Blutalkohol 2005 - BADS (Bund gegen Alkohol und Drogen im ...

Verner/Schneider/Gebel/Panning/Wiese/Tröger/Breitmeier,
Blood ethanol concentrations and inebriation symptoms following percutaneous ethanol injection
therapy (PEIT) carried out on patients suffering from hepatocellular carcinoma
opinion the clinical symptoms after percutaneous ethanol injection were not effected by
the anaesthetics. At the time of examination the anaesthetics had been broken down completely.
By some authors it would mentioned, that acutely elevated alcohol levels can put the patient
at risk of atrial fibrillation, atrial flutter, and ventricular tachycardia [30, 31]. In addition,
acute alcohol consumption is also associated with myocardial depression and a risk of
developing angina pectoris in adults [30]. TSOKOS et al. couldn’t found any association
between treatment-assiciated complications and systemic blood ethanol concentration following
percutaneous ethanol injection therapy (PEIT) measured in minipigs [32]. Other
authors [33,34] mentioned about acute cardiovascular instability, bradycardia, sudden
hypotension, and sinus arrest to be connected with percutaneous ethanol injection therapy
for hepatocellular carcinoma. Without further investigations in this therapy it is at the
moment impossible to forecast how much and at which interval alcohol is released into the
hepatic veins and distributed systemically. Due to this route of ethanol administration and
compared to the normal methods such as oral intake this method effects a very short time
till the maximum BEC is reached. During this study after the commencement of the instillation
therapy the maximum blood ethanol concentration was recorded to be between 5 and
25 minutes. The average was measured at 13 minutes ± 4.9 minutes.
The patients in this study were devided in Child A and B, Okuda I and II (one patient
with Okuda III), and all patients did only have moderate cirrhosis. The elimination rate
wasn’t slowed in patients with liver cancer treated with PEI. The rate of ethanol disappearence
probably corresponded to normal healthy people. Additional studies with a
longer period of blood taking time after PEI are necessary to determine the accurate elemination
rate in patients with HCC treated by PEI.
In addition there was often plateau formation during the distribution and elemination of
the alcohol due to the fact that the tumour was for example subjected to continuous alcohol
doses over a longer period of time (Fig. 1). Or rather there were several peak formations
as the tumour dispersed alcohol into vascular system at different intervals in time
(Fig. 1). For this very reason it is not possible to fulfil normal kinetic requirements using
this method of alcohol induction. The result of this study could possibly only be compared
to subjects drinking different volumes of alcohol at several different intervals in this case
several peaks can be observed. Similarly by alcohol instillation into the tumour using the
above mentioned method, the dispersed amount or rather the time period in which the
alcohol is dispersed is not calculable due to the fact that the distribution of alcohol takes
place through the tumour itself.
In nine cases the BEC reached peak values of measured c max higher than the values of
calculated c max . This is due to the fact that the ethanol was injected directly into the liver
veins instead of the tumour. In five cases the main part of the injection was deposited into
the tumour and the release was rather slow resulting thus, in the calculated c max being higher
than the measured c max.
The main reason for the variance in the venous blood alcohol levels could be due to the
variable amount and unknown time course of alcohol release from the tumor into the intervascular
compartment. It can be concluded from the findings of this study, that the
ethanol distribution and elimination follows the recognised process of distribution and
elimination only after complete release of ethanol out of the tumour into hepatic veins. For
that reason the traditional elimination kinetic of alcohol can not be applied immediate in
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BLUTALKOHOL VOL. 42/2005