Recognition of a disulfiram ethanol reaction in the emergency department is not always straightforward

Objectives Disulfiram is an adjunct in the treatment of alcohol use disorders, but case reports indicate that disulfiram ethanol reactions are not always recognized in the emergency department. Our first aim is to remind of this risk with two case reports of life-threatening reactions not immediately considered by the emergency physician. The second aim is to estimate the probability that a disulfiram reaction goes unrecognized with the use of a retrospective study of patients admitted to the emergency department. Methods Clinical files of patients admitted between October 1, 2010 and September 30, 2014 to the emergency department were retrospectively screened for the key words “ethanol use” and “disulfiram”. Their diagnoses were then scored by a panel regarding the probability of an interaction. Results Seventy-nine patients were included, and a disulfiram-ethanol reaction was scored as either ‘highly likely’, ‘likely’ or ‘possible’ in 54.4% and as ‘doubtful’ or ‘certainly not present’ in 45.6% of the patients. The interrater agreement was 0.71 (95% CI: 0.64–0.79). The diagnosis was not considered or only after a delay in 44.2% of the patients with a ‘possible’ to ‘highly likely’ disulfiram interaction. One patient with a disulfiram overdose died and was considered as a ‘possible’ interaction. Discussion and conclusions A disulfiram ethanol interaction can be life threatening and failure to consider the diagnosis in the emergency department seems frequent. Prospective studies with documentation of the intake of disulfiram and evaluation of the value of acetaldehyde as a biomarker are needed to determine the precise incidence. Improving knowledge of disulfiram interactions and adequate history taking of disulfiram intake may improve the care for patients.

Computational Investigation of HCCI Engine Performance With Fuel Reforming Effect on Lean Ethanol

In this study, a mechanism containing ethanol reactions is employed and the effects of exhaust gas fuel reforming on operation parameters such as ignition timing, burn duration, temperature, pressure and NOx emission are studied in which a homogeneous mixture is assumed. The results show that hydrogen in the form of reformed gas helps in lowering the intake temperature required for stable HCCI operation. It is concluded that the addition of hydrogen advances the start of combustion in the cylinder. This is a result of the lowering of the minimum intake temperature required for auto-ignition to occur during the compression stroke, resulting in advanced combustion for the same intake temperatures. The obtained results from the model are compared with the experimental data published in the literature and the comparison showed a reasonable compatibility.