Impact of alcohol intoxication on hemodynamic, metabolic, and cytokine responses to hemorrhagic shock

Herbert Phelan, Paul Stahls, John Hunt, Gregory J. Bagby, Patricia E. Molina

Research output: Contribution to journalArticle

71 Citations (Scopus)

Abstract

Background: Alcohol intoxication is associated with a high incidence of traumatic injury, particularly in the young healthy population. The impact of alcohol intoxication on the immediate pathophysiologic response to injury has not been closely examined. We hypothesized that acute alcohol intoxication would aggravate the immediate outcome from hemorrhagic shock by impairing homeostatic counterregulation to blood loss. Methods: Chronically catheterized male Sprague-Dawley rats were randomized to receive an intragastric infusion of ethyl alcohol (1.75 g/kg followed by 250-300 mg/kg/h) or isocaloric dextrose (3-mL bolus + 0.375 mL/h) for 15 hours. Before initiating fixed-pressure hemorrhage followed by fluid resuscitation, an additional intragastric bolus of ethyl alcohol (1.75 g/kg) was administered. Hemodynamic, metabolic, cytokine, and acid-base parameters were assessed during the hemorrhage period and at completion of resuscitation. Lungs were obtained for cytokine determinations. Results: Basal mean arterial pressure was significantly lower in alcohol-intoxicated (blood-alcohol concentration, 135 ± 12 mg/dL) animals than in controls during baseline (20%) and after the initial fluid resuscitation period (30%). Hemorrhage decreased arterial HCO3 and PCO2, and increased PO2 without significant alteration in arterial blood pH. Alcohol intoxication blunted the decrease in PCO2 and increase in PO2 and decreased blood pH during baseline and throughout the course of the hemorrhage period. Hemorrhage produced marked and progressive elevations in plasma glucose and lactate levels in controls, and this was inhibited by alcohol intoxication. Hemorrhage elevated plasma tumor necrosis factor-α (TNF-α) (686 ± 252 pg/mL) and interleukin (IL)-10 (178 ± 25 pg/mL), and did not alter IL-6 and IL-1 levels. Alcohol blunted the hemorrhage-induced rise in plasma TNF-α (142 ± 48 pg/mL) and enhanced the hemorrhage-induced increase in IL-10 (678 ± 187 pg/mL). Hemorrhage produced a two- to threefold increase in lung content of TNF-α, IL-1α, and IL-6 without significantly altering lung IL-10. Alcohol exacerbated the hemorrhage-induced increase in lung TNF-α, and did not alter the IL-1α, IL-6, and IL-10 lung responses. Conclusion: These results indicate marked alterations in the hemodynamic and metabolic responses to hemorrhagic shock by alcohol intoxication. Furthermore, our findings suggest that alcohol modulates the early proinflammatory responses to hemorrhagic shock. Taken together, these alterations in metabolic and inflammatory responses to hemorrhage are likely to impair immediate outcome and predispose to tissue injury.

Original languageEnglish (US)
Pages (from-to)675-682
Number of pages8
JournalJournal of Trauma - Injury, Infection and Critical Care
Volume52
Issue number4
StatePublished - 2002

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Alcoholic Intoxication
Hemorrhagic Shock
Hemodynamics
Hemorrhage
Cytokines
Interleukin-10
Lung
Tumor Necrosis Factor-alpha
Interleukin-1
Alcohols
Resuscitation
Interleukin-6
Wounds and Injuries
Ethanol
Glucose
Sprague Dawley Rats
Lactic Acid
Arterial Pressure

Keywords

  • Acid-base
  • Alcohol
  • Blood pressure
  • Cytokines
  • Rats
  • Shock

ASJC Scopus subject areas

  • Surgery

Cite this

Impact of alcohol intoxication on hemodynamic, metabolic, and cytokine responses to hemorrhagic shock. / Phelan, Herbert; Stahls, Paul; Hunt, John; Bagby, Gregory J.; Molina, Patricia E.

In: Journal of Trauma - Injury, Infection and Critical Care, Vol. 52, No. 4, 2002, p. 675-682.

