Zieve's Syndrome

A syndrome that is characterized by acute metabolic condition that can occur during prolonged alcohol abuse. It was described initially in 1958 by Dr Leslie Zieve for patients with a combination of alcoholic liver disease Hemolytic Anemia and Hypertriglyceridemia. Zieve's syndrome exhibits liver and blood abnormalities caused by heavy alcohol consumption.

This is a condition associated with chronic alcoholism, frequently encountered in hospitalized alcoholics who have suddenly stopped alcohol. The underlying cause is liver delipidization and hemolytic anemia. This is distinct from alcoholic hepatitis which may be present simultaneously or develop later. The syndrome is defined by excessive blood lipoprotein, jaundice and abdominal pain.

Symptoms

Most common symptoms due to long-term history of chronic alcoholism include:

Nausea
Vomiting after heavy drinking
Anorexia
Abdominal pain
Hepatomegaly, enlarged spleen, late cirrhosis
Skin and yellow sclera
Hemolytic Anemia, Hemoglobinuria (hemoglobin is excreted in urine) and Hemosiderin (insoluble form of storage iron complex) in urine.
Hepatic dysfunction, Jaundice, Hyperlipidemia and reversible hemolytic anemia after alcohol abuse are prominent symptoms.

Causes of Zieve's Syndrome

Zieve's syndrome is caused by alcoholism due to liver cell damage and various degrees of cholestasis thus causing cancer. Fatty liver production of free fatty acids into blood stream, increased triglycerides that causes hyperlipidemia and increased cholesterol and phospholipid deposition, and damaged red blood cells which become hard and brittle and blocked by splenic sinusoids. In addition, alcoholism induced pancreatitis and vitamin E deficiency is associated with hemolysis.

Diagnosis of Zieve's Syndrome

The diagnosis is based from objective information about alcoholism, and blood test for the abnormalities. It is based on history and the triple disease – jaundice, hemolytic anemia and hyperlipidaemia. For jaundice, moderate and direct bilirubin test is done. Hemolytic anemia is visible in hemoglobinuria and hemosiderin urine. There could be drop in hemoglobin, reticulocytes, bone marrow erythroblastic hyperplasia, and increased erythrocyte fragility and shortened life of red blood cells.

Hyperlipidemia is detected by increase in cholesterol, triglycerides and phospholipids. Diagnostic tests include hemoglobin, bone marrow examination, blood lipids including cholesterol, phospholipids, triglycerides, serum bilirubin, alkaline phosphatase, and liver function test and liver biopsy. Ultrasonography is done to reveal the syndrome. There could be rapid serum level rise after alcohol withdrawal in patients with denial of drinking.

Treatment

Temperance for two to three weeks is essential for symptoms to disappear. A diet high in sugar-protein, vitamins and hepatoprotective drug is necessary. In addition to jaundice, treatment for high blood cholesterol and hemolytic anemia are essential. Basic therapy includes bed rest, adequate food intake, hydration and vitamin supplementation. The patient usually recovers from the symptoms very quickly, but the disease can recur if alcohol abuse persists.

High Triglyceride

Triglycerides are vital to various cells functions and determine the amount of reserve energy that our body can offer. Triglycerides come from food and are also produced by the body. High blood triglyceride or hypertriglyceridemia is a lipid disorder. High Triglyceride levels are usually accompanied by high total blood cholesterol levels. Blood Triglyceride levels are indicative of a person's susceptibility to various diseases such as hypertension, heart attack, cardiovascular disease and atherosclerosis. High levels of Triglycerides increase the risk of diabetes and pancreatitis. Blood triglyceride levels of around 150 to 170 mg/dL are considered normal. While high Triglyceride levels are those above 200 mg/dL, those having triglyceride levels greater than 499 mg/dL are at high risk. (see below the table) High Triglyceride levels also put a person at increased risk of thrombosis.

To evaluate the risk factors associated with elevated levels of cholesterol, levels of Triglyceride must also be factored in as cholesterol and Triglyceride levels can vary independently.

