Question

65-year-old man who presented to the emergency department with syncope, hypotension (80/60 mm Hg), tachycardia (110 bpm), diffuse erythema, hypothermia (35.5oC), and shivering. Laboratory tests revealed metabolic acidosis (pH 7.33, lactate 8.7 mmol/L).
He was initially treated for anaphylactic shock, as well as with broad-spectrum antibiotics for possible sepsis. He reported drinking a half liter of wine shortly before symptoms onset.
Additional history elicited that he had also ingested disulfiram 500 mg 1 hour before the wine intake. All manifestations resolved within 6 hours. Cultures were negative.
The final diagnosis was severe disulfiram ethanol reaction (DER).
Questions:
1. What is disulfiram?
2. What is mechanism of action of interaction in above case?
3. Which other drugs can have disulfiram like reaction with ethanol?
4. What amount of alcohol is required to produce this reaction?

Answer 1

Disulfiram - It is a dig which is used for the treatment of chronic alcoholism by producing au aute sensitivity to ethanol. * Consuming high doses of alcohol after taking large doses of disulfiram con result in severe side effects and life-threatening reactions. The mechanism of action of interaction. in the mentioned case as the reaction between disulfiram and ethanol as it causes toxicity Ethanol blood level as low as 5-10 mg/dl. can precipitate a disceltiram - ethanol reaction 120-150 mg/dL can lead to unconsciouness. The drugs which causes disulfiram- like reactions upon ingestion of alcohol as an unintended effect include such as Abacavir, Cephalosporins. The amount of alcohol is required to produce disulfuram reaction as the symptoms are fully developed at song per 100ml and unconsciousness ósually results when the blood alcohol level reaches 125 to 1song,