Disulfiramlike Toxin Toxicity Workup

  • Author: C Crawford Mechem, MD, MS, FACEP; Chief Editor: Asim Tarabar, MD   more...
 
Updated: Mar 9, 2011
 

Laboratory Studies

The extent of diagnostic testing is guided by the patient's clinical presentation. Appropriate laboratory studies may include the following:

  • Electrolytes, BUN, creatinine levels (assess for dehydration and electrolyte abnormalities)
  • Serum ethanol levels (may be of value to determine if more acetaldehyde formation and progression of toxicity can be expected)
  • No clinical role for determination of acetaldehyde concentrations
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Other Tests

  • Obtaining an ECG in patients with chest pain would be prudent. A recent case report described a 22-year-old chronic alcoholic male on disulfiram who consumed alcohol and then developed anginal symptoms.[4] ECG changes were consistent with an inferior wall myocardial infarction (MI). He underwent coronary angiography, which revealed clean vessels, and his MI was attributed to vasospasm.
  • Mycologist may positively identify mushroom species involved; however, unlike Amanita phalloides, positive identification of coprine-containing mushrooms rarely contributes to diagnosis or alters management.
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Contributor Information and Disclosures
Author

C Crawford Mechem, MD, MS, FACEP  Associate Professor, Department of Emergency Medicine, University of Pennsylvania School of Medicine; Emergency Medical Services Medical Director, Philadelphia Fire Department

C Crawford Mechem, MD, MS, FACEP is a member of the following medical societies: American College of Emergency Physicians, National Association of EMS Physicians, and Society for Academic Emergency Medicine

Disclosure: Nothing to disclose.

Specialty Editor Board

B Zane Horowitz, MD, FACMT  Professor, Department of Emergency Medicine, Oregon Health and Sciences University; Medical Director, Oregon Poison Center; Medical Director, Alaska Poison Control System

B Zane Horowitz, MD, FACMT is a member of the following medical societies: American Academy of Clinical Toxicology and American College of Medical Toxicology

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.

Michael Hodgman, MD  Assistant Clinical Professor of Medicine, Department of Emergency Medicine, Bassett Healthcare

Michael Hodgman, MD is a member of the following medical societies: American College of Medical Toxicology, American College of Physicians, Medical Society of the State of New York, 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

  1. Malcolm R, Olive MF, Lechner W. The safety of disulfiram for the treatment of alcohol and cocaine dependence in randomized clinical trials: guidance for clinical practice. Expert Opin Drug Saf. Jul 2008;7(4):459-72. [Medline].

  2. Garbutt JC. The state of pharmacotherapy for the treatment of alcohol dependence. J Subst Abuse Treat. Jan 2009;36(1):S15-23; quiz S24-5. [Medline].

  3. Bronstein AC, Spyker DA, Cantilena LR Jr, Green JL, Rumack BH, Giffin SL. 2009 Annual Report of the American Association of Poison Control Centers' National Poison Data System (NPDS): 27th Annual Report. Clin Toxicol (Phila). Dec 2010;48(10):979-1178. [Medline].

  4. Tayyareci Y, Acarel E. Acute myocardial infarction associated with disulfiram-alcohol interaction in a young man with normal coronary arteries. Turk Kardiyol Dern Ars. 2009;37(1):48-50. [Medline].

  5. Banys P. The clinical use of disulfiram (Antabuse): a review. J Psychoactive Drugs. Jul-Sep 1988;20(3):243-61. [Medline].

  6. Berger KJ, Guss DA. Mycotoxins revisited: Part II. J Emerg Med. Feb 2005;28(2):175-83. [Medline].

  7. Brent J, McMartin K, Phillips S, Aaron C, Kulig K; Methylpyrazole for Toxic Alcohols Study Group. Fomepizole for the treatment of methanol poisoning. N Engl J Med. Feb 2001;344(6):424-9. [Medline].

  8. Carlsson A, Henning M, Lindberg P, Martinson P, Trolin G, Waldeck B, et al. On the disulfiram-like effect of coprine, the pharmacologically active principle of Coprinus atramentarius. Acta Pharmacol Toxicol (Copenh). Apr 1978;42(4):292-7. [Medline].

  9. Christensen JK, Moller IW, Ronsted P, Angelo HR, Johansson B. Dose-effect relationship of disulfiram in human volunteers. I: Clinical studies. Pharmacol Toxicol. Mar 1991;68(3):163-5. [Medline].

  10. Hender E, May T, Beulke S. Poisoning due to eating fungi in Victoria. Aust Fam Physician. Oct 2000;29(10):1000-4. [Medline].

  11. Ho MP, Yo CH, Liu CM, Chen CL, Lee CC. Refractive hypotension in a patient with disulfiram-ethanol reaction. Am J Med Sci. Jan 2007;333(1):53-5. [Medline].

  12. Kunkel DB, Connor DA. Coprine-containing mushrooms. In: Spoerke DG, Rumack BH. Handbook of Mushroom Poisoning: Diagnosis and Treatment. CRC Press, LLC; 1994:303-7.

  13. Meyer JH, Herlocher JE, Parisian J. Esophageal rupture after mushroom-alcohol ingestion. N Engl J Med. Dec 2 1971;285(23):1323. [Medline].

  14. Michelot D. Poisoning by Coprinus atramentarius. Nat Toxins. 1992;1(2):73-80. [Medline].

  15. Miller NS, Goodwin DW, Jones FC, Gabrielli WF, Pardo MP, Anand MM, et al. Antihistamine blockade of alcohol-induced flushing in orientals. J Stud Alcohol. Jan 1988;49(1):16-20. [Medline].

  16. Suh JJ, Pettinati HM, Kampman KM, O'Brien CP. The status of disulfiram: a half of a century later. J Clin Psychopharmacol. Jun 2006;26(3):290-302. [Medline].

  17. Wright C, Moore RD. Disulfiram treatment of alcoholism. Am J Med. Jun 1990;88(6):647-55. [Medline].

  18. Yilmaz A, Gursoy S, Varol O, Nur N, Ozyilkan E. Emergency room cases of mushroom poisoning. Saudi Med J. Jun 2006;27(6):858-61. [Medline].

 
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