Question

J.G, a 49 year-old male, was assessed in the emergency department (ED) 4 days ago. He was diagnosed with alcohol intoxication and released after 8 hours into his brother’s care. He was readmitted to the ED 12 hours ago with a gastrointestinal (GI) bleed and is being transferred to the intensive care unit (ICU). His diagnosis is upper GI bleed and alcohol intoxication.

You are assigned to J.G. for the remainder of your shift. According to the ED notes, his admission vital signs (VS) were BP 84/56, HT 110, RR 26, and he was vomiting bright red blood. He was given IV fluids and transfused 6 units of packed red blood cells (PRBCs) in the ED. On initial assessment, you note that J.G.’s VS are Temp. 102.2* F 939*C), BP 174/98, HR 110, RR 24. He has a slight tremor in his hands, is diaphoretic, and he appears anxious. He reports a headache and appears flushed. No report of vomiting, frank red blood or melena in the stools, according to the chart, for the past 5 hours. In response to your questions, J.G. denies he has an alcohol problem but later on admits to drinking approximately a fifth of vodka daily for the past 2 months. He admits to having seizures while withdrawing from alcohol in the past. He tells you that he "just can’t help it" and has strong urges to drink, but that he never means "to drink very much." He has had trouble keeping a job over the past several months.

Admission Laboratory Work

Hgb 10.9 g/dL (109 g/L)

Hct 23%

ALT (formerly SGPT) 69 units/L

AST (formerly SGOT) 111 units/L

GGT 75 units/L

ETOH 291 mg/dL (63 mmol/L)

aPTT 35 seconds

PT/INR 12 seconds/1

Hepatitis C screening Negative

Based on the DSM-Vf criteria, how would you rate the severity of J.G.’s alcohol use? Explain your decision.

a. No problem
b. Mild
c. Moderate
d. Severe

Answer 1

J.G.'s alcohol use disorder is rated as severe due to his physical dependence, inability to fulfill responsibilities, health consequences, and admission laboratory results indicating chronic alcohol abuse.

Step-by-step explanation:

Based on the DSM-V criteria, J.G.’s alcohol use should be rated as severe. Several factors contribute to this assessment. J.G. has needed to drink more to achieve the desired effect, indicating tolerance, and has experienced withdrawal symptoms such as seizures, suggesting physical dependence. Additionally, his alcohol intake has caused significant impairment or distress, manifested in his inability to maintain a job and repeated hospital admissions for alcohol-related health issues, including gastrointestinal bleeding and altered mental status. Furthermore, J.G.’s admission laboratory work shows elevated liver enzymes (ALT, AST, and GGT), which could signal liver injury due to chronic alcohol abuse. His alcohol level upon admission was substantially high, reflecting acute intoxication. The combination of these clinical signs, symptoms, and behavioral impacts aligns with a severe rating for J.G.’s alcohol use disorder according to the DSM-V criteria.