Research output: Contribution to journalArticle

Phelan, Herbert ; Stahls, Paul ; Hunt, John ; Bagby, Gregory J. ; Molina, Patricia E. / Impact of alcohol intoxication on hemodynamic, metabolic, and cytokine responses to hemorrhagic shock. In: Journal of Trauma - Injury, Infection and Critical Care. 2002 ; Vol. 52, No. 4. pp. 675-682.
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abstract = "Background: Alcohol intoxication is associated with a high incidence of traumatic injury, particularly in the young healthy population. The impact of alcohol intoxication on the immediate pathophysiologic response to injury has not been closely examined. We hypothesized that acute alcohol intoxication would aggravate the immediate outcome from hemorrhagic shock by impairing homeostatic counterregulation to blood loss. Methods: Chronically catheterized male Sprague-Dawley rats were randomized to receive an intragastric infusion of ethyl alcohol (1.75 g/kg followed by 250-300 mg/kg/h) or isocaloric dextrose (3-mL bolus + 0.375 mL/h) for 15 hours. Before initiating fixed-pressure hemorrhage followed by fluid resuscitation, an additional intragastric bolus of ethyl alcohol (1.75 g/kg) was administered. Hemodynamic, metabolic, cytokine, and acid-base parameters were assessed during the hemorrhage period and at completion of resuscitation. Lungs were obtained for cytokine determinations. Results: Basal mean arterial pressure was significantly lower in alcohol-intoxicated (blood-alcohol concentration, 135 ± 12 mg/dL) animals than in controls during baseline (20{\%}) and after the initial fluid resuscitation period (30{\%}). Hemorrhage decreased arterial HCO3 and PCO2, and increased PO2 without significant alteration in arterial blood pH. Alcohol intoxication blunted the decrease in PCO2 and increase in PO2 and decreased blood pH during baseline and throughout the course of the hemorrhage period. Hemorrhage produced marked and progressive elevations in plasma glucose and lactate levels in controls, and this was inhibited by alcohol intoxication. Hemorrhage elevated plasma tumor necrosis factor-α (TNF-α) (686 ± 252 pg/mL) and interleukin (IL)-10 (178 ± 25 pg/mL), and did not alter IL-6 and IL-1 levels. Alcohol blunted the hemorrhage-induced rise in plasma TNF-α (142 ± 48 pg/mL) and enhanced the hemorrhage-induced increase in IL-10 (678 ± 187 pg/mL). Hemorrhage produced a two- to threefold increase in lung content of TNF-α, IL-1α, and IL-6 without significantly altering lung IL-10. Alcohol exacerbated the hemorrhage-induced increase in lung TNF-α, and did not alter the IL-1α, IL-6, and IL-10 lung responses. Conclusion: These results indicate marked alterations in the hemodynamic and metabolic responses to hemorrhagic shock by alcohol intoxication. Furthermore, our findings suggest that alcohol modulates the early proinflammatory responses to hemorrhagic shock. Taken together, these alterations in metabolic and inflammatory responses to hemorrhage are likely to impair immediate outcome and predispose to tissue injury.",
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AU - Stahls, Paul

AU - Hunt, John

AU - Bagby, Gregory J.

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N2 - Background: Alcohol intoxication is associated with a high incidence of traumatic injury, particularly in the young healthy population. The impact of alcohol intoxication on the immediate pathophysiologic response to injury has not been closely examined. We hypothesized that acute alcohol intoxication would aggravate the immediate outcome from hemorrhagic shock by impairing homeostatic counterregulation to blood loss. Methods: Chronically catheterized male Sprague-Dawley rats were randomized to receive an intragastric infusion of ethyl alcohol (1.75 g/kg followed by 250-300 mg/kg/h) or isocaloric dextrose (3-mL bolus + 0.375 mL/h) for 15 hours. Before initiating fixed-pressure hemorrhage followed by fluid resuscitation, an additional intragastric bolus of ethyl alcohol (1.75 g/kg) was administered. Hemodynamic, metabolic, cytokine, and acid-base parameters were assessed during the hemorrhage period and at completion of resuscitation. Lungs were obtained for cytokine determinations. Results: Basal mean arterial pressure was significantly lower in alcohol-intoxicated (blood-alcohol concentration, 135 ± 12 mg/dL) animals than in controls during baseline (20%) and after the initial fluid resuscitation period (30%). Hemorrhage decreased arterial HCO3 and PCO2, and increased PO2 without significant alteration in arterial blood pH. Alcohol intoxication blunted the decrease in PCO2 and increase in PO2 and decreased blood pH during baseline and throughout the course of the hemorrhage period. Hemorrhage produced marked and progressive elevations in plasma glucose and lactate levels in controls, and this was inhibited by alcohol intoxication. Hemorrhage elevated plasma tumor necrosis factor-α (TNF-α) (686 ± 252 pg/mL) and interleukin (IL)-10 (178 ± 25 pg/mL), and did not alter IL-6 and IL-1 levels. Alcohol blunted the hemorrhage-induced rise in plasma TNF-α (142 ± 48 pg/mL) and enhanced the hemorrhage-induced increase in IL-10 (678 ± 187 pg/mL). Hemorrhage produced a two- to threefold increase in lung content of TNF-α, IL-1α, and IL-6 without significantly altering lung IL-10. Alcohol exacerbated the hemorrhage-induced increase in lung TNF-α, and did not alter the IL-1α, IL-6, and IL-10 lung responses. Conclusion: These results indicate marked alterations in the hemodynamic and metabolic responses to hemorrhagic shock by alcohol intoxication. Furthermore, our findings suggest that alcohol modulates the early proinflammatory responses to hemorrhagic shock. Taken together, these alterations in metabolic and inflammatory responses to hemorrhage are likely to impair immediate outcome and predispose to tissue injury.

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