1: Int J Clin Pharmacol Ther Toxicol 1983 Nov;21(11):552-7 Related Articles,  Links 

Renin-aldosterone axis in ethanol intoxication during sodium and fluid repletion versus depletion.

Nieminen MM.

Renin-aldosterone axis in acute moderate ethanol intoxication was studied in four healthy males during sodium depletion and during sodium and volume repletion. Ethanol (1.2 g/kg body wt) was taken orally in supine position at a steady rate for 90 min. In sodium-depleted subjects starting levels of plasma renin activity (PRA) and plasma aldosterone were increased as expected. During ethanol intoxication PRA rose further (p less than 0.001), whereas aldosterone showed a decreasing trend, albeit not significant. Thus, a dissociation between PRA and plasma aldosterone was noticed. Increased serum NA+/K+ ratio (p less than 0.02), or an inhibitory action of ethanol on aldosterone secretion, may explain the broken renin-aldosterone nexus. In the second experiment, the subjects were sodium replete. During ethanol intoxication, 1350-1420 ml isotonic NaCl was infused intravenously to compensate for fluid loss due to alcohol diuresis. In that experiment neither PRA nor plasma aldosterone showed significant changes. Thus, dehydration due to alcohol diuresis appears to be the main reason for increased PRA during ethanol intoxication. As in previous studies increased serum Na+/K+ ratio along with rising blood alcohol concentration was observed, independently of sodium and fluid balance.

PMID: 6360917 [PubMed - indexed for MEDLINE]

ETHANOL

Ethanol (ethyl alcohol, grain alcohol) is a clear, colorless liquid with a characteristic, agreeable odor. In dilute aqueous solution, it has a somewhat sweet flavor, but in more concentrated solutions it has a burning taste. Ethanol, CH3CH2OH, is an alcohol, a group of chemical compounds whose molecules contain a hydroxyl group, –OH, bonded to a carbon atom. The word alcohol derives from Arabic al-kuhul, which denotes a fine powder of antimony produced by distilling antimony and used as an eye makeup. Alcohol originally referred to any fine powder, but medieval alchemists later applied the term to the refined products of distillation, and this led to the current usage.

If you note in the first part of the abstract it says:

"Renin-aldosterone axis in acute moderate ethanol intoxication was studied in four healthy males during sodium depletion and during sodium and volume repletion. Ethanol (1.2 g/kg body wt) was taken orally in supine position at a steady rate for 90 min. In sodium-depleted subjects starting levels of plasma renin activity (PRA) and plasma aldosterone were increased as expected."

So if it causes the increased production of aldosterone in sodium depleted Individuals without CAH OR SWCAH, it makes you wonder what it can cause in SWCAH patients that are running low on sodium.  Since activiating that axis would cause salt loss and atleast  healthy individuals with healthy adrenal glands can make extra aldosterone.  In SWCAH they cannot.  To some extent thay can with just CAH. 

Maybe the key is to make sure you have plenty of sodium replacement before and after drink as well as drinking non-alcoholic drinks inbetween alcoholic ones (staggering them) and to drink in moderation?  I cannot find the sheet that I had with this regard, but the Doctors here did comment on the aldosterone Hypothalmic pituitary axis somewhere in it and related also that CAH’ers that drink too much may be more at risk to injury when drunk.  That is why I mention to drink in moderation and just on special occasions or not too frequently.  

After reading the above, I think I would be inclined to educate Ashley more around drink and most certainly if he were to indulge that he have his medica alert bracelet on and educate his friends about what they should do in an emergency.  However, since most kids tend to drink too much at times and get intoxicated, one has to question the fact that they may be too drunk to be concerned about your teen when out and if something did happen to them.  Very difficult one really as you want them to lead a normal life, but in reality there are just some things they will not be able to do the same as other healthy individuals without considering the consequences and acting wisely and doing things in moderation.