RT Book, Section A1 Bales, Brian D. A1 Hensel, Max A2 Knoop, Kevin J. A2 Stack, Lawrence B. A2 Storrow, Alan B. A2 Thurman, R. Jason SR Print(0) ID 1181053300 T1 Alcohol Use Disorder T2 The Atlas of Emergency Medicine, 5e YR 2021 FD 2021 PB McGraw-Hill PP New York, NY SN 9781260134940 LK accessemergencymedicine.mhmedical.com/content.aspx?aid=1181053300 RD 2024/03/29 AB It is estimated that between 4% and 40% of all medical and surgical patients experience problems related to alcohol. It well known that alcohol use contributes significant to morbidity and mortality, and it is estimated that roughly 1 in 10 deaths among working-age adults results from excessive alcohol use. DSM-5 characterizes alcohol use disorder as a problematic pattern of use leading to clinically significant impairment or distress, as manifested by multiple psychosocial, behavioral, or physiologic features. Clinical manifestations of alcohol abuse may present in all organ systems, although advanced liver disease is a hallmark of long-term alcohol abuse. Skin changes such as palmar erythema (Fig. 27.19) and spider angioma (Video 27.1) are thought to develop due to increased circulating levels of estrogen due to inadequate hepatic metabolism of steroid hormones. Asterixis, also coined “liver flap,” is a type of negative myoclonus seen in advanced liver disease (Video 27.2). Conjunctival icterus may be seen when circulating serum bilirubin levels rise above 3 mg/dL in the setting of liver disease (Fig. 27.21). Alcohol is an indirect γ-aminobutyric acid (GABA) agonist, and when removed, symptoms of central nervous stimulation dominate, including agitation, tremulousness, hypertension, diaphoresis, and, when severe, seizures.