Disulfiram Toxicity Workup

  • Author: Samara Soghoian, MD, MA; Chief Editor: Asim Tarabar, MD   more...
 
Updated: Apr 29, 2011
 

Laboratory Studies

For suspected disulfiram toxicity, the following laboratory studies should be obtained:

  • Glucose level
  • Electrolyte levels
  • Renal function tests
  • Liver function tests
  • Ethanol level
  • Acetaminophen level
  • Arterial blood gas analysis
  • Methemoglobin level (%)
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Imaging Studies

CT of the head and/or MRI studies are valuable in demonstrating CNS involvement (eg, basal ganglia ischemia, infarction) as well as in excluding other causes of altered mental status.

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Other Tests

Specific laboratory studies generally have little value in the treatment of acute toxicity. In addition, results are not usually available in a timely fashion.

Other specific laboratory studies to consider are as follows:

  • Acetaldehyde level test (toxic level >5 mg/L)
  • DDC level test
  • CS2 level test
  • Tetraethylthiuram level (disulfiram level) test
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Procedures

In patients with hypotension and/or tachycardia, an ECG may assist in the assessment of potential end-organ damage as well as the exclusion of other possible causes of the patient's symptoms.[5]

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Contributor Information and Disclosures
Author

Samara Soghoian, MD, MA  Clinical Assistant Professor of Emergency Medicine, New York University School of Medicine, Bellevue Hospital Center

Samara Soghoian, MD, MA is a member of the following medical societies: American Academy of Clinical Toxicology, American College of Medical Toxicology, and Society for Academic Emergency Medicine

Disclosure: Nothing to disclose.

Coauthor(s)

Sage W Wiener, MD  Assistant Professor, Department of Emergency Medicine, State University of New York Downstate Medical Center; Assistant Director of Medical Toxicology, Department of Emergency Medicine, Kings County Hospital Center

Sage W Wiener, MD is a member of the following medical societies: American Academy of Clinical Toxicology, American Academy of Emergency Medicine, American College of Medical Toxicology, and Society for Academic Emergency Medicine

Disclosure: Nothing to disclose.

José Eric Díaz-Alcalá, MD, FAAEM,  Consulting Staff in Medicine Service, Division of Emergency Medicine/Medical Toxicology, Veterans Affairs Caribbean Healthcare System; Medical Director, Puerto Rico Poison Control Center, San Juan, Puerto Rico

José Eric Díaz-Alcalá, MD, FAAEM, is a member of the following medical societies: American Academy of Clinical Toxicology, American Academy of Emergency Medicine, and American College of Medical Toxicology

Disclosure: Nothing to disclose.

Specialty Editor Board

David C Lee, MD  Research Director, Department of Emergency Medicine, Associate Professor, North Shore University Hospital and New York University Medical School

David C Lee, MD is a member of the following medical societies: American Academy of Emergency Medicine, American College of Emergency Physicians, American College of Medical Toxicology, and Society for Academic Emergency Medicine

Disclosure: Nothing to disclose.

John T VanDeVoort, PharmD  Regional Director of Pharmacy, Sacred Heart & St. Joseph's Hospitals

John T VanDeVoort, PharmD is a member of the following medical societies: American Society of Health-System Pharmacists

Disclosure: Nothing to disclose.

John G Benitez, MD, MPH, FACMT, FAACT, FACPM, FAAEM,  Associate Professor, Department of Medicine, Medical Toxicology, Vanderbilt University Medical Center; Managing Director, Tennessee Poison Center

John G Benitez, MD, MPH, FACMT, FAACT, FACPM, FAAEM, is a member of the following medical societies: American Academy of Clinical Toxicology, American Academy of Emergency Medicine, American College of Medical Toxicology, American College of Preventive Medicine, Society for Academic Emergency Medicine, Undersea and Hyperbaric Medical Society, and Wilderness Medical Society

Disclosure: Nothing to disclose.

John D Halamka, MD, MS  Associate Professor of Medicine, Harvard Medical School, Beth Israel Deaconess Medical Center; Chief Information Officer, CareGroup Healthcare System and Harvard Medical School; Attending Physician, Division of Emergency Medicine, Beth Israel Deaconess Medical Center

John D Halamka, MD, MS is a member of the following medical societies: American College of Emergency Physicians, American Medical Informatics Association, Phi Beta Kappa, and Society for Academic Emergency Medicine

Disclosure: Nothing to disclose.

