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REPLY
Patients with Alcohol Problems
David A. Fiellin, MD;
M. Carrington Reid, PhD, MD; and
Patrick G. O'Connor, MD, MPH
6 November 2001 | Volume 135 Issue 9 | Page 841
IN RESPONSE:
Drs. Milionis and Elisaf acknowledge the importance of formal screening instruments in helping primary care clinicians identify patients with latent alcohol problems. We agree that selected laboratory tests can provide clues to the presence of unsuspected alcohol problems without having the appropriate operating characteristics to make useful screening tools (1, 2). Drs. Milionis and Elisaf point out that patients with alcohol problems may have electrolyte disorders and cite studies conducted among patients admitted for causes related to alcohol abuse (3, 4). We appreciate their description of this unique cohort of patients and agree that these clues to excessive alcohol consumption may often be overlooked in routine clinical practice.
In our recent systematic review of this literature, no studies focused on the operating characteristics of electrolyte disturbances in primary care. Therefore, their sensitivity and specificity in this clinical setting are unknown (2). Additional studies may be warranted to determine the operating characteristics of these laboratory analyses in primary care. Given the prevalence of alcohol disorders in primary care, the demonstrated value of formal screening instruments in identifying patients with latent alcohol problems in this setting, and the benefits of early treatment, we recommend that busy clinicians use such screening methods as the CAGE questionnaire and AUDIT, both of which are efficient and effective in identifying patients with alcohol problems.
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Author and Article Information
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Yale University School of Medicine; New Haven, CT 06520-8025 (Fiellin, Reid, O'Connor)
1. Fiellin DA, Reid MC, O'Connor PG. Outpatient management of patients with alcohol problems Ann Intern Med. 2000;133:815-27. [PMID: 11085845].[Abstract/Free Full Text]
2. Fiellin DA, Reid MC, O'Connor PG. Screening for alcohol problems in primary care: a systematic review Arch Intern Med. 2000;160:1977-89. [PMID: 10888972].[Abstract/Free Full Text]
3. Elisaf M, Merkouropoulos M, Tsianos EV, Siamopoulos KC. Pathogenetic mechanisms of hypomagnesemia in alcoholic patients J Trace Elem Med Biol. 1995;9:210-4. [PMID: 8808192].[Medline]
4. Elisaf M, Merkouropoulos M, Tsianos EV, Siamopoulos KC. Acid-base and electrolyte abnormalities in alcoholic patients Miner Electrolyte Metab. 1994;20:274-81. [PMID: 7700215].[Medline]
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Outpatient Management of Patients with Alcohol Problems
David A. Fiellin, M. Carrington Reid, AND Patrick G. O'Connor
- Annals 2000 133: 815-827.
[ABSTRACT][Full Text]
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