"Cephalosporin is wine, say and go" is a well-known sentence, how terrible are the consequences of the two?
Hangzhou Red Cross Hospital recently has a very typical example, a 63-year-old female patient just ate a bowl of wine stuffed dumplings, did not expect that the alcohol and cephalosporin drugs in the wine stuffed dumplings had a disulfiram-like reaction, there was flushing, breathing difficulties, to the ghost door closed for a while.
After eating the sake stuffed dumplings, hang up cephalosporin saline
Causes a disulfiram-like reaction
Aunt Zhou, 63, who lives in Yuhang, was hospitalized in the General Surgery Department of Hangzhou Red Cross Hospital for liver abscess. After the operation, her body gradually recovered, but her appetite was still not very good, and she lost a lot of weight. Her husband, Uncle Chen, was very distressed and wanted her to eat more every day.
Last Tuesday morning, Aunt Zhou went for an abdominal CT on an empty stomach. Chen Dabot bought a sake dumpling and sent it to the snack bar outside the hospital.
At about 10 o'clock, after Aunt Zhou completed the examination, she sat in the small garden of the hospital with Uncle Chen, drank the wine and stuffed dumplings, and walked in the small garden for a while, and then went back to the ward to hang salt water.
Back in the ward, it was close to 11 o'clock in the afternoon, and the nurse hung up salt water for Aunt Zhou. As usual, Aunt Zhou didn't feel anything uncomfortable. But after about three minutes, she suddenly felt chest tightness and breathlessness, so she quickly rang the bell and called for a nurse.
Hearing the ringtone, the nurse ran over to take a look and found that Aunt Zhou's situation was not right, so she immediately called the doctor in charge to inform the doctor in charge.
The doctor in charge, Ying Jiake, rushed to the bedside at the first time and found that Aunt Zhou was already flushed, breathing difficult, and unable to speak.
Could it be an acute drug allergy? However, Aunt Zhou has been hospitalized in the hospital for more than ten days, and the treatment drugs have not been changed, so the possibility of drug allergies was first ruled out.
Could it be that there was a conflict between what I had eaten before and what I had taken? After some questioning by the responsible nurse, Aunt Zhou's wife said that she had just eaten wine stuffed dumplings, and the salt water that the nurse hung was cefmetazole (antibiotic). The doctor in charge should judge that Aunt Zhou was "using antibiotics after drinking" and caused disulfiram-like reactions.
Dr. Ying Jiake said, "We first removed the cephalosporin saline, replaced it with a rapid instillation of Ringer's liquid, immediately applied ECG monitoring to monitor vital signs, mask oxygen and used dexamethasone to accelerate ethanol oxidation and naloxone antagonism to ethanol, rehydration and diuretics symptomatic treatment."
After the full rescue of the medical staff, after half an hour, Aunt Zhou improved significantly, and her breathing gradually calmed down, but her face was already relatively red, like a drunken state. After an hour, Aunt Zhou's blood pressure and other vital signs gradually returned to normal, and her face basically returned to normal.
What is a disulfiram-like reaction?
Disulfiram is a kind of alcohol abstinence drug, even if you drink a small amount of alcohol after taking it, the body will produce serious discomfort to achieve the purpose of abstinence from alcohol. However, it's not just disulfiram that causes these discomforts, and many drugs have similar effects to disulfiram.
Disulfiram-like reactions occur after drinking or drinking alcohol after medication, symptoms generally appear within 5-30 minutes, the slowest 4 hours, mild face flushing and fever, headache, palpitations, chest tightness, nausea and vomiting, dizziness; chest pain, arrhythmias, heart failure, shock, and even death.
The severity of disulfiram-like reactions is related to the dose of medication and alcohol consumption, and usually occurs five minutes to one hour after the drug is in contact with alcohol. It is more severe in general for the elderly, children, patients with cardiovascular and cerebrovascular diseases, and those who are sensitive to ethanol.
After eating cephalosporin, it is not only drinking alcohol that is dangerous
"In fact, as soon as I was admitted to the ward, the nurse told me not to drink alcohol during my hospitalization. I still know this basic common sense, and I don't usually drink alcohol. Unexpectedly, a bowl of sake stuffed dumplings can also eat the body badly. Aunt Zhou sighed.
Many people have the same idea as Aunt Zhou: "People who don't drink alcohol don't have to worry about disulfiram reaction." Ying Jiake, the attending physician of general surgery, believes that this idea is very wrong. After eating cephalosporin, it is not only drinking alcohol that is dangerous. In fact, in life, in addition to alcohol, many foods and drugs in ethanol content is also very high, some people even eat a small piece of curd milk, or treat the skin with alcohol, will also occur disulfiram-like reaction.
"A little over a year ago, we saw a girl in her 20s who was treated in the hospital for lymphadenitis. At that time, there were also cephalosporin drugs, and the little girl usually liked to eat wine and chocolate, and the family often prepared such small snacks, so they were taken to the hospital for her to eat. As a result, she ate a few chocolates after hanging up the water, and it did not take long for her to start dizziness, cold sweat, and breathing difficulties, and it was later confirmed that disulfiram reactions also occurred. Dr. Ying Jiake said.
Drugs containing ethanol:
●Oral medicine: Huoxiang zhengqi water, belladonna tincture, 10 drops of water, Yunnan baiyao tincture, orange peel tincture.
●Injections: hydrocortisone injection, nimodipine injection, punctuated amber injection, diazepam injection, etc.
Foods containing ethanol:
●Beverages: including cooking wine, fruit beer, sake brewing, etc.
●Dishes: Drunken shrimp and drunken crab, beer duck, curd milk, etc.
● Fruit snacks: chocolate with wine hearts, and some fruits with high sugar content such as lychees and durians.
