substances leads to the outbreak of the symptoms of intoxication.
With acetaldehyde syndrome, no aftercare is usually possible or necessary. The syndrome itself must necessarily be treated by a doctor, as it can lead to the death of the person affected in the worst case. An early diagnosis and treatment of the acetaldehyde syndrome have a very positive effect on the further course of this disease and can prevent further complications.
The treatment of the syndrome itself is usually done with the help of activated carbon. The sufferer must take the drug regularly to completely detoxify the body. It is also important to pay attention to a high amount of fluid, as the body has mostly lost fluid.
Similarly, sufferers should refrain from taking alcohol and nicotine as much as possible to speed healing. As a rule, the symptoms of acetaldehyde syndrome usually disappear after a few days, so that aftercare is not possible and not necessary.
The causes of poisoning should be avoided as far as possible in the future in order to avoid the recurrence of the acetaldehyde syndrome. In the case of a loss of consciousness, however, an emergency doctor should be called directly or visited the hospital, as it is a serious poisoning.
You can do that yourself
The best thing a patient can do to prevent the acetaldehyde syndrome is to generally consume little or no alcohol. However, this also applies in general, and not only in relation to the acetaldehyde syndrome. Nevertheless, should (too much) alcohol be consumed, possible side effects can not be ruled out.
As sufferers break down the alcohol in their blood more slowly, they are already affected by smaller amounts. Often, however, only the interaction of different substances leads to the onset of poisoning symptoms. Therefore, avoiding different types of fungi, such as wrinkles or sycamores, may be helpful. Since many mushrooms are similar in their appearance and thus a likelihood of confusion exists, should be waived in doubt, rather than their consumption. When taking medications, the package leaflet should be carefully studied in any case, in order to avoid possible interaction with alcohol and / or other products.
In the acute case, the person affected by vomiting may be able to alleviate the symptoms. A treatment with activated carbon can also have a positive effect. If necessary, however, first aid measures must be applied. Until normal health is restored, alcohol should be strictly avoided. To protect the body bed rest is recommended.