[Postoperative therapy of an alcoholic patient with an unusually high ethanol metabolic rate]

To avoid alcohol withdrawal syndrome (AWS) a pre-operative withdrawal, post-operative drug therapy or continued substitution of ethanol may be tried. However, substitution of ethanol needs an exact dosage and has to be controlled very carefully. The dose calculation is based on an assumed breakdown rate of 0.15 g%/1000/h, as evaluated in forensic studies. We report on a patient who throws the basis for these calculations into question. The breakdown rate of this 43-year-old man was extraordinary higher than the average turnover. This high level of the turnover rate occurred with no detectable impairment of the liver or other organs. This case demonstrates the importance of a close control of the blood alcohol level during the post-operative administration of ethanol. The individual doses of ethanol to avoid AWS has to be found individually for each patient.