On 2014 Mar 18, Gwinyai Masukume commented:

Nejad and colleagues present a case of a man with alcohol withdrawal delirium and multifactorial delirium. This patient had thrombocytopenia and part of his work-up included testing for antibodies against heparin-platelet factor 4 complexes to elucidate the cause of the thrombocytopenia - the test was negative (1). Thrombocytopenia in early alcohol withdrawal is associated with development of delirium tremens or seizures (2). In patients who develop severe alcohol withdrawal syndrome (like the one presented) thrombocytopenia is more frequent (2).

Additionally, from the provided laboratory data, this patient has a De Ritis (aspartate aminotransferase/alanine aminotransferase) ratio greater than 2. His albumin/globulin ratio of less than 1.6 is low. Given his history of alcoholism, a De Ritis ratio greater then 2, and a decreased albumin/globulin ratio a diagnosis of alcoholic liver disease is made (3,4). Liver disease is briefly mentioned in the article; however it is important to highlight the role of laboratory data in diagnosing alcoholic liver disease.

References

(1) Nejad SH, Schaefer PW, Bajwa EK, Smith FA. Case records of the Massachusetts General Hospital. Case 39-2012. A 55-year-old man with alcoholism, recurrent seizures, and agitation. N Engl J Med 2012, 367(25):2428-34.

(2) Berggren U, Fahlke C, Berglund KJ, Blennow K, Zetterberg H, Balldin J. Thrombocytopenia in early alcohol withdrawal is associatedwith development of delirium tremens or seizures. Alcohol Alcohol 2009, 44(4):382-6. Berggren U, 2009

(3) Majhi S, Baral N, Lamsal M, Mehta KD. De Ritis ratio as diagnostic marker of alcoholic liver disease. Nepal Med Coll J 2006, 8(1):40-2. Majhi S, 2006

(4) Das SK, Vasudevan DM. Biochemical diagnosis of alcoholism. Indian J Clin Biochem 2005, 20(1):35-42. Das SK, 2005

On 2014 Mar 18, Gwinyai Masukume commented:

Nejad and colleagues present a case of a man with alcohol withdrawal delirium and multifactorial delirium. This patient had thrombocytopenia and part of his work-up included testing for antibodies against heparin-platelet factor 4 complexes to elucidate the cause of the thrombocytopenia - the test was negative (1). Thrombocytopenia in early alcohol withdrawal is associated with development of delirium tremens or seizures (2). In patients who develop severe alcohol withdrawal syndrome (like the one presented) thrombocytopenia is more frequent (2).

Additionally, from the provided laboratory data, this patient has a De Ritis (aspartate aminotransferase/alanine aminotransferase) ratio greater than 2. His albumin/globulin ratio of less than 1.6 is low. Given his history of alcoholism, a De Ritis ratio greater then 2, and a decreased albumin/globulin ratio a diagnosis of alcoholic liver disease is made (3,4). Liver disease is briefly mentioned in the article; however it is important to highlight the role of laboratory data in diagnosing alcoholic liver disease.

References

(1) Nejad SH, Schaefer PW, Bajwa EK, Smith FA. Case records of the Massachusetts General Hospital. Case 39-2012. A 55-year-old man with alcoholism, recurrent seizures, and agitation. N Engl J Med 2012, 367(25):2428-34.

(2) Berggren U, Fahlke C, Berglund KJ, Blennow K, Zetterberg H, Balldin J. Thrombocytopenia in early alcohol withdrawal is associatedwith development of delirium tremens or seizures. Alcohol Alcohol 2009, 44(4):382-6. Berggren U, 2009

(3) Majhi S, Baral N, Lamsal M, Mehta KD. De Ritis ratio as diagnostic marker of alcoholic liver disease. Nepal Med Coll J 2006, 8(1):40-2. Majhi S, 2006

(4) Das SK, Vasudevan DM. Biochemical diagnosis of alcoholism. Indian J Clin Biochem 2005, 20(1):35-42. Das SK, 2005