Reference Range of Triglyceride:

• Normal: Less than 150 mg/dL
  
• Borderline High: 150 - 199 mg/dL
  
• High : 200 - 499 mg/dL
  
• Very High : Greater than or equal to 500 mg/dL
  

Clinical Information on Triglyceride: Triglycerides are esters of the trihydric alcohol glycerol with three long chain fatty acids. They are partly synthesized in the liver and some of it come from the diet. Enhanced plasma levels of Triglycerides reflect metabolic abnormality. High level of Triglycerides by itself, is not nearly as harmful as LDL cholesterol. Together with high cholesterol level, it constitutes a high risk factor for any of the following diseases:

• biliary obstruction
  
• diabetes mellitus
  
• nephrotic syndrome
  
• Renal Failure
  

Or metabolic disorders related to endocrinopathies. Another cause of high levels of Triglycerides can be drug induced - e.g.;prednisone, isotretinoin.

High levels of Triglycerides beyond 1000 mg/dL can be fatal because of chylomicron induced pancreatitis which may show only abdominal pain as a symptom.

Blood Triglyceride levels are measured with a blood test after abstaining from food for 12 hours and alcohol for 72 hours before testing. Drugs such as fibrates are often prescribed to reduce elevated levels of triglycerides and cholesterol. Tips to lower triglyceride:

• Losing excess weight
  
• Regular exercise regimen
  
• Reducing caloric intake especially fatty foods
  
• Restricting alcohol intake
  

Dyslipidemia

Dyslipidemia indicates the presence of increased cholesterol in the blood. In general the cholesterol in the body is categorized as good and bad forms, thus referring to its functionality. Good cholesterol also known as high density lipoproteins are required for the body to carry out regular metabolic activities. Estimation of triglyceride levels in the blood serves as a key factor in identifying the amount of disordered fats in the body or dyslipidemia. Dyslipidemia is one of the important causes for the onset of coronary artery disease.

Clinical evaluations of blood cholesterol levels

Clinical presentation of blood cholesterol levels aids estimation of the onset of conditions such as dyslipidemia which leads to cardio vascular disease. Blood cholesterol determination includes the estimation of high density lipoproteins, triglycerides and low density lipoproteins. Values in the case of dyslipidemia contain increased total cholesterol levels i.e. high LDL levels and decreased HDL levels. These levels are checked on fasting for at least 10 hours. Clinical interventions are recommended in the treatment of dyslipidemia to understand the possibility of cardio vascular disease in a patient and to differentiate the primary and secondary categories of this disease.

Diabetes and dyslipidemia

Type 2 diabetes is an underlying medical condition in which dyslipidemia is often noticed. It is measured by the lipid profile analysis. Insulin resistance is the predominant cause of low serum HDL. Insulin resistance promotes another condition called hypertriglyceridemia. This eventually leads to the increase of LDL or low density lipoproteins in the blood which can initiate the onset of atherosclerosis. Patients suffering diabetes with increased values of LDL and VLDL fall under the risk group for coronary artery disease. In addition to this, the metabolism of lipids is directly associated with the release of thyroid hormone. In patients with diabetes and hypothyroidism, the chance of cardiovascular disease is imminent.

Other factors

Dyslipidemia can occur because of various factors. Most of them are induced by altered lifestyle patterns affecting the metabolism of a person. Obesity is the predominant cause of cardiovascular disease which is directly associated with the presence of dyslipidemia in the person. Symptoms associated are lethargy, gasping and difficulty in participating in any kind of physical activity. Alcohol consumption is also a major cause for the onset of dyslipidemia as it is related to the damage caused to the liver which produces major enzymes for lipid metabolism and fat emulsification processes. Other caused include Cushing's syndrome, Polycystic ovarian disease and liver cirrhosis.

Treatment

Dyslipidemia is a condition which is treated with effective counseling about healthy lifestyle choices. Eating right and handling stressful factors can subsequently act on the regulation of metabolism. Patients are advised to exercise regularly to prevent the onset of atherosclerosis caused because of dyslipidemia.