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Diagnosis of Alcoholism

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Diagnosis of Alcoholism

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diagnosis of alcoholismYou are an attorney handling a case in which the question is raised about whether the patient is an alcoholic. You wonder if the patient’s lab work confirms that she is an alcoholic.

There are 5 blood tests that are hallmarks of alcoholism 95% of the time. Although these tests are elevated in other conditions, when all are elevated, they point to alcoholism. Each laboratory has slightly different normal ranges. Be sure to compare the blood test result with the range the lab identifies as normal.

1. Increased alkaline phosphatase – this is a liver enzyme. It may be abbreviated as Alk Phos.
2. Increased uric acid
3. Increased GGT – GGT stands for gamma glutamyltransferase. Elevations may indicate acute hepatic disease or alcohol ingestion.
4. Increased triglycerides – may indicate cirrhosis
5. Increased MCV or mean corpuscular volume – red blood cells enlarge

What are other abnormal lab results in alcoholism?
These tests listed below may be increased because of other reasons than alcoholism.

Bilirubin increases when the liver function is impaired by alcohol.
Lipase and amylase may be elevated if the patient has pancreatitis. About half of all cases of pancreatitis are related to alcohol.
Blood sugar – The liver produces glycogen to replace the blood sugar lost by an increased production of insulin. Glycogen results in an increase in blood sugar.
Liver function tests – In addition to an elevated alkaline phosphatase, other enzymes may be elevated: SGPT, SGOT, AST, ALT and CDT.
Platelets, red blood cells and white blood cell production are inhibited because the bone marrow is depressed by alcohol.
Sodium, magnesium, phosphorus and chloride may be decreased because the body excretes less of these essential electrolytes.
Ammonia may build up in the blood as the liver fails.
Blood alcohol level – These levels are a highly reliable way to diagnose alcoholism: a blood alcohol level of greater than 100 mg/dl found during routine examination, a blood alcohol level of greater than 150 mg/dl without obvious evidence of intoxication, or a blood alcohol level over 300 mg/dl. (1)
Prothrombin – Clotting time is prolonged when the patient has liver damage.
Albumin – The patient’s poor nutritional status may be shown by low protein/albumin levels.

CAGE questionnaire
One of the most sensitive tests for alcoholism is not found in a lab- the CAGE questionnaire. It is simple and accurate. If the patient answers yes to more than 2 questions, there is a 95% chance the patient is dependent on alcohol:

1. Have you felt the need to Cut down on your drinking?
2. Do you feel Annoyed by people complaining about your drinking?
3. Do you ever feel Guilty about your drinking?
4. Do you ever drink an Eye-opener in the morning to relieve shakes?

(1) Warren Thompson, Alcoholism Workup, Medscape Reference

Med league provides well-qualified expert witnesses and provide detailed chronologies for cases involving alcohol. Contact us for help.

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