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Br Heart J. 1994 December; 72(6): 554–560.
PMCID: PMC1025642

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


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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  • Petersson B, Krantz P, Kristensson H, Trell E, Sternby NH. Alcohol-related death: a major contributor to mortality in urban middle-aged men. Lancet. 1982 Nov 13;2(8307):1088–1090. [PubMed]
  • 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]
  • Clark JC. Sudden death in the chronic alcoholic. Forensic Sci Int. 1988 Jan;36(1-2):105–111. [PubMed]
  • Pohorecky LA. Influence of alcohol on peripheral neurotransmitter function. Fed Proc. 1982 Jun;41(8):2452–2455. [PubMed]
  • Lim P, Jacob E. Magnesium status of alcoholic patients. Metabolism. 1972 Nov;21(11):1045–1051. [PubMed]
  • 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]
  • Iseri LT, Freed J, Bures AR. Magnesium deficiency and cardiac disorders. Am J Med. 1975 Jun;58(6):837–846. [PubMed]
  • Millane TA, Ward DE, Camm AJ. Is hypomagnesemia arrhythmogenic? Clin Cardiol. 1992 Feb;15(2):103–108. [PubMed]
  • 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. [PubMed]
  • Zilm DH, Jacob MS, MacLeod SM, Sellers EM, Ti TY. Propranolol and chlordiazepoxide effects on cardiac arrhythmias during alcohol withdrawal. Alcohol Clin Exp Res. 1980 Oct;4(4):400–405. [PubMed]
  • 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. [PubMed]
  • 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. [PMC free article] [PubMed]
  • Wannamethee G, Shaper AG. Alcohol and sudden cardiac death. Br Heart J. 1992 Nov;68(5):443–448. [PMC free article] [PubMed]
  • Patterson E, Dormer KJ, Scherlag BJ, Kosanke SD, Schaper J, Lazzara R. Long-term intracoronary ethanol administration electrophysiologic and morphologic effects. Alcohol. 1987 Sep-Oct;4(5):375–384. [PubMed]
  • Patel R, McArdle JJ, Regan TJ. Increased ventricular vulnerability in a chronic ethanol model despite reduced electrophysiologic responses to catecholamines. Alcohol Clin Exp Res. 1991 Oct;15(5):785–789. [PubMed]
  • Gould L, Reddy CV, Becker W, Oh KC, Kim SG. Electrophysiologic properties of alcohol in man. J Electrocardiol. 1978 Jul;11(3):219–226. [PubMed]
  • Greenspon AJ, Schaal SF. The "holiday heart": electrophysiologic studies of alcohol effects in alcoholics. Ann Intern Med. 1983 Feb;98(2):135–139. [PubMed]
  • Buckingham TA, Kennedy HL, Goenjian AK, Vasilomanolakis EC, Shriver KK, Sprague MK, Lyyski D. Cardiac arrhythmias in a population admitted to an acute alcoholic detoxification center. Am Heart J. 1985 Nov;110(5):961–965. [PubMed]
  • Banerjee SP, Sharma VK, Khanna JM. Alterations in beta-adrenergic receptor binding during ethanol withdrawal. Nature. 1978 Nov 23;276(5686):407–409. [PubMed]
  • Sellers EM, Degani NC, Zilm DH, Macleod SM. Letter: Propranolol-decreased noradrenaline excretion and alcohol withdrawal. Lancet. 1976 Jan 10;1(7950):94–95. [PubMed]
  • Little RA, Frayn KN, Randall PE, Yates DW. Plasma catecholamines and cardiac arrest. Lancet. 1985 Aug 31;2(8453):509–510. [PubMed]
  • Whang R, Whang DD, Ryan MP. Refractory potassium repletion. A consequence of magnesium deficiency. Arch Intern Med. 1992 Jan;152(1):40–45. [PubMed]
  • Tso EL, Barish RA. Magnesium: clinical considerations. J Emerg Med. 1992 Nov-Dec;10(6):735–745. [PubMed]
  • Reinhart RA. 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. [PubMed]
  • Ryzen E, Elbaum N, Singer FR, Rude RK. Parenteral magnesium tolerance testing in the evaluation of magnesium deficiency. Magnesium. 1985;4(2-3):137–147. [PubMed]
  • Rasmussen HS, McNair P, Gøransson L, Balsløv S, Larsen OG, 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]
  • Gullestad L, Dolva LO, 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. [PubMed]
  • Ralston MA, Murnane MR, Kelley RE, Altschuld RA, Unverferth DV, Leier CV. Magnesium content of serum, circulating mononuclear cells, skeletal muscle, and myocardium in congestive heart failure. Circulation. 1989 Sep;80(3):573–580. [PubMed]
  • Reinhart RA, Broste SK, Spencer S, Marx JJ, Jr, Haas RG, 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]
  • 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]
  • Whyte KF, Addis GJ, Whitesmith R, Reid JL. Adrenergic control of plasma magnesium in man. Clin Sci (Lond) 1987 Jan;72(1):135–138. [PubMed]
  • Dyckner T. Serum magnesium in acute myocardial infarction. Relation to arrhythmias. Acta Med Scand. 1980;207(1-2):59–66. [PubMed]
  • Dyckner T, Helmers C, Lundman T, Wester PO. 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. [PubMed]
  • Algra A, Tijssen JG, Roelandt JR, 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. [PubMed]
  • Topol EJ, Lerman BB. Hypomagnesemic torsades de pointes. Am J Cardiol. 1983 Dec 1;52(10):1367–1368. [PubMed]
  • Ramee SR, White CJ, Svinarich JT, Watson TD, Fox RF. Torsade de pointes and magnesium deficiency. Am Heart J. 1985 Jan;109(1):164–167. [PubMed]
  • Day CP, James OF, Butler TJ, Campbell RW. QT prolongation and sudden cardiac death in patients with alcoholic liver disease. Lancet. 1993 Jun 5;341(8858):1423–1428. [PubMed]
  • Brohult J, Levi L, Reichard H. Urinary excretion of adrenal hormones in man. Acta Med Scand. 1970 Jul-Aug;1-2(1):5–13. [PubMed]
  • Majumdar SK. Chlormethiazole: current status in the treatment of the acute ethanol withdrawal syndrome. Drug Alcohol Depend. 1991 May;27(3):201–207. [PubMed]
  • Ogren SO. Chlormethiazole--mode of action. Acta Psychiatr Scand Suppl. 1986;329:13–27. [PubMed]
  • Gullestad L, Dolva LO, Søyland E, Manger AT, 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. [PubMed]

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