4 ms·

Doc here. An alcoholic in DTs could spend a week in the hospital. I've seen an alcoholic who lied to her surgeon, said she had a couple of glasses of wine a nig

Doc here. An alcoholic in DTs could spend a week in the hospital. I've seen an alcoholic who lied to her surgeon, said she had a couple of glasses of wine a night. Right. Couple of bottles. Her liver couldn't handle the anesthetic. She died, but only after 2 weeks in the ICU and her 8 year old and 10 year old daughters asked her dad why. He only brought them so they would remember. He couldn't wait for her to die. So, the long-term effect of a bender is to upregulate production of alcohol dehydrogenase in your liver, which allows you drink more before you're drunk, but also allows you to pickle your liver faster. That takes a long time to recover from. That and the physical dependency. And the obesity. See, the liver saves you from killing yourself by turning that EtOH into fatty acids. And, since you probably ate a fair bit too, you'll get a lot of fat there. If you don't eat, you end up with Vitamin B12 deficiency. Even well-to-do, upstanding drinkers with the self control to not eat while drinking may end up with numbness in their extremities due to that. Now, as for the short-term recovery from a bender: you need to hydrate before you go to sleep and then probably during the night. If you wake up in the middle of the night with heartburn, it may well be from the temporary gastroparesis induced by the alcohol. Drink some water and stay upright for awhile. Some advil will probably help. Then work out the next morning and, then have some coffee. Then eat. Preferably some yogurt to replace the gut bacteria you poisoned the night before. Then accept that you'll be cranky for the rest of the day. You're neurons generally aren't happy when the neighbors die. But 36 hours after, when you wake up the day after the day after, you should be fine. Minus the alcohol dehydrogenase, fat, dead brain cells, and extra 1/2 lb of fat.

