Acta Med Scand 205: 317-318, 1979
Serum Ethanol, Hepatic Enzymes and Length of Debauch in Chronic Alcoholics J. Wadstein and G. Skude’ From the Depurtments of Alcohol Diseuses und Clinical Chemistry, University of Lund, Malmii Generul Hospital, M a h o . Sweden
ABSTRACT. The serum concentration of ethanol and the activities of aspartate aminotransferase, alanine aminotransferase and y-glutamyltransferase (GT) in 40 male chronic alcoholics were determined on admission to hospital. The serum activities of the enzymes were highest in patients with established alcoholism for less than 5 years. The serum concentration of ethanol, however, was lowest among these patients and gradually increased with the duration of alcoholism. No correlation was found between the serum ethanol level and the activity of any of the enzymes. The duration of the current debauch, which was shortest in cases of long-standing alcoholism, showed a positive correlation with the S-GT activity.
and more than 10 (mean 18) years. The mean number of hospitalizations at the clinic for the various groups as well as the mean number of attacks of delirium tremens during the last 5 years are given in Table I. The mean duration of the current debauch given in Table I is based on the anamnesis. Blood samples were drawn on admission. The serum ethanol concentration was determined by gas chromatography and the enzyme activities were determined according to the recommendations of the Scandinavian Enzyme Committee (4). Using a reference group of 97 subjectively healthy adult males without previous control of their drinking habits, the upper normal limit (mean + 2 S.D.) was found to be 0.65 pkat/l for S-ASAT, 0.85 for S-ALAT and 1.2 for S-GT (18).
Key words: alcoholism, alanine aminotransferase, aspartate aminotransferase, gamma-glutamyltransferase.
RESULTS
Acta Med Scand 205: 317, 1979.
Increased serum activities of aspartate aminotransferase (ASAT, GOT), alanine aminotransferase (ALAT, GPT) and y-glutamyltransferase (GT) in chronic alcoholics have been reported by several authors (1, 3, 8, 1 1 , 12, 14, 15, 16, 18, 21, 23). The relation of the enzyme activities to the current debauch has, however, not yet been established. The present paper evaluates the serum activities of these enzymes in relation to the serum ethanol concentration on arrival at hospital and the duration of the current debauch in chronic alcoholism of varying duration a5 well as the relation between serum ethanol concentration and duration of the disease.
All three groups of alcoholics had significantly increased serum activities of all three enzymes. The activity of S-GT was highest (mean 4.5 pkatll) in patients with a duration of alcoholism of 0-5 years and decreased gradually with increasing duration (Fig. 1). The same general pattern was found for S-ASAT, while the changes were less pronounced and not significant for S-ALAT (Fig. I). The concentration of S-ethanol, on the other hand, showed the lowest mean, 61 mmol/l (2.8%0), in the group with 0-5 years’ duration of alcoholism. After 5-10 years of alcoholism the mean concentration was 71 mmol/l ( 3 . 3 % 0 ) and in the group with more than 10 years’ history of alcoholism the mean value reached 80 mmol/l (3.6%0). The duration of the current debauch for the various groups was 8, 10 and 4 weeks, respectively (Table I ) .
PATIENTS AND METHODS The patient series consisted of 40 male inpatients, aged 25-60 years, at the Department of Alcohol Diseases. All patients had been brought to hospital in an unconscious state due to acute ethanol intoxication and all fulfilled the criteria of y-alcoholism ( 5 , 6). They were divided into 3 groups according to the duration of alcoholism: 0-5, 5-10
I
present uddress,. D~~~~~~~~~of clinical Chemistry, ~ ~sweden, l ~ ~ ~
central Hospital,
Abbreviutions: ASAT=aspartate aminotransferase, ALAT=alanine aminotransferase, GT=y-glutamyltransferase.
,
J . Wudstein und G . Skude
318
iji '1 60
100
T
50
'
0-5
5 -10
>lo
1
years
Fig. 1. Serum activities of GT, ASAT and ALAT, and
serum concentration of ethanol in relation to duration of chronic alcoholism (mean k S.E.M.).
