DESCRIPTION OF BILIRUBIN CONDITION CHECKING ON ALCOHOL CONSUMER IN EAST POHUWATO VILLAGE, POHUWATO DISTRICT

Fransiskawati Polangitan1), Dede Sutriono2), and Natan Pasiga3) 1,2) Bina Mandiri University of 3) Puskesmas Suwawa E-mail: [email protected]

ABSTRACT Based on 2014 WHO data, 61.7% of the world's population has consumed alcohol for more than 12 months which has caused around 3.3 million deaths or 5.9% of all deaths worldwide. For the 2018 RISKESDAS data in , the first highest alcohol consumption area is North Sulawesi 16%, followed by East Nusa Tenggara 15.6, then Bali area 14%, and for Gorontalo area 11.3%. The purpose of this study was to determine the description of bilirubin levels in alcohol consumers in Pohuwato Timur Village, Pohuwato Regency including the length of time of consumption, age, types of drinks frequently consumed, frequency of alcohol consumption, and frequency of the amount of alcohol in one drink. This research uses descriptive research which is quantitative in nature. The population in the study was 55 samples with a sample size of 36 respondents who used the sampling technique, namely simple random sampling. The results showed that of the 36 respondents where the normal bilirubin levels were 14 respondents or if the percentage was 39%, while for the abnormal or high bilirubin levels there were 22 respondents or if the percentage was 61%. Based on the results obtained, it can be concluded that the results of the examination of bilirubin levels in alcohol consumers in Pohuwato Timur Village, Pohuwato Regency are more dominant with abnormal or high levels compared to normal bilirubin levels. Keywords: Alcohol, liver, bilirubin levels

INTRODUCTION important role in measuring the degree of Success. implementation. health is public health. The indicators used in very much determined by the continuity assessing the health status of a community between program and sector efforts, as are the morbidity and mortality rates [9]. well as the continuity with the efforts that Illness can arise from several habits, have been implemented by the previous one of which is the habit of the government. Health development efforts community in consuming alcoholic in Indonesia need to be carried out in an beverages which are often considered integrated manner so that existing normal. Alcohol is a liquid that is clear in resources can be utilized effectively and color and contains ether in the form of efficiently [9]. liquid or liquefied through the Disease control is an effort to reduce fermentation process. Commonly the incidence, prevalence, morbidity or consumed alcohol is also known as ethyl mortality of a disease which plays an alcohol (ethanol) [11].

28 Overview of Testing Bilirubin Levels in Alcohol Consumers in the village of East Pohuwato, Pohuwato Regency

Liquor has long been recognized Data in Indonesia for the highest among the public and has become a alcohol consuming region is North common problem around the world. As Sulawesi at 16%, followed by East Nusa many as 61.7% of the population Tenggara (NTT) 15.6%, then Bali area worldwide has consumed alcohol for more 14%, and for the Gorontalo area as much than 12 months which causes as 11.3% [14]. approximately 3.3 million deaths or 5.9% Data on alcohol consumption in of all deaths worldwide [22]. Gorontalo Province for the first regency in World alcohol consumption is alcohol consumption per liter in 1 year, equivalent to 6.2 liters of pure alcohol namely at 148.52 / consumed per person aged 15 years or liter, in the second position Gorontalo over which means 13.5 grams of pure Regency at 118.77 / liter, then Bone alcohol per day. A quarter of this Bolango Regency at 98.4 / liter, after that, consumption (24.8%) unrecorded is Pohuwato Regency was 88.93 / liter, then homemade alcohol and is produced or North was 80.58 / sold illegally outside government control. liter, and finally Gorontalo City was 16.25 Of the total recorded alcohol consumed / liter [1]. throughout the world, namely amounting According to the results of direct to 50.1% [21]. observations made by researchers on the More than 3 million people habit of consuming alcohol in the worldwide die from drinking alcohol and community in Pohuwato Timur Village, the largest number of victims occurs in Pohuwato Regency, it was found that Europe. This is due to a lack of public there were three residents who awareness about the dangers of experienced several disorders of body consuming alcohol. On average, every function after several years of consuming person in the world aged 15 or over alcohol. Where the malfunctioning of the consumes 6.2 liters of pure alcohol per body includes damage to lung function day. About 16% of drinkers in the world and the presence of symptoms of damage engage in heavy episodic drinking or often to liver function, namely having referred to as binge drinking and this is experienced symptoms of jaundice or the most dangerous for health, especially where the body and eyes are yellowish. for the liver which functions to filter the Dependence on alcohol consumption entry of foreign substances or toxins in the is very dangerous for the health of the body [20]. human body, one of which is harmful to Data from 241,000,000 people in the health of the liver. The liver is the Indonesia, the prevalence of disorders due largest and most metabolically complex to alcohol use is 0.8% and the prevalence organ in the body. The liver itself is of alcohol dependence is 0.7% in both involved in the metabolism of food men and women. When viewed from the substances, as well as most drugs and percentage, the prevalence of disorders toxins. The liver has the main task of due to alcohol use and the prevalence of neutralizing toxins in the body, making alcohol dependence is very small. the toxins that have been entering our However, if this figure is multiplied by the bodies from food or the environment able total population of Indonesia, as many as to be neutralized by the liver. There are 1,928,000 Indonesians suffer from alcohol many factors that can cause liver damage, use disorders and 1,180,900 Indonesians such as viruses, bacteria, toxicity from experience alcohol dependence [22]. drugs and chemicals and excessive alcohol consumption [6].

