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. 1994 Dec;72(6):554–560. doi: 10.1136/hrt.72.6.554

Influence of increased adrenergic activity and magnesium depletion on cardiac rhythm in alcohol withdrawal.

H Denison 1, S Jern 1, R Jagenburg 1, C Wendestam 1, S Wallerstedt 1
PMCID: PMC1025642  PMID: 7857739

Abstract

OBJECTIVE--To investigate the prevalence of arrhythmias in alcoholic men during detoxification and its relation to neuroendocrine activation and electrolyte disturbances. DESIGN--Consecutive case-control study. SETTING--Primary and secondary care, detoxification ward. PATIENTS AND CONTROLS--19 otherwise healthy alcoholic men (DSM-III-R) with withdrawal symptoms necessitating detoxification in hospital. 19 age matched, healthy non-alcoholic men as controls for Holter recordings. INTERVENTIONS--Treatment with chlomethiazole; additional treatment with carbamazepine in patients with previous seizures. MAIN OUTCOME MEASURES--Computer based analyses of mean heart rate and arrhythmias from 24 hour Holter recordings, 24 hour urinary excretion of adrenaline and noradrenaline, magnesium retention measured by means of intravenous loading test, and serum concentrations of electrolytes. RESULTS--The 24 hour mean heart rate was higher in the alcoholic men (97.4 beats/minute, 95% confidence interval (CI) 91.2 to 103.6) than in the controls (69.6 beats/minute, 95% CI 65.4 to 73.8, P < 0.001). However, there was no difference in diurnal heart rate variation. The prevalence of premature supraventricular depolarisations was lower in the alcoholic men (P < 0.05). Neither atrial fibrillation nor malignant ventricular arrhythmias occurred. The sinus tachycardia in the alcoholic men correlated with the concomitant urinary excretion of catecholamines (P < 0.05). The mean serum magnesium concentration was 0.78 mmol/l (95% CI 0.73 to 0.83) in the alcoholic men and 0.83 mmol/l (95% CI 0.81 to 0.85) in a reference population of 55 men aged 40. Magnesium depletion (defined as magnesium retention > 30%) was detected in 10 alcoholic men (53%). Three alcoholic men had serum potassium concentrations < or = 3.3 mmol/l on admission. CONCLUSION--Increased adrenergic activity, magnesium depletion, and hypokalaemia are often seen after heavy drinking, but in alcoholic men without clinical heart disease these changes were not accompanied by arrhythmias other than sinus tachycardia during detoxification in hospital.

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Selected References

These references are in PubMed. This may not be the complete list of references from this article.