Taking all three groups together, the mean S-GT activity was within the reference range when the debauch period was shorter than 2 weeks, just above the reference range with a debauch of 2-6 weeks and markedly increased when the drinking period exceeded 6 weeks, the activities being 0.65, 1.55 and 5.80 pkatll, respectively. No correlation was found between the S-ASAT or S-ALAT activities and the duration of the debauch. Nor was there any correlation between the enzyme activities and the ethanol concentrations in serum. Thus, at a S-ethanol level of 65 mmol/l(3.0%0)the S-GT activity varied from 0.3 to 9.0 pkatll, just as it did at an S-ethanol concentration of 137 mmol/l(6.4%0). DISCUSSION The high frequency of increased serum activities of the enzymes investigated is reflected by the high mean values. The rise was most pronounced for S-GT, followed by S-ASAT, and least for S-ALAT,
Table I. Churucterizution of the putirnt groups Years of chronic alcoholism
No. of pats. Mean age (y.) Admissions for detoxication ( n ) Attacks of delirium tremens ( n ) Mean duration of current debauch f S.D. (weeks)
0-5
5-10
>I0 (mean 18)
10 39
12 42
18 49
1.511
16
0.8
0.8
2.1
8 f 2 IOk2 4 f 2
which is in accordance with earlier reported values (8, 16, 18). A tendency found earlier towards normalization of the serum activities after prolonged alcoholism (18) was confirmed in the present study. This finding may have to do with the observation that the S-GT levels were related to the duration of the current debauch. The mean duration of the debauch was shortest in cases with longstanding alcoholism (Table I). Thus the tendency towards normalization of the laboratory parameters in long-standing alcoholism is probably an expression of a short debauch rather than an indicator of increased individual resistance to the toxic effects of ethanol, as was proposed in the earlier report (18). The finding of a short duration of the current debauch in combination with the highest S-ethanol concentrations in patients with more than 10 years' history of alcoholism could indicate that subjects belonging to this group drink more heavily for a shorter period than those with a briefs history of alcoholism and/or that they have a less effective ethanol degradation and already need hospitalization afier a rather short debauch. The main factor behind the rise of the S-GT activity is not a high serum concentration of ethanol but a prolonged intake of alcohol. References are given in the preceding paper.
Serum Ethanol, Hepatic Enzymes and Length of Debauch in Chronic Alcoholics J. Wadstein and G. Skude’ From the Depurtments of Alcohol Diseuses und Clinical Chemistry, University of Lund, Malmii Generul Hospital, M a h o . Sweden
ABSTRACT. The serum concentration of ethanol and the activities of aspartate aminotransferase, alanine aminotransferase and y-glutamyltransferase (GT) in 40 male chronic alcoholics were determined on admission to hospital. The serum activities of the enzymes were highest in patients with established alcoholism for less than 5 years. The serum concentration of ethanol, however, was lowest among these patients and gradually increased with the duration of alcoholism. No correlation was found between the serum ethanol level and the activity of any of the enzymes. The duration of the current debauch, which was shortest in cases of long-standing alcoholism, showed a positive correlation with the S-GT activity.
and more than 10 (mean 18) years. The mean number of hospitalizations at the clinic for the various groups as well as the mean number of attacks of delirium tremens during the last 5 years are given in Table I. The mean duration of the current debauch given in Table I is based on the anamnesis. Blood samples were drawn on admission. The serum ethanol concentration was determined by gas chromatography and the enzyme activities were determined according to the recommendations of the Scandinavian Enzyme Committee (4). Using a reference group of 97 subjectively healthy adult males without previous control of their drinking habits, the upper normal limit (mean + 2 S.D.) was found to be 0.65 pkat/l for S-ASAT, 0.85 for S-ALAT and 1.2 for S-GT (18).
Key words: alcoholism, alanine aminotransferase, aspartate aminotransferase, gamma-glutamyltransferase.
RESULTS
Acta Med Scand 205: 317, 1979.
Increased serum activities of aspartate aminotransferase (ASAT, GOT), alanine aminotransferase (ALAT, GPT) and y-glutamyltransferase (GT) in chronic alcoholics have been reported by several authors (1, 3, 8, 1 1 , 12, 14, 15, 16, 18, 21, 23). The relation of the enzyme activities to the current debauch has, however, not yet been established. The present paper evaluates the serum activities of these enzymes in relation to the serum ethanol concentration on arrival at hospital and the duration of the current debauch in chronic alcoholism of varying duration a5 well as the relation between serum ethanol concentration and duration of the disease.