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Bilirubin examination is one of the does not meet exclusion criteria that parameters of laboratory tests, where this isrespondents who are not willing to have examination functions to detect damage to their blood samples taken, respondents liver function and bile ducts. For damage cannot communicate well, alcohol to liver function, several diseases can consumers who are not in Pohuwato occur, including hemolytic anemia, liver Timur Village, Marisa District, Gorontalo cirrhosis, hepatitis, and hepatitis City, alcohol consumers who are rarely or carcinoma, where if some of these no longer consume it, and alcohol diseases occur it will be marked by consumers who are not aged 21- 60 years. increased levels of bilirubin in the body. The sample size is 36 samples determined So if the liver and bile function are in by the Slovin formula. The sampling good condition, the bilirubin levels in the technique is Simple Random Sampling. body are also normal [5]. The technique of data analysis is Based on the description and research univariate analysis and data presentation above, the researchers are interested in is the frequency distribution table [10]. conducting research on the description of checking bilirubin levels in alcohol RESEARCH RESULT consumers in Pohuwato Timur Village, This study aims to determine the Pohuwato Regency. Where the purpose of description of bilirubin levels in alcohol this study is to determine the description consumers in Pohuwato Timur Village, of bilirubin levels in alcohol consumers in Pohuwato Regency and based on East Pohuwato village with several factors respondent characteristics such as age, such as age, duration of alcohol duration of alcohol consumption, type of consumption, type of drink, alcohol alcohol drink, alcohol consumption in a consumption in a week, and the amount of week, and the amount of alcohol at one alcohol in one drink. time. Table 1. RESEARCH METHODS Distribution of Bilirubin Levels by Age This research uses descriptive research with a quantitative approach [15]and a cross sectional research design [13]. The sampling location was in Pohuwato Timur Village, Pohuwato Regency and examination of serum bilirubin samples at Bumi Panua Pohuwato Hospital. The research was carried out on 23-29 October 2020. The sample in this study was alcohol consumers in Pohuwato Timur Village, Source: Primary Data, 2020 Pohuwato Regency. The sample met the Based on table 1, it shows that the inclusion criteria, namelyrespondents are abnormal bilirubin level is higher at the willing to have blood samples taken, can age of 22-41 years, which is as much as communicate well, are alcohol consumers 50% compared to the age of 22-41 years who are in Pohuwato Timur Village, which is as much as 11%. Marisa District, Gorontalo City, alcohol consumers who up to now still frequently Table 2. consume alcohol, and alcohol consumers Distribution of Bilirubin Levels Based on who are 21-60 years old andthe sample Duration of Alcohol Consumption

30 Overview of Testing Bilirubin Levels in Alcohol Consumers in the village of East Pohuwato, Pohuwato Regency

Source: Primary Data, 2020 Based on table 4, it shows that abnormal bilirubin levels are more in Source: Primary Data, 2020 alcohol consumption in a week, namely 2- Based on table 2, it shows that the 3 times as much as 47% compared to abnormal bilirubin level is higher in the 2- alcohol consumption in a week every day year consumption period, which is 55% as much as 6% and 4-5 times as much as compared to the normal bilirubin level for 8%. alcohol consumption> 6 months and 1 Table 5. year, i.e. there is no abnormal bilirubin Frequency Distribution of Bilirubin Levels level. Based on the Amount of Alcohol One Table 3. Drink Distribution of Bilirubin Levels by Type of Drink

Source: Primary Data, 2020 Based on table 5, it shows that the Source: Primary Data, 2020 abnormal bilirubin level is more in the Based on table 3, it shows that the amount of alcohol at one time, namely 4-6 abnormal bilirubin level is more in the glasses as much as 39% compared to the type of rat stamp drink, namely as much amount of alcohol once drinking 2-3 as 53% compared to the type of beer glasses as much as 19% and those> 6 drink, which is as much as 8%. glasses as much as 6%.

