Acetaldehyde syndrome

Of a Acetaldehyde syndrome is talked about when symptoms of poisoning occur after consuming alcohol or certain mushrooms. The poisoning can result from several different substances.

What is acetaldehyde syndrome?

The acetaldehyde syndrome is also under the names Antabus syndrome, Coprinus Syndrome or Disulfiram Syndrome known. This means acute poisoning after consuming certain substances. This primarily includes alcohol, medication or mushrooms such as the wrinkle ink.

People of Asian descent are particularly affected by acetaldehyde syndrome. They are more likely to have a genetic polymorphism of aldehyde dehydrogenase than in people of European descent. This leads to a slower breakdown of the aldehyde acetaldehyde. Doctors also speak of one ALDH-2 defect.

causes

Acetaldehyde syndrome is caused by a blockade of the enzyme aldehyde dehydrogenase or ALDH-1 and ALDH-2. This in turn inhibits the oxidation of acetaldehyde to acetic acid, which occurs when alcohol is broken down. This leads to a toxic increase in the formation of hydroxyl radicals, which are among the most common radicals.

There are numerous different substances that can cause acetaldehyde syndrome to develop after consuming alcohol. This includes medicines taken at the same time such as antibiotics. More precisely, these are cephalosporins with a lateral methylthiotetrazole chain such as moxalactam, cefoperazone, cefotetan, cefmenoxime and cefamandol, imidazoles that are effective against anaerobic pathogens such as tinidazole or metronidazole, antifungal substances such as cotoxicolofulvin and other antibiotics such as cotoxicolofulvin.

Other drugs that can cause acetaldehyde syndrome are antimalarials such as quinacrine, antidiabetic drugs that belong to the sulfonylureas such as chlorpropamide, acetohexamide, glipizide, glyburide and tolbutamide, vasodilators, which come from the genus of nitrates, isosorbitidine nitrate or nitroglycerin. Chemical substances such as pesticides, which are used to kill pests, are also possible causes of acetaldehyde syndrome.

Primarily these are Sulfiram and Carbamates. The name giver for the antabuse syndrome or disulfiram syndrome was the medical active ingredient disulfiram, which was used in earlier years as a drug against alcoholism under the trade name Antabuse.

The medicine prevents alcohol from being converted to acetic acid by blocking the enzyme aldehyde dehydrogenase. In this way, even small amounts of alcohol that are consumed can cause severe intolerance reactions such as palpitations, headaches and nausea. In the worst case, these reactions can even result in the death of the person concerned with larger amounts of alcohol.

For this reason, disulfiram is rarely used these days. The triggers of acetaldehyde syndrome also include several edible mushrooms such as the wrinkled inks and the witch's boletus. The mushrooms contain the fungal toxin coprin, which has the property of blocking the enzyme aledehyde dehydrogenase.

As Coprinus syndrome, this in turn leads to symptoms of poisoning when alcohol is consumed at the same time. Without the connection with alcohol, however, the coprin cannot develop any harmful effects.

Symptoms, ailments & signs

It only takes a few minutes or up to 72 hours for the first effects of acetaldehyde syndrome to become apparent after consuming alcohol. Even a few milliliters of alcohol can trigger noticeable redness on the face, neck, throat and chest as well as pronounced heat feelings.

In some people, the redness occurs all over the body. The patients also suffer from itching, tingling, a metallic taste in the mouth, too high or too low blood pressure and coldness in the arms and legs.

In addition, symptoms such as sweating, nausea, vomiting, diarrhea, headache, cramps and tremors are possible. Tightness in the chest that can range up to an attack of angina pectoris, cardiac arrhythmias, disorders of movement or ataxia are also rarely seen. In the worst case, the patient collapses and falls into a coma. However, symptoms usually improve after three to six hours.

Diagnosis & course

The diagnosis of acetaldehyde syndrome or Coprinus syndrome is based on the typical symptoms. In addition, the doctor asks the patient about his alcohol consumption and whether he has eaten certain mushrooms or taken special medication at the same time. A physical exam will also be performed.

In most patients, acetaldehyde syndrome takes a positive course. In this way, the unpleasant symptoms disappear on their own after a few hours. In isolated cases, however, there is a risk of serious complications such as circulatory collapse or a coma. However, deaths from acetaldehyde syndrome were very rare.

When should you go to the doctor?

Whether medical treatment is necessary for acetaldehyde syndrome cannot generally be predicted and usually also depends on the severity of the symptoms. If the symptoms only occur to a very minor extent and do not restrict the life of the person concerned too much, no treatment is necessary. The symptoms usually disappear after a few minutes or hours and do not lead to any further symptoms. However, if the patient has a potential alcohol or drug addiction, they should go to a counselor or a rehab clinic.

