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“ Any patient denying alcohol ingestion but who have elevated blood alcohol levels or positive breathalyzer results should be investigated for ABS,” they conclu

“ Any patient denying alcohol ingestion but who have elevated blood alcohol levels or positive breathalyzer results should be investigated for ABS,” they concluded. How you know an academic has never worked the ER.

jasonmp85 7y ago
I mean in previous instances they held the patient until any previously ingested alcohol must have been processed, waited for their BAC to show a clear descent, then gave the patient sugar and watched the BAC go up at subsequent timepoints. I don’t think even the most isolated docs would be naive enough to trust an incoming intoxicated patient about their own substance use.
npo9 7y ago
I think it really depends on the cost of an ABS test, how common ABS is, how common patients lie about alcohol consumption, and the cost savings for dealing with ABS sooner rather than later. If you are going to hold someone in the ER until their BAC is 0 it seems fairly cheap to give them sugar water and see if their BAC increases.
- snagglegaggle 7y ago
  They can hold you for that? Why?
  - Scoundreller 7y ago
    Usually you can be held if you’re a threat to yourself or others. Which is probably what got you taken to the ED in the first place.
  - arkades 7y ago
    They can't "hold you" in the sense of denying you the ability to leave against medical advice. "Harm to self or others" is a whole different category of hold and no one is doing it for a random drunk in the ER. However, if you're waiting for an actual discharge from the ER, it's common to hold onto the patient until their BAC is under the legal limit, do another quick neuro exam, and then start discharge procedures. The idea here is "the patient is almost certainly just drunk, but it's not impossible they have an underlying problem such as hepatic encephalopathy. So I'm going to wait for them to sober up enough that I can tell the difference between 'drunk' and 'underlying altered mental status' before I start discharge. The time it will take the discharge to go through will be enough to get their BAC to 0, and I will therefore not be liable if they walk out of the ER and fall and crack their head."
    - snagglegaggle 7y ago
      > However, if you're waiting for an actual discharge from the ER To me this implies they can hold you, as I can't just walk out whenever I want? Why? I feel no compulsion to be held so that they can minimize their liability.
      - vertex-four 7y ago
        You can walk out whenever you want against medical advice. This is different from being discharged, which is when a doctor says "you're probably ok to go home" and fills out some paperwork to that effect.
      - xbmcuser 7y ago
        It's about liability you go without doctors permission and something happens it's on you. If the doctor's says you are good to go and the something happens the the doctor and hospital will face the liability.
- BubRoss 7y ago
  You think it should be cheap to hold someone in the ER for multiple hours just to sober them up and test for a rare condition? Breathalyzers don't cost much at all, ER visits costs thousands of dollars. You can tell someone to go drink sugar water at home. Why would a doctor need to hold someone and give the sugar water?
vo2maxer 7y ago
I don’t think the paper suggests that this protocol be implemented in an ER to evaluate all inebriated patients. Should there be a suspicion of ABS, it would be appropriate to refer for further outpatient management. This would be the case with any other differential diagnoses. In addition, the authors are clinicians who likely have had plenty of ER experience in their training.
asveikau 7y ago
Well certainly one can imagine how frustrating it must be to have this condition and nobody believes you, i.e. they think you are a lying drunk. So likely there is a happy medium between (1) being totally naive towards everyone who comes into the ER and (2) denying that ABS exists. i.e. Be aware of alternative explanations which may be rare but not non-existent.
bayesian_horse 7y ago
In many cases the patients are hospitalized, without access to alcohol, and the doctors still presume they sneaked in some booze. That attitude, while somewhat justified, contributes to the stated underdiagnosis...

jasonmp85 7y ago

I mean in previous instances they held the patient until any previously ingested alcohol must have been processed, waited for their BAC to show a clear descent, then gave the patient sugar and watched the BAC go up at subsequent timepoints. I don’t think even the most isolated docs would be naive enough to trust an incoming intoxicated patient about their own substance use.

npo9 7y ago

I think it really depends on the cost of an ABS test, how common ABS is, how common patients lie about alcohol consumption, and the cost savings for dealing with ABS sooner rather than later. If you are going to hold someone in the ER until their BAC is 0 it seems fairly cheap to give them sugar water and see if their BAC increases.

snagglegaggle 7y ago
They can hold you for that? Why?
- Scoundreller 7y ago
  Usually you can be held if you’re a threat to yourself or others. Which is probably what got you taken to the ED in the first place.
- arkades 7y ago
  They can't "hold you" in the sense of denying you the ability to leave against medical advice. "Harm to self or others" is a whole different category of hold and no one is doing it for a random drunk in the ER. However, if you're waiting for an actual discharge from the ER, it's common to hold onto the patient until their BAC is under the legal limit, do another quick neuro exam, and then start discharge procedures. The idea here is "the patient is almost certainly just drunk, but it's not impossible they have an underlying problem such as hepatic encephalopathy. So I'm going to wait for them to sober up enough that I can tell the difference between 'drunk' and 'underlying altered mental status' before I start discharge. The time it will take the discharge to go through will be enough to get their BAC to 0, and I will therefore not be liable if they walk out of the ER and fall and crack their head."
  - snagglegaggle 7y ago
    > However, if you're waiting for an actual discharge from the ER To me this implies they can hold you, as I can't just walk out whenever I want? Why? I feel no compulsion to be held so that they can minimize their liability.
    - vertex-four 7y ago
      You can walk out whenever you want against medical advice. This is different from being discharged, which is when a doctor says "you're probably ok to go home" and fills out some paperwork to that effect.
    - xbmcuser 7y ago
      It's about liability you go without doctors permission and something happens it's on you. If the doctor's says you are good to go and the something happens the the doctor and hospital will face the liability.
BubRoss 7y ago
You think it should be cheap to hold someone in the ER for multiple hours just to sober them up and test for a rare condition? Breathalyzers don't cost much at all, ER visits costs thousands of dollars. You can tell someone to go drink sugar water at home. Why would a doctor need to hold someone and give the sugar water?

vo2maxer 7y ago

I don’t think the paper suggests that this protocol be implemented in an ER to evaluate all inebriated patients. Should there be a suspicion of ABS, it would be appropriate to refer for further outpatient management. This would be the case with any other differential diagnoses. In addition, the authors are clinicians who likely have had plenty of ER experience in their training.

asveikau 7y ago

Well certainly one can imagine how frustrating it must be to have this condition and nobody believes you, i.e. they think you are a lying drunk. So likely there is a happy medium between (1) being totally naive towards everyone who comes into the ER and (2) denying that ABS exists. i.e. Be aware of alternative explanations which may be rare but not non-existent.

bayesian_horse 7y ago

In many cases the patients are hospitalized, without access to alcohol, and the doctors still presume they sneaked in some booze. That attitude, while somewhat justified, contributes to the stated underdiagnosis...