Table 4. Table 6. Distribution of Bilirubin Levels Based on Distribution of Bilirubin Level Weekly Alcohol Consumption Examination in Alcohol Consumers

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changes occur both physically and biologically. These changes will affect the absorption process in the body. At a young age, namely the age of 18 years and over is the productive age. The human body is still in a period of increased Source: Primary Data, 2020 metabolism this is due to the fact that the Based on table 6, it shows that the body experiences significant growth bilirubin level is more at the abnormal which is influenced by one's physiological bilirubin level as much as 61% compared condition. As you get older, at the to the normal bilirubin level as much as beginning of the age of 30 years the 39%. amount of muscle will begin to decrease and the body's ability to metabolize the DISCUSSION body will decrease and at the age of 40 the Alcohol is a psychoactive substance body's metabolism will continue to with addiction-producing properties that decline. So it can be explained that age have been widely used in many cultures and the body's defense system can be the for centuries. Harmful use of alcohol can reasons for the abnormal bilirubin levels cause many diseases. Alcohol-related in the respondents in this study. harm is determined by the volume of Based on the age distribution, the first alcohol consumed, drinking patterns, and started from the age range 22-41 years the level of alcohol consumed [20]. where the abnormal level was more Alcohol metabolism is processed in dominant, namely 50%. This is because in the liver. Where if the concentration of that age range a person begins to consume alcohol consumed is still within normal alcohol frequently, and is supported by limits, it will not significantly affect liver strenuous activities, where the majority of damage. But if the concentration of the men in Pohuwato Timur Village work alcohol consumed has exceeded the as fishermen. So that the habit of normal limit or is excessive, it will affect frequently consuming alcohol in excess liver function damage, one of which can can cause damage to the liver, one of affect the increase in bilirubin levels in the which is an increase in bilirubin levels in liver. the liver. Then for the age range 42-60 Liver damage can cause several liver years, the abnormal bilirubin level was diseases, one of which is liver cirrhosis. 11%. This means that for this age group Where the disease is 50% caused by long- less than the first age group. This is term effects in the abuse of alcohol caused by the age factor itself. Where at consumption. To be able to detect liver that age is susceptible to disease and the cirrhosis, liver function tests can be done, immune system at that age range begins to one of which is checking the bilirubin decline. Then in that age range there was levels. also some decline in organ function, one of which was the liver. So if at that age the liver is often exposed to alcohol, it Characteristics of Respondents by Age The human body is equipped with a will further aggravate the physiological set of defense systems and in response to condition of a person [11]. free radicals, the liver can regenerate itself Characteristics of Respondents Based but the ability to regenerate is greatly on Duration of Alcohol Consumption influenced by age [15]. Increasing age Chronic alcohol consumption of 90g affects metabolism in the body so that of alcohol per day for 5 years or more in

32 Overview of Testing Bilirubin Levels in Alcohol Consumers in the village of East Pohuwato, Pohuwato Regency humans can result in pathological changes Respoden Characteristics Based on and diseases in several organ systems such Alcohol Consumption in a Week as liver, heart and pancreas, pathological Excessive intake of alcohol and for a changes observed are fibrosis and long time will cause an increase in cardiopathy due to alcohol poisoning [17]. bilirubin levels, this is because alcohol Based on the distribution of the will stimulate more microsomal enzymes duration of alcohol consumption, the to be produced. Microsomal enzymes are abnormal bilirubin level was higher in the 5 enzymes that play a role in the 2-year consumption period, namely as metabolism of drugs and other toxic much as 55%. Then for the duration of substances such as alcohol [7]. alcohol consumption> 6 months and 1 For alcohol consumption in a week year there were no abnormal bilirubin where the abnormal bilirubin level is more levels. in consumption 2-3 times a week, namely 47%. Then the abnormal bilirubin level in Characteristics of Respondents by Type alcohol consumption every