  1. Algra A., Tijssen J. G., Roelandt J. R., Pool J., Lubsen J. QTc prolongation measured by standard 12-lead electrocardiography is an independent risk factor for sudden death due to cardiac arrest. Circulation. 1991 Jun;83(6):1888–1894. doi: 10.1161/01.cir.83.6.1888. [DOI] [PubMed] [Google Scholar]
  2. Ballas M., Zoneraich S., Yunis M., Zoneraich O., Rosner F. Noninvasive cardiac evaluation in chronic alcoholic patients with alcohol withdrawal syndrome. Chest. 1982 Aug;82(2):148–153. doi: 10.1378/chest.82.2.148. [DOI] [PubMed] [Google Scholar]
  3. Banerjee S. P., Sharma V. K., Khanna J. M. Alterations in beta-adrenergic receptor binding during ethanol withdrawal. Nature. 1978 Nov 23;276(5686):407–409. doi: 10.1038/276407a0. [DOI] [PubMed] [Google Scholar]
  4. Brohult J., Levi L., Reichard H. Urinary excretion of adrenal hormones in man. Acta Med Scand. 1970 Jul-Aug;1-2(1):5–13. doi: 10.1111/j.0954-6820.1970.tb07999.x. [DOI] [PubMed] [Google Scholar]
  5. Buckingham T. A., Kennedy H. L., Goenjian A. K., Vasilomanolakis E. C., Shriver K. K., Sprague M. K., Lyyski D. Cardiac arrhythmias in a population admitted to an acute alcoholic detoxification center. Am Heart J. 1985 Nov;110(5):961–965. doi: 10.1016/0002-8703(85)90192-9. [DOI] [PubMed] [Google Scholar]
  6. Bøhmer T., Mathiesen B. Magnesium deficiency in chronic alcoholic patients uncovered by an intravenous loading test. Scand J Clin Lab Invest. 1982 Dec;42(8):633–636. [PubMed] [Google Scholar]
  7. Clark J. C. Sudden death in the chronic alcoholic. Forensic Sci Int. 1988 Jan;36(1-2):105–111. doi: 10.1016/0379-0738(88)90222-8. [DOI] [PubMed] [Google Scholar]
  8. Day C. P., James O. F., Butler T. J., Campbell R. W. QT prolongation and sudden cardiac death in patients with alcoholic liver disease. Lancet. 1993 Jun 5;341(8858):1423–1428. doi: 10.1016/0140-6736(93)90879-l. [DOI] [PubMed] [Google Scholar]
  9. Dyckner T., Helmers C., Lundman T., Wester P. O. Initial serum potassium level in relation to early complications and prognosis in patients with acute myocardial infarction. Acta Med Scand. 1975 Mar;197(3):207–210. doi: 10.1111/j.0954-6820.1975.tb04903.x. [DOI] [PubMed] [Google Scholar]
  10. Dyckner T. Serum magnesium in acute myocardial infarction. Relation to arrhythmias. Acta Med Scand. 1980;207(1-2):59–66. doi: 10.1111/j.0954-6820.1980.tb09676.x. [DOI] [PubMed] [Google Scholar]
  11. Gould L., Reddy C. V., Becker W., Oh K. C., Kim S. G. Electrophysiologic properties of alcohol in man. J Electrocardiol. 1978 Jul;11(3):219–226. doi: 10.1016/s0022-0736(78)80120-4. [DOI] [PubMed] [Google Scholar]
  12. Greenspon A. J., Schaal S. F. The "holiday heart": electrophysiologic studies of alcohol effects in alcoholics. Ann Intern Med. 1983 Feb;98(2):135–139. doi: 10.7326/0003-4819-98-2-135. [DOI] [PubMed] [Google Scholar]
  13. Gullestad L., Dolva L. O., Søyland E., Manger A. T., Falch D., Kjekshus J. Oral magnesium supplementation improves metabolic variables and muscle strength in alcoholics. Alcohol Clin Exp Res. 1992 Oct;16(5):986–990. doi: 10.1111/j.1530-0277.1992.tb01906.x. [DOI] [PubMed] [Google Scholar]
  14. Gullestad L., Dolva L. O., Waage A., Falch D., Fagerthun H., Kjekshus J. Magnesium deficiency diagnosed by an intravenous loading test. Scand J Clin Lab Invest. 1992 Jun;52(4):245–253. doi: 10.3109/00365519209088355. [DOI] [PubMed] [Google Scholar]
  15. Iseri L. T., Freed J., Bures A. R. Magnesium deficiency and cardiac disorders. Am J Med. 1975 Jun;58(6):837–846. doi: 10.1016/0002-9343(75)90640-3. [DOI] [PubMed] [Google Scholar]
  16. Landahl S., Graffner C., Jagenburg R., Lundborg P., Steen B. Prevalence and treatment of hypomagnesemia in the elderly studies in a representative in 70-year-old population and in geriatric patients. Aktuelle Gerontol. 1980 Sep;10(9):397–402. [PubMed] [Google Scholar]
  17. Lim P., Jacob E. Magnesium status of alcoholic patients. Metabolism. 1972 Nov;21(11):1045–1051. doi: 10.1016/0026-0495(72)90035-2. [DOI] [PubMed] [Google Scholar]
  18. Lithell H., Aberg H., Selinus I., Hedstrand H. Alcohol intemperance and sudden death. Br Med J (Clin Res Ed) 1987 Jun 6;294(6585):1456–1458. doi: 10.1136/bmj.294.6585.1456. [DOI] [PMC free article] [PubMed] [Google Scholar]
  19. Little R. A., Frayn K. N., Randall P. E., Yates D. W. Plasma catecholamines and cardiac arrest. Lancet. 1985 Aug 31;2(8453):509–510. doi: 10.1016/s0140-6736(85)90451-9. [DOI] [PubMed] [Google Scholar]
  20. Majumdar S. K. Chlormethiazole: current status in the treatment of the acute ethanol withdrawal syndrome. Drug Alcohol Depend. 1991 May;27(3):201–207. doi: 10.1016/0376-8716(91)90001-f. [DOI] [PubMed] [Google Scholar]
