SHM Converge Scientific Abstract ePoster Gallery-Unmasking Hallucinations: Distilling Truths With Alcohol Use Biomarkers

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This case describes a 14-year-old female with a history of marijuana use and superior mesenteric artery syndrome who presented with one day of tremors, auditory hallucinations, and visual hallucinations. On exam, she was tachycardic and hypertensive, with generalized tremors, tongue fasciculations, and evidence of prior self-harm. Initial testing showed metabolic abnormalities including an elevated anion gap, ketosis, mild hyponatremia, elevated AST and ALT, macrocytosis, and a negative blood alcohol level. Urine drug screen was positive for cannabinoids. CT head was normal.<br /><br />She was treated on the CIWA alcohol withdrawal protocol and received lorazepam, after which she was safely transferred to inpatient psychiatric care for further substance use management.<br /><br />The poster emphasizes that alcohol withdrawal can be life-threatening if missed or undertreated, and that this patient’s symptoms were consistent with withdrawal due to sympathetic overactivity, hallucinations, tremors, and anxiety. It also highlights laboratory clues of chronic alcohol use, such as AST-predominant liver enzyme elevation and macrocytosis.<br /><br />A major focus is phosphatidylethanol (PEth), a biomarker formed only in the presence of alcohol and used to assess alcohol use over the prior 2–4 weeks. PEth is not influenced by age, sex, or many comorbidities, has high sensitivity, and a level ≥200 ng/mL suggests heavy chronic intake, roughly equivalent to about four standard drinks per day. In this case, a PEth level of 900 ng/mL supported substantial recent alcohol use. The conclusion is that PEth is useful for confirming chronic alcohol exposure, but acute alcohol withdrawal remains a clinical diagnosis that must be managed promptly.

Asset Subtitle

Kendall Trieglaff

Meta Tag

Author List Kendall Trieglaff, Leah Cotter

Category Clinical Vignettes

Concept Alcohol Withdrawal

Concept Autonomic Instability

Concept Tremor

Concept ASTALT Ratio

Concept Phosphatidylethanol

Distinguished Non-Finalist

Presenter Organization Medical College of Wisconsin

Presenting Author Kendall Trieglaff

Track Pediatric

Keywords

alcohol withdrawal

PEth biomarker

adolescent female

hallucinations

tremors

macrocytosis

AST elevation

CIWA protocol

substance use

cannabinoids

Alcohol Withdrawal

Autonomic Instability

Tremor

ASTALT Ratio

Phosphatidylethanol