Alex3917 15y ago
"Some advil will probably help." Mixing alcohol with advil to relieve an upset stomach sounds like a dubious idea. Why not just vape a little weed, which would not only work better, but also doesn't come with the risk of dying. Plus using weed may help reduce the brain damage caused by drinking.[1] [1] http://www.sciencedirect.com/science/article/pii/S0892036209001457 http://www.sciencedirect.com/science/article/pii/S0892036209...
brianleb 15y ago
Doctor of Pharmacy here. You haven't actually addressed what he said. None of that indicates that one heavy night of drinking takes a week to recover from (how? mentally? physically? emotionally? enzymatically?). Where's the PubMed or Medline citation? DTs occur in patients undergoing life threatening alcohol withdrawal. These people have often been drinking upwards of a twelve-pack of beer a day for years. Almost all alcoholics lie about their drinking. This is expected in both ambulatory and critical care. Implying that this patient's alcoholism killed her because her liver couldn't handle the anesthetic is disingenuous at best. If you're talking about a patient who was admitted with DTs, she should not have even been administered an anesthetic. If it was something else entirely, from the limited information you've provided I have to find fault with the anesthetist. The Glasgow Coma Scale is your friend, and it (and other scales of conscious) must be constantly used. A single bender is not going to upregulate liver enzymes, just like a single dose of medication won't. It takes weeks or months of consistent exposure to make that happen. Again, this has nothing to do with the original, uncited claim that a single night of drinking takes a week to recover from. And finally, do not recommend to your heavy drinking patients that they should take ibuprofen. NSAIDs, by virtue of their nonspecific effect on cycloxygenase, decrease the protective prostaglandins that are produced in the stomach to maintain the mucosal lining. Taking Advil after a night of heavy drinking is only going to make it more likely that the patient throws up blood the next day and needs to go to the hospital. NSAIDs have absolutely no positive effect on acid reflux - they will only make it worse. If a patient has heartburn, give them the obvious recommendation: take an antacid. Heartburn is not the same kind of discomfort as hitting your thumb with a hammer. Coffee before food will make this heartburn worse due to the acidity. Again, a single serving of yogurt isn't going to have an appreciable effect on your gut flora. You need to be eating it regularly for a few weeks before the bacteria can overcome your natural defenses and the other flora to colonize. This is all misinformation you've provided, and it's not even relevant to what you're replying to.
- niels_olson 15y ago
  First, thanks for replying. Perhaps I was to casual in my initial reply. I think we're in agreement that alcohol is a bad idea. I was assuming I was addressing a 20-40 year old entrepreneur, and my impression of these guys, on the forum and those I've met in person, is that they're generally healthy and interested in staying that way, they go to parties now and again, and once in a blue moon wake up with a nasty headache. My goal was to first address that there are generally long term effects and short term effects, and leave it as exercise to the reader to see that there's not much in the 1-week range. With regards to your specific concerns: > DTs vs anesthesia These were intended as two separate examples. I could have made that more clear. I absolutely agree, anesthesia is a very bad idea for someone in DTs. The larger point being, alcohol is a bad idea. > A single bender is not going to upregulate liver enzymes I argue a single bender will upregulate liver enzymes. Not a lot, but a little. A single workout will build muscle and improve your physical fitness. Not a lot, but a little. The larger point no doubt being one you're in favor of: alcohol is a bad idea. > do not recommend to your heavy drinking patients that they should take ibuprofen I would not recommend a heavy-drinking patient take ibuprofen. That said, alcoholics in the hospital vomiting blood are classically associated with esophageal varices due to a cirrhotic liver, which bleed spontaneously and then they vomit. They are not coming in for gastric ulcers, which generally require days to weeks of NSAIDs, and are more classically associated with aspirin, which irreversibly acetylates the COX enzymes, whereas ibuprofen binds reversibly. The larger point being, alcohol is a bad idea. > Coffee before food will make this heartburn worse due to the acidity. I didn't recommend coffee as an antidote to heartburn. I recommended some water and staying upright. The coffee recommendation was for the next morning. The caffeine will activate cAMP, causing some dilation of cerebral blood vessels, getting more profusion to the noggin, helping overcome the headache. The larger point being, alcohol is a bad idea. > a single serving of yogurt isn't going to have an appreciable effect on your gut flora Are you arguing against yogurt? Let me take the opportunity to suggest that I don't advocate drinking as a solution to problems. Quite the opposite. But keep it coming. Glad you came across my comment. Look forward to seeing you around.
gonzo 15y ago
wait,B-12 deficiency can cause numbness in my extremities? and I thought it was the ascending aortic dissection that traveled all the way to the right iliac branch whereupon the false lumen completely blocked any indication of a pulse for a period of at least 8 hours (in the ER, while the attending followed the wrong path on his ddx). 11 hours of surgery followed. but seriously.. I'm sure it's the beta-blocker they have me on as a result (reducing contraction velocity). (and I've all but stopped drinking since the surgery.)

Alex3917 15y ago

"Some advil will probably help." Mixing alcohol with advil to relieve an upset stomach sounds like a dubious idea. Why not just vape a little weed, which would not only work better, but also doesn't come with the risk of dying. Plus using weed may help reduce the brain damage caused by drinking.[1] [1] http://www.sciencedirect.com/science/article/pii/S0892036209001457 http://www.sciencedirect.com/science/article/pii/S0892036209...