All three groups of alcoholics had significantly increased serum activities of all three enzymes. The activity of S-GT was highest (mean 4.5 pkatll) in patients with a duration of alcoholism of 0-5 years and decreased gradually with increasing duration (Fig. 1). The same general pattern was found for S-ASAT, while the changes were less pronounced and not significant for S-ALAT (Fig. I). The concentration of S-ethanol, on the other hand, showed the lowest mean, 61 mmol/l (2.8%0), in the group with 0-5 years’ duration of alcoholism. After 5-10 years of alcoholism the mean concentration was 71 mmol/l ( 3 . 3 % 0 ) and in the group with more than 10 years’ history of alcoholism the mean value reached 80 mmol/l (3.6%0). The duration of the current debauch for the various groups was 8, 10 and 4 weeks, respectively (Table I ) .
PATIENTS AND METHODS The patient series consisted of 40 male inpatients, aged 25-60 years, at the Department of Alcohol Diseases. All patients had been brought to hospital in an unconscious state due to acute ethanol intoxication and all fulfilled the criteria of y-alcoholism ( 5 , 6). They were divided into 3 groups according to the duration of alcoholism: 0-5, 5-10
I
present uddress,. D~~~~~~~~~of clinical Chemistry, ~ ~sweden, l ~ ~ ~
central Hospital,
Abbreviutions: ASAT=aspartate aminotransferase, ALAT=alanine aminotransferase, GT=y-glutamyltransferase.
,
J . Wudstein und G . Skude
318
iji '1 60
100
T
50
'
0-5
5 -10
>lo
1
years
Fig. 1. Serum activities of GT, ASAT and ALAT, and
serum concentration of ethanol in relation to duration of chronic alcoholism (mean k S.E.M.).
Taking all three groups together, the mean S-GT activity was within the reference range when the debauch period was shorter than 2 weeks, just above the reference range with a debauch of 2-6 weeks and markedly increased when the drinking period exceeded 6 weeks, the activities being 0.65, 1.55 and 5.80 pkatll, respectively. No correlation was found between the S-ASAT or S-ALAT activities and the duration of the debauch. Nor was there any correlation between the enzyme activities and the ethanol concentrations in serum. Thus, at a S-ethanol level of 65 mmol/l(3.0%0)the S-GT activity varied from 0.3 to 9.0 pkatll, just as it did at an S-ethanol concentration of 137 mmol/l(6.4%0). DISCUSSION The high frequency of increased serum activities of the enzymes investigated is reflected by the high mean values. The rise was most pronounced for S-GT, followed by S-ASAT, and least for S-ALAT,
Table I. Churucterizution of the putirnt groups Years of chronic alcoholism
No. of pats. Mean age (y.) Admissions for detoxication ( n ) Attacks of delirium tremens ( n ) Mean duration of current debauch f S.D. (weeks)
0-5
5-10
>I0 (mean 18)
10 39
12 42
18 49
1.511
16
0.8
0.8
2.1
8 f 2 IOk2 4 f 2
which is in accordance with earlier reported values (8, 16, 18). A tendency found earlier towards normalization of the serum activities after prolonged alcoholism (18) was confirmed in the present study. This finding may have to do with the observation that the S-GT levels were related to the duration of the current debauch. The mean duration of the debauch was shortest in cases with longstanding alcoholism (Table I). Thus the tendency towards normalization of the laboratory parameters in long-standing alcoholism is probably an expression of a short debauch rather than an indicator of increased individual resistance to the toxic effects of ethanol, as was proposed in the earlier report (18). The finding of a short duration of the current debauch in combination with the highest S-ethanol concentrations in patients with more than 10 years' history of alcoholism could indicate that subjects belonging to this group drink more heavily for a shorter period than those with a briefs history of alcoholism and/or that they have a less effective ethanol degradation and already need hospitalization afier a rather short debauch. The main factor behind the rise of the S-GT activity is not a high serum concentration of ethanol but a prolonged intake of alcohol. References are given in the preceding paper.