Cephalosporin + alcohol = poisoning
The most serious consequence is death
After using cephalosporin drugs and then drinking alcohol, is there really such a big harm?
Dr. Zhou Quan, deputy director of the Department of Pharmacy of the Second Affiliated Hospital of Zhejiang University School of Medicine, said that this is definitely not alarmist. The chemical composition of alcohol is ethanol, which is first broken down into acetaldehyde in the human body. Acetaldehyde is toxic, and if accumulated in the body, there will be symptoms of drunkenness such as facial flushing, violent pulsation of blood vessels in the head and neck, dizziness, nausea, and vomiting. Antibiotics, especially cephalosporins and metronidazoles, cause acetaldehyde to accumulate in the body. Injections, eating cephalosporins and then drinking alcohol, possible symptoms are facial redness, headache, nausea and vomiting, severe can lead to tachycardia heart failure acute myocardial infarction is life-threatening.
Dr. Zhou Quan said that some antibacterial drugs cannot be taken with alcohol. The most common are cephalosporins, such as cefoperazone, cefazoline, cefmonddo, laoxycephalus, and other cephalosporins containing thiophetrazolium groups. "Remember not to drink alcohol while taking these antibacterial drugs or within a week of stopping the drug."
In addition to cephalosporins, common drugs that cause "disulfiram-like reactions" are imidazole drugs: such as metronidazole, ornidazole, etc.; other antibiotics: such as furazolidone, ketoconazole, compound sulfamethoxazole, isoniazid, etc.; sulfonylurea hypoglycemic drugs: such as gliclazide, glipizide, etc.; other drugs: warfarin, tolasuline, etc.
Zhou Quan said that in general, these drugs, in the drug instructions will be noted on the precautions, reminded to try not to drink alcohol during the medication, patients on whether there is a reminder of alcohol taboo, if not sure, you can consult a professional doctor and pharmacist.
In addition, it should be reminded that due to the presence of alcohol in the body after drinking, do not take drugs that may cause disulfiram reactions for 2 days after drinking alcohol.
Dr. Ying Cancore also recommends that alcohol has an effect on the metabolism of most drugs, and try not to drink alcohol during medication. During the period of taking the drug, or for at least 7 days after discontinuation of the drug, it is forbidden to drink alcohol or come into contact with substances containing alcohol. In addition, in addition to drinking alcohol, foods containing alcohol, drugs, and even treating the skin with alcohol also need to be paid attention to.
What are the common drugs that cause disulfiram-like reactions?
1. Antibacterial drugs, mainly cephalosporins.
Such as cefoperazone, cefoperazone sulbactam, cefmetazole, ceftiam, cefotaxime, ceftazidime, ceftriaxone, cefaclosklor, cefaladin, cefoxitin, cefoxitin, etc.;
2. Non-cephalosporin drugs:
●Treatment of oral infections, gynecological infections and other diseases: metronidazole, tinidazole, ornidazole
●Hypoglycemic drugs: gliclazide, glipizide, insulin, etc.
●Treatment of intestinal infections and diarrhea: Furazolidone (dysentery)
●Treatment of onychomycosis, nail fungus, etc.: fluconazole, griseofulvin
●Treatment of various skin ringworms: ketoconazole
●Others: Warfarin, omeprazole, etc.
【News to watch】
Professor of Xuanwu Hospital suffered a terrifying "life and death robbery"
How to save yourself in such an emergency?
In 2018, Professor Ling Feng, chief expert of Xuanwu Hospital, went to the ghost gate because of the "disulfiram reaction", but fortunately received timely treatment to pick up a life. Afterwards, Professor Ling wrote down this thrilling experience and reminded everyone with a painful lesson not to be careless.
According to Professor Ling Feng:
On December 7, 2018, he ate a slice of cephalosporin (0.5 grams) before his business trip due to a ruptured sebaceous cyst, "Less than two minutes after taking cephalosporin, he suddenly felt an itch in his left palm." After a few scratches, the palm of his right hand began to itch. In just a few tens of seconds, this sensation appears around the mouth and goes down the pharynx. "After that, the whole person felt groggy. In less than 3 minutes, I couldn't hold my phone and lost consciousness.
The driver diagnosed him after taking him to the hospital, drug anaphylactic shock!
"From the loss of consciousness after getting on the bus to the treatment in the emergency room, I was in a coma for about 30 minutes."
After treatment, he was discharged the next day. Only afterwards did he react, it turned out that the night before, he had drunk half a glass of red wine at the event!
"This damn disulfiram reaction almost killed me!"
How to save myself when a disulfiram reaction occurs?
Professor Ling Feng said that if it happens at home, the first thing is to level the patient so that the brain has sufficient blood supply. Second, call 120 immediately and tell the patient's condition and address. Third, if there is no sphygmomanometer at home, feel the pulse.
If you can feel the pulse at the wrist, there is probably a blood pressure of not less than 60. If the hand can't touch it, the carotid artery can still be touched, and there is breathing, the blood pressure will be about 40, then chest compressions must be performed. And hold up the mandible to allow for easy breathing. If both breathing and heartbeat stop and your face is blue, you should immediately follow the standard to perform chest compressions and mouth-to-mouth artificial respiration.
Anaphylactic shock comes very quickly, and blood pressure may drop to zero in 2-3 minutes! If you are in the car, you can only increase the throttle and run to the hospital with a red light. The principles of hospital selection are:
1. Nearest hospital.
2. The same distance is the most familiar hospital. Don't just run to the big hospital, give up the near and seek the far, delay the best time for rescue!
Before 120 arrives at the hospital, they will contact each emergency department to prepare for receiving patients. Driving to the hospital, the allergen is best explained clearly, the doctor can immediately decide to dispose of the doctor's orders, and every second at this moment is precious.
Source: City Express