A couple of nights ago we admitted one of our fine upstanding citizens after a fall on the ice.  He admitted to drinking 2 24oz.  beers to fortify himself for the trek to the local corner store to replenish his supplies while there was a lull between the snow and ice.  On admit to the ED he was lethargic, but woke on command and talked, albeit with slurred speech.  Not apparently that drunk and considering the large lump and laceration on his forehead, maybe he was still a little dazed.

They did the standard work-up as the sutured (poorly..) his laceration, including labs and a head CT.  The CT was negative for any acute process, but did show some atrophy.  Labs with one exception were relatively normal, kind of.

Any guesses what his ETOH level was?

A.  >10
B. 223
C.  499
D.  156

Not to mention issues with his ETOH level, he also had end-stage liver disease, status-post TIPS with esophageal varices and a history of seizure disorder.  Not exactly the most well-kempt of individuals mind you.  You could smell him in the hallway and he was far too lethargic to have him shower.  But back to his level.

If you guessed C., you would be correct.  Yep, 499.  Based on an online calculator, he would have had to drink 15 12oz. malt liquors in 1 hour to get a level that high.  2 big beers my ass.  He was dedicated.  Dedicated to destroying his young life.  And that was the kicker, he was only 38.  It’s sad and sick all at the same time.  The worst was that he had been doing this for many years to achieve the level of liver damage he was experiencing.  Unfortunately it seemed like the wasn’t going to stop and that the social safety nets in-place were either burned away or had completely failed.  And no matter what we as health care professionals did, he had continued to do this for years and probably wouldn’t stop until he ended up dead.  Which maybe was his ulterior motive in it all.  Now, when I crack open a beer I think about this case and realize how lucky I am.


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