Chief Editor

Asim Tarabar, MD  Assistant Professor, Director, Medical Toxicology, Department of Emergency Medicine, Yale University School of Medicine; Consulting Staff, Department of Emergency Medicine, Yale-New Haven Hospital

Disclosure: Nothing to disclose.

References

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  2. Vaccari A, Ferraro L, Saba P, et al. Differential mechanisms in the effects of disulfiram and diethyldithiocarbamate intoxication on striatal release and vesicular transport of glutamate. J Pharmacol Exp Ther. Jun 1998;285(3):961-7. [Medline].

  3. Filosto M, Tentorio M, Broglio L, et al. Disulfiram neuropathy: two cases of distal axonopathy. Clin Toxicol (Phila). Apr 2008;46(4):314-6. [Medline].

  4. Burman WJ, Terra M, Breese P, et al. Lack of toxicity from concomitant directly observed disulfiram and isoniazid-containing therapy for active tuberculosis. Int J Tuberc Lung Dis. Sep 2002;6(9):839-42. [Medline].

  5. Milne HJ, Parke TR. Hypotension and ST depression as a result of disulfiram ethanol reaction. Eur J Emerg Med. Aug 2007;14(4):228-9. [Medline].

  6. de Mari M, De Blasi R, Lamberti P, et al. Unilateral pallidal lesion after acute disulfiram intoxication: a clinical and magnetic resonance study. Mov Disord. Apr 1993;8(2):247-9. [Medline].

  7. Ellenhorn MJ. Disulfiram. In: Ellenhorn's Medical Toxicology. Vol 2. Lippincott Williams & Wilkins; 1997:1356-62.

  8. Enghusen Poulsen H, Loft S, Andersen JR, et al. Disulfiram therapy--adverse drug reactions and interactions. Acta Psychiatr Scand Suppl. 1992;369:59-65; discussion 65-6. [Medline].

  9. Forns X, Caballeria J, Bruguera M, et al. Disulfiram-induced hepatitis. Report of four cases and review of the literature. J Hepatol. Nov 1994;21(5):853-7. [Medline].

  10. Heath MJ, Pachar JV, Perez Martinez AL, et al. An exceptional case of lethal disulfiram-alcohol reaction. Forensic Sci Int. Sep 1992;56(1):45-50. [Medline].

  11. Hirschberg M, Ludolph A, Grotemeyer KH, et al. Development of a subacute tetraparesis after disulfiram intoxication. Case report. Eur Neurol. 1987;26(4):222-8. [Medline].

  12. Kirubakaran V, Faiman MD, Liskow B, et al. Plasma measurements of disulfiram and its metabolites in a case of severe disulfiram-ethanol reaction. Psychiatr J Univ Ott. Sep 1986;11(3):166-8. [Medline].

  13. Krauss JK, Mohadjer M, Wakhloo AK, et al. Dystonia and akinesia due to pallidoputaminal lesions after disulfiram intoxication. Mov Disord. 1991;6(2):166-70. [Medline].

  14. Kuffner EK. Disulfiram and disulfiram-like reactions. In: Flomenbaum NE, Goldfrank LR, Hoffman RS, Howland MA, Lewin NA, Nelson LS. Goldfrank's Toxicology Emergencies. 8th ed. McGraw-Hill; 2006:1176-1183.

  15. Laplane D, Attal N, Sauron B, et al. Lesions of basal ganglia due to disulfiram neurotoxicity. J Neurol Neurosurg Psychiatry. Oct 1992;55(10):925-9. [Medline].

  16. Mahajan P, Lieh-Lai MW, Sarnaik A, et al. Basal ganglia infarction in a child with disulfiram poisoning. Pediatrics. Apr 1997;99(4):605-8. [Medline].

  17. Nasrallah HA. Vulnerability to disulfiram psychosis. West J Med. Jun 1979;130(6):575-7. [Medline].

  18. Stransky G, Lambing MK, Simmons GT, et al. Methemoglobinemia in a fatal case of disulfiram-ethanol reaction. J Anal Toxicol. Mar-Apr 1997;21(2):178-9. [Medline].

  19. Zorzon M, Mase G, Biasutti E, et al. Acute encephalopathy and polyneuropathy after disulfiram intoxication. Alcohol Alcohol. Sep 1995;30(5):629-31. [Medline].

 
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The pathway of ethanol metabolism. Disulfiram reduces the rate of oxidation of acetaldehyde by competing with the cofactor nicotinamide adenine dinucleotide (NAD) for binding sites on aldehyde dehydrogenase (ALDH).
Disulfiram, prodrug for active metabolites.
 
 
 
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