Acetaldehyde syndrome

The acetaldehyde syndrome , more rarely also called Coprinus syndrome , disulfiram syndrome or antabus syndrome , describes the occurrence of a clinical picture of acute intoxication (poisoning) after ingestion of or contact with certain substances.

Regardless of this, acetaldehyde syndrome occurs more frequently in people of Asian descent after alcohol consumption alone, as they more often have a genetic polymorphism of aldehyde dehydrogenase (ALDH-2 defect) than people of European descent, which leads to a slower metabolism of acetaldehyde in those affected .

trigger

Several substances can cause acetaldehyde syndrome:

• Medicines of the following categories:
  • Antibiotics , including
    • Cephalosporins that have a methylthiotetrazole side chain, such as. B. cefamandol, cefotetan, cefoperazone, cefmenoxime, moxalactam
    • Nitrofurans , such as nitrofurantoin and furazolidine
    • Antimalarials , such as quinacrine
    • Imidazoles effective against anaerobic germs , such as metronidazole (according to some sources, correlation to the syndrome doubtful) and tinidazole
    • other antibiotics, such as chloramphenicol and co- trimoxazole
    • Antifungals: griseofulvin
  • Antidiabetic drugs of the sulfonylureas genus , such as tolbutamide , chlorpropamide , glyburide , glipizide , tolazamide , acetohexamide
  • Disulfiram (former trade name Antabus ), both eponymous for the syndrome. It is a remedy that was previously used to help quit alcohol
• Pesticides , such as carbamates and sulfirams
• Vasodilators , of the nitrate genus , such as nitroglycerin and isosorbitol dinitrate
• Some edible mushrooms ( witch's boletus , wrinkled ink , possibly also Schüpplinge ) contain the substance coprin , which together with alcohol causes the symptoms.
• The syndrome can occur due to the simultaneous intake of calcium cyanamide and alcohol and leads to alcohol intolerance even with small amounts of a few mg .

root cause

Blocking of aldehyde dehydrogenase (ALDH-1 & -2) with resulting inhibition of the oxidation of the acetaldehyde to acetic acid , which is formed during alcohol breakdown , toxic increased formation of hydroxyl radicals .

Symptoms

Minutes (or up to 72 hours) after drinking even a few milliliters of alcohol, there is a sensation of heat and severe reddening of the face, neck, neck and chest ( flush ). In severe cases, this redness can spread all over the body. A typical symptom complex consists of a metallic taste, tingling or itching as well as a feeling of cold in the arms and legs, palpitations and tachycardia (racing heart), rise or fall in blood pressure. Further signs can be headache, sweating, nausea and vomiting, diarrhea, feeling of fear, dizziness, tremors, cramps, overstimulation, more rarely also cardiac arrhythmia , tightness up to angina pectoris , dyspnoea , ataxia , collaptic conditions and coma . In most cases, symptoms resolve after three to six hours.

therapy

Since the symptoms only last for a short time, no medical treatment is usually necessary for milder courses. If necessary, therapy consists of supportive measures to alleviate individual symptoms. There is no causal therapy. Each patient receives 1 gram of medical charcoal per kilogram of body weight. If necessary, the patient should be sedated. The consumption of alcohol of any kind should be avoided for at least five days after contact with the triggering substance. Clinical monitoring should be undertaken.

Individual evidence

1. ↑ Disulfiram-like Reaction to Certain Cephalosporins , article summary at lww.com (Lippincott, Williams & Wilkins, English), accessed August 28, 2014.
2. ↑ Pharmaceutical agents known to produce disulfiram-like reaction: effects on hepatic ethanol metabolism and brain monoamines , (English), PMID 17963129 .
3. ↑ Lack of disulfiram-like reaction with metronidazole and ethanol , (English), PMID 12022894 .
4. ↑ Disulfiram-like reactions , abstract of the article on umem.org (University of Maryland, English), accessed on August 28, 2014.
5. ↑ Potential risks to human health and the environment from the use of calcium cyanamide as fertiliser (PDF, 1534 kB, English, Scientific Committee on Health and Environmental Risks , March 2016, accessed on July 22, 2017)
6. ↑ Disulfiram Toxicity Clinical Presentation , Symptoms of the Syndrome (English), accessed August 28, 2014.