{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,6,4]],"date-time":"2026-06-04T14:00:42Z","timestamp":1780581642671,"version":"3.54.1"},"reference-count":60,"publisher":"Public Library of Science (PLoS)","issue":"12","license":[{"start":{"date-parts":[[2020,12,3]],"date-time":"2020-12-03T00:00:00Z","timestamp":1606953600000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["www.plosone.org"],"crossmark-restriction":false},"short-container-title":["PLoS ONE"],"abstract":"<jats:sec id=\"sec001\"><jats:title>Objectives<\/jats:title><jats:p>Disulfiram is an adjunct in the treatment of alcohol use disorders, but case reports indicate that disulfiram ethanol reactions are not always recognized in the emergency department. Our first aim is to remind of this risk with two case reports of life-threatening reactions not immediately considered by the emergency physician. The second aim is to estimate the probability that a disulfiram reaction goes unrecognized with the use of a retrospective study of patients admitted to the emergency department.<\/jats:p><\/jats:sec><jats:sec id=\"sec002\"><jats:title>Methods<\/jats:title><jats:p>Clinical files of patients admitted between October 1, 2010 and September 30, 2014 to the emergency department were retrospectively screened for the key words \u201cethanol use\u201d and \u201cdisulfiram\u201d. Their diagnoses were then scored by a panel regarding the probability of an interaction.<\/jats:p><\/jats:sec><jats:sec id=\"sec003\"><jats:title>Results<\/jats:title><jats:p>Seventy-nine patients were included, and a disulfiram-ethanol reaction was scored as either \u2018highly likely\u2019, \u2018likely\u2019 or \u2018possible\u2019 in 54.4% and as \u2018doubtful\u2019 or \u2018certainly not present\u2019 in 45.6% of the patients. The interrater agreement was 0.71 (95% CI: 0.64\u20130.79). The diagnosis was not considered or only after a delay in 44.2% of the patients with a \u2018possible\u2019 to \u2018highly likely\u2019 disulfiram interaction. One patient with a disulfiram overdose died and was considered as a \u2018possible\u2019 interaction.<\/jats:p><\/jats:sec><jats:sec id=\"sec004\" sec-type=\"conclusions\"><jats:title>Discussion and conclusions<\/jats:title><jats:p>A disulfiram ethanol interaction can be life threatening and failure to consider the diagnosis in the emergency department seems frequent. Prospective studies with documentation of the intake of disulfiram and evaluation of the value of acetaldehyde as a biomarker are needed to determine the precise incidence. Improving knowledge of disulfiram interactions and adequate history taking of disulfiram intake may improve the care for patients.<\/jats:p><\/jats:sec>","DOI":"10.1371\/journal.pone.0243222","type":"journal-article","created":{"date-parts":[[2020,12,3]],"date-time":"2020-12-03T21:08:37Z","timestamp":1607029717000},"page":"e0243222","update-policy":"https:\/\/doi.org\/10.1371\/journal.pone.corrections_policy","source":"Crossref","is-referenced-by-count":12,"title":["Recognition of a disulfiram ethanol reaction in the emergency department is not always straightforward"],"prefix":"10.1371","volume":"15","author":[{"given":"Kristof","family":"Segher","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Liesbeth","family":"Huys","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-2337-4411","authenticated-orcid":true,"given":"Tania","family":"Desmet","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Evi","family":"Steen","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Stefanie","family":"Chys","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Walter","family":"Buylaert","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Peter","family":"De Paepe","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"340","published-online":{"date-parts":[[2020,12,3]]},"reference":[{"issue":"2","key":"pone.0243222.ref001","doi-asserted-by":"crossref","first-page":"e87366","DOI":"10.1371\/journal.pone.0087366","article-title":"Disulfiram efficacy in the treatment of alcohol dependence: a meta-analysis","volume":"9","author":"MD Skinner","year":"2014","journal-title":"Plos ONE"},{"key":"pone.0243222.ref002","doi-asserted-by":"crossref","first-page":"1889","DOI":"10.1001\/jama.2014.3628","article-title":"Pharmacotherapy for adults with alcohol use disorders in outpatient settings. 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