  21. Millane T. A., Ward D. E., Camm A. J. Is hypomagnesemia arrhythmogenic? Clin Cardiol. 1992 Feb;15(2):103–108. doi: 10.1002/clc.4960150210. [DOI] [PubMed] [Google Scholar]
  22. Ogren S. O. Chlormethiazole--mode of action. Acta Psychiatr Scand Suppl. 1986;329:13–27. [PubMed] [Google Scholar]
  23. Patel R., McArdle J. J., Regan T. J. Increased ventricular vulnerability in a chronic ethanol model despite reduced electrophysiologic responses to catecholamines. Alcohol Clin Exp Res. 1991 Oct;15(5):785–789. doi: 10.1111/j.1530-0277.1991.tb00601.x. [DOI] [PubMed] [Google Scholar]
  24. Patterson E., Dormer K. J., Scherlag B. J., Kosanke S. D., Schaper J., Lazzara R. Long-term intracoronary ethanol administration electrophysiologic and morphologic effects. Alcohol. 1987 Sep-Oct;4(5):375–384. doi: 10.1016/0741-8329(87)90070-x. [DOI] [PubMed] [Google Scholar]
  25. Petersson B. Analysis of the role of alcohol in mortality, particularly sudden unwitnessed death, in middle-aged men in Malmö, Sweden. Alcohol Alcohol. 1988;23(4):259–263. [PubMed] [Google Scholar]
  26. Petersson B., Krantz P., Kristensson H., Trell E., Sternby N. H. Alcohol-related death: a major contributor to mortality in urban middle-aged men. Lancet. 1982 Nov 13;2(8307):1088–1090. doi: 10.1016/s0140-6736(82)90015-0. [DOI] [PubMed] [Google Scholar]
  27. Pohorecky L. A. Influence of alcohol on peripheral neurotransmitter function. Fed Proc. 1982 Jun;41(8):2452–2455. [PubMed] [Google Scholar]
  28. Ralston M. A., Murnane M. R., Kelley R. E., Altschuld R. A., Unverferth D. V., Leier C. V. Magnesium content of serum, circulating mononuclear cells, skeletal muscle, and myocardium in congestive heart failure. Circulation. 1989 Sep;80(3):573–580. doi: 10.1161/01.cir.80.3.573. [DOI] [PubMed] [Google Scholar]
  29. Ramee S. R., White C. J., Svinarich J. T., Watson T. D., Fox R. F. Torsade de pointes and magnesium deficiency. Am Heart J. 1985 Jan;109(1):164–167. doi: 10.1016/0002-8703(85)90432-6. [DOI] [PubMed] [Google Scholar]
  30. Rasmussen H. S., McNair P., Gøransson L., Balsløv S., Larsen O. G., Aurup P. Magnesium deficiency in patients with ischemic heart disease with and without acute myocardial infarction uncovered by an intravenous loading test. Arch Intern Med. 1988 Feb;148(2):329–332. [PubMed] [Google Scholar]
  31. Reinhart R. A., Broste S. K., Spencer S., Marx J. J., Jr, Haas R. G., Rae P. Relation between magnesium and potassium concentrations in myocardium, skeletal muscle, and mononuclear blood cells. Clin Chem. 1992 Dec;38(12):2444–2448. [PubMed] [Google Scholar]
  32. Reinhart R. A. Magnesium metabolism. A review with special reference to the relationship between intracellular content and serum levels. Arch Intern Med. 1988 Nov;148(11):2415–2420. doi: 10.1001/archinte.148.11.2415. [DOI] [PubMed] [Google Scholar]
  33. Rosengren A., Wilhelmsen L., Pennert K., Berglund G., Elmfeldt D. Alcoholic intemperance, coronary heart disease and mortality in middle-aged Swedish men. Acta Med Scand. 1987;222(3):201–213. doi: 10.1111/j.0954-6820.1987.tb10661.x. [DOI] [PubMed] [Google Scholar]
  34. Ryzen E., Elbaum N., Singer F. R., Rude R. K. Parenteral magnesium tolerance testing in the evaluation of magnesium deficiency. Magnesium. 1985;4(2-3):137–147. [PubMed] [Google Scholar]
  35. Sellers E. M., Degani N. C., Zilm D. H., Macleod S. M. Letter: Propranolol-decreased noradrenaline excretion and alcohol withdrawal. Lancet. 1976 Jan 10;1(7950):94–95. doi: 10.1016/s0140-6736(76)90193-8. [DOI] [PubMed] [Google Scholar]
  36. Topol E. J., Lerman B. B. Hypomagnesemic torsades de pointes. Am J Cardiol. 1983 Dec 1;52(10):1367–1368. doi: 10.1016/0002-9149(83)90611-2. [DOI] [PubMed] [Google Scholar]
  37. Tso E. L., Barish R. A. Magnesium: clinical considerations. J Emerg Med. 1992 Nov-Dec;10(6):735–745. doi: 10.1016/0736-4679(92)90534-z. [DOI] [PubMed] [Google Scholar]
  38. Wannamethee G., Shaper A. G. Alcohol and sudden cardiac death. Br Heart J. 1992 Nov;68(5):443–448. doi: 10.1136/hrt.68.11.443. [DOI] [PMC free article] [PubMed] [Google Scholar]
  39. Whang R., Whang D. D., Ryan M. P. Refractory potassium repletion. A consequence of magnesium deficiency. Arch Intern Med. 1992 Jan;152(1):40–45. [PubMed] [Google Scholar]
  40. Whyte K. F., Addis G. J., Whitesmith R., Reid J. L. Adrenergic control of plasma magnesium in man. Clin Sci (Lond) 1987 Jan;72(1):135–138. doi: 10.1042/cs0720135. [DOI] [PubMed] [Google Scholar]
  41. Zilm D. H., Jacob M. S., MacLeod S. M., Sellers E. M., Ti T. Y. Propranolol and chlordiazepoxide effects on cardiac arrhythmias during alcohol withdrawal. Alcohol Clin Exp Res. 1980 Oct;4(4):400–405. doi: 10.1111/j.1530-0277.1980.tb04839.x. [DOI] [PubMed] [Google Scholar]

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