brianleb 15y ago

Doctor of Pharmacy here. You haven't actually addressed what he said. None of that indicates that one heavy night of drinking takes a week to recover from (how? mentally? physically? emotionally? enzymatically?). Where's the PubMed or Medline citation? DTs occur in patients undergoing life threatening alcohol withdrawal. These people have often been drinking upwards of a twelve-pack of beer a day for years. Almost all alcoholics lie about their drinking. This is expected in both ambulatory and critical care. Implying that this patient's alcoholism killed her because her liver couldn't handle the anesthetic is disingenuous at best. If you're talking about a patient who was admitted with DTs, she should not have even been administered an anesthetic. If it was something else entirely, from the limited information you've provided I have to find fault with the anesthetist. The Glasgow Coma Scale is your friend, and it (and other scales of conscious) must be constantly used. A single bender is not going to upregulate liver enzymes, just like a single dose of medication won't. It takes weeks or months of consistent exposure to make that happen. Again, this has nothing to do with the original, uncited claim that a single night of drinking takes a week to recover from. And finally, do not recommend to your heavy drinking patients that they should take ibuprofen. NSAIDs, by virtue of their nonspecific effect on cycloxygenase, decrease the protective prostaglandins that are produced in the stomach to maintain the mucosal lining. Taking Advil after a night of heavy drinking is only going to make it more likely that the patient throws up blood the next day and needs to go to the hospital. NSAIDs have absolutely no positive effect on acid reflux - they will only make it worse. If a patient has heartburn, give them the obvious recommendation: take an antacid. Heartburn is not the same kind of discomfort as hitting your thumb with a hammer. Coffee before food will make this heartburn worse due to the acidity. Again, a single serving of yogurt isn't going to have an appreciable effect on your gut flora. You need to be eating it regularly for a few weeks before the bacteria can overcome your natural defenses and the other flora to colonize. This is all misinformation you've provided, and it's not even relevant to what you're replying to.

niels_olson 15y ago
First, thanks for replying. Perhaps I was to casual in my initial reply. I think we're in agreement that alcohol is a bad idea. I was assuming I was addressing a 20-40 year old entrepreneur, and my impression of these guys, on the forum and those I've met in person, is that they're generally healthy and interested in staying that way, they go to parties now and again, and once in a blue moon wake up with a nasty headache. My goal was to first address that there are generally long term effects and short term effects, and leave it as exercise to the reader to see that there's not much in the 1-week range. With regards to your specific concerns: > DTs vs anesthesia These were intended as two separate examples. I could have made that more clear. I absolutely agree, anesthesia is a very bad idea for someone in DTs. The larger point being, alcohol is a bad idea. > A single bender is not going to upregulate liver enzymes I argue a single bender will upregulate liver enzymes. Not a lot, but a little. A single workout will build muscle and improve your physical fitness. Not a lot, but a little. The larger point no doubt being one you're in favor of: alcohol is a bad idea. > do not recommend to your heavy drinking patients that they should take ibuprofen I would not recommend a heavy-drinking patient take ibuprofen. That said, alcoholics in the hospital vomiting blood are classically associated with esophageal varices due to a cirrhotic liver, which bleed spontaneously and then they vomit. They are not coming in for gastric ulcers, which generally require days to weeks of NSAIDs, and are more classically associated with aspirin, which irreversibly acetylates the COX enzymes, whereas ibuprofen binds reversibly. The larger point being, alcohol is a bad idea. > Coffee before food will make this heartburn worse due to the acidity. I didn't recommend coffee as an antidote to heartburn. I recommended some water and staying upright. The coffee recommendation was for the next morning. The caffeine will activate cAMP, causing some dilation of cerebral blood vessels, getting more profusion to the noggin, helping overcome the headache. The larger point being, alcohol is a bad idea. > a single serving of yogurt isn't going to have an appreciable effect on your gut flora Are you arguing against yogurt? Let me take the opportunity to suggest that I don't advocate drinking as a solution to problems. Quite the opposite. But keep it coming. Glad you came across my comment. Look forward to seeing you around.

gonzo 15y ago

wait,B-12 deficiency can cause numbness in my extremities? and I thought it was the ascending aortic dissection that traveled all the way to the right iliac branch whereupon the false lumen completely blocked any indication of a pulse for a period of at least 8 hours (in the ER, while the attending followed the wrong path on his ddx). 11 hours of surgery followed. but seriously.. I'm sure it's the beta-blocker they have me on as a result (reducing contraction velocity). (and I've all but stopped drinking since the surgery.)