test results and metabolism

I am a 47 year old male with a 15 year history of alcohol abuse as much as a fifth a day at my worst. I have also been on several kinds of antidepressants and anti anxiety medications the past 10 years. I quit alcohol in 2000 but relapsed Oct. 2003 but limited my intake to at the most 6 drinks over a 6 hour time frame and was taking clonopin and wellbutrin for anxiety and depression. I drank straight, no mixer so I might drink as much as 1/2 a fifth at most. My medications changed in Oct. 2004 to lexapro for depression and seraquel for anxiety which I take just before bed. I have been gradually cutting back on my alcohol intake to where a fifth could last 3 days. I only drank after work and confined myself to my home when drinking. In January 2005 I was told by my supervisor that I had an odor about me and was required to go take a breathalyzer. Since my job sometimes requires me to be on standby I had only consumed maybe at most 4 drinks, then dinner, my medications, and was in bed by 9:30 p.m. I was requested to take the breathalyzer at 8:00 a.m. the next day and it came up at .08 BAC, not good. Why would this be? I couldn't understand why since I hadn't anything to drink for nearly 12 hours. A couple days later I ended up at the emergency room diagnosed with high blood ammonia levels. I had had a couple of drinks the night before but because I wasn't feeling well I cut it off there. The attending wrote that I reeked of alcohol and prescribed laculose and to stop alcohol and referred me to a family med doctor the next week. I admit that I didn't completely give up drinking and didn't take the laculose but I had cut down to only 2 maybe 3 drinks/day. The day before my appointment with the family med I had only 1 drink the night before my 10 a.m. visit. She took blood tests said I smelled of alcohol and had a jaundiced look. My comp. metabolic panel test results came up positive for alcohol .104 % with a cutoff at .010 %, serum sodium 128L mmol/L serum chloride 91L mmol/L total serum protein 5.4 L g/dl, serum albumin 3.1 L g/dl total bilirubin 6.6 H mg/dl, serum alkaline phosphatase 542 H IU/L, AST 396 H IU/L, ALT 164 H IU/L, B12 1681 H pg/ml. My hepatic function panel results were total bilirubin is 11.0 H mg/dl, direct  bilirubin 6.83 H mg/dl, serum alkaline phosphatase 508 H IU/L, AST 360 H IU/L, ALT 320 H IU/L and ethanol was neg.. I was just told today that my ultrasound indicated sluge in my gallbladder and I need see a G.I. specialist and probably get a liver biopsy. What do these numbers indicate and why do I post a positive on ethanol screens?
At the normal metabolization rate of alcohol I should have been able to process more than what I ingested and still be negative after 12 hours. I do not drink at all now and God willing never will again but I still take a multi vitamin,100 mg seraquel and 20 mg lexapro daily. Thank you for any information.

[Kevin Pho, MD]

The lab numbers are indicative of a degree of liver failure.  Specifically, the elevated AST/ALT and the total bilirubin is markedly high.  The liver biopsy is necessary to help determine the degree of liver disease.

The liver damage is the most likely reason why you are not able to metabolize the alcohol properly.  I would advise abstaining from alcohol until you can get to the bottom of the liver damage.  

A GI evaluation or a liver specialist would be recommended at this point.

Followup with your personal physician is essential.

This answer is not intended as and does not substitute for medical advice - the information presented is for patient education only. Please see your personal physician for further evaluation of your individual case.

Kevin, M.D.
Medical Weblog:
kevinmd_b

[mizzzfrizzz]

A related discussion, Breathalyzer Readings and Liver Damage was started.