A doctor must then be consulted if, for example, heart problems arise due to acetaldehyde syndrome. In the worst case, these can lead to the death of the person concerned. However, treatment by a doctor should also take place in the event of vomiting or sensitivity disorders so that there are no consequential damages. If a collapse or a coma occurs, the emergency doctor must be called in any case. The symptoms usually disappear after three hours at the latest. If there is still no improvement after this period, medical treatment must also take place.

Doctors & therapists in your area

Complications

Since the effects of acetaldehyde syndrome can vary widely, the course of the disease is important when making a prognosis. If the symptoms are mild, no medical treatment is necessary. The symptoms that have arisen also disappear after a short time. Should treatment be desired or necessary, it is the symptoms that are addressed.

So far, however, there are no corresponding therapeutic measures. In most cases, activated charcoal is prescribed in the event of severe disease. In a few cases, cardiovascular symptoms such as tachycardia, where the heart begins to race, or hypotension, which is blood pressure that is too low, can occur.

With the help of beta blockers, the rapid heartbeat can be contained very quickly. Treatment of low blood pressure due to acetaldehyde syndrome is carried out with volume replacement, which is used to compensate for excessive loss of body fluids. All of these measures are monitored with the monitor, so that here too there is a prospect of a full recovery.

Sedation, i.e. reassurance of the patient, is only necessary in isolated cases. Consistent abstinence from alcohol is recommended after the treatment.

Treatment & Therapy

If the acetaldehyde syndrome is mild, there is usually no need for medical treatment. The complaints usually only last a short time. In addition, because there are no causal therapeutic measures, the symptoms are treated instead, if necessary.

If the poisoning is severe, the patient is often given activated charcoal. If there are cardiovascular complaints, the administration of beta blockers against a racing heart (tachycardia) or a volume substitution against blood pressure that is too low (hypotension) is considered useful. The patient is simultaneously monitored on the screen.

Sometimes it may also be necessary to sedate (calm down) the patient with medication. The person affected must refrain from consuming any alcohol for at least five days.

Outlook & forecast

As a rule, acetaldehyde syndrome causes various unpleasant symptoms after consuming alcohol. This leads to severe reddening and itching of the face. The patient feels unwell and has decreased blood pressure. The low blood pressure can also lead to a loss of consciousness. Loss of consciousness often leads to a fall, which can injure the person concerned.

The patient also suffers from convulsions and tremors. In the worst case, the heart is also affected, leading to a circulatory collapse. In most cases, however, there are no life-threatening complications when acetaldehyde syndrome is treated. The symptoms will then go away after a few hours.

Medicines are used in treatment. In severe cases, the affected person may have to spend a few days in the hospital until the symptoms have improved. Even after the treatment, it is necessary to refrain from alcohol for a period of one week. It cannot be ruled out that acetaldehyde syndrome will occur again when consuming alcohol. Usually the syndrome does not reduce life expectancy.

prevention

The best prevention against acetaldehyde syndrome is to avoid the simultaneous consumption of alcohol, mushrooms such as wrinkled inks and witch's tubes, as well as certain drugs, all of which can trigger poisoning. Usually only the interaction of the individual substances leads to the outbreak of the symptoms of poisoning.

Aftercare

In the case of acetaldehyde syndrome, follow-up care is usually not possible or necessary. The syndrome itself must be treated by a doctor, because in the worst case it can lead to death of the person affected. 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 syndrome itself is usually treated with the help of activated charcoal. The sufferer needs to take the drug regularly in order to completely detoxify the body. It is also important to ensure that there is a large amount of fluid, as the body has mostly lost fluid.

Likewise, the person affected should avoid taking alcohol and nicotine as much as possible in order to accelerate healing. As a rule, the symptoms of acetaldehyde syndrome usually disappear after a few days, so that follow-up care is neither possible nor necessary.

The causes of the poisoning should be avoided in the future as far as possible in order to avoid the recurrence of the acetaldehyde syndrome. In the event of a loss of consciousness, however, an emergency doctor should be called directly or the hospital should be visited, as this is serious poisoning.

You can do that yourself

The best measure a patient can take to prevent acetaldehyde syndrome is to generally consume very little or no alcohol. However, this also applies in general and not only with regard to acetaldyhad syndrome. Should (too much) alcohol be consumed anyway, possible side effects cannot be ruled out.

Since those affected break down the alcohol in their blood more slowly, they are affected by smaller amounts. Often, however, only the interaction of different substances leads to the outbreak of the symptoms of poisoning. Therefore, doing without different types of mushrooms, such as B. Wrinkled inks, or witch bolsters, may be helpful. Since many mushrooms are similar in their appearance and therefore there is a risk of confusion, in case of doubt it is better not to consume them. When taking medication, the package insert must be studied carefully in order to avoid possible interaction with alcohol and / or other products.

In acute cases, vomiting may help relieve the symptoms. Treatment with activated charcoal can also have a positive effect. If necessary, however, first aid measures must be applied. Alcohol should be strictly avoided until normal health is restored. Bed rest is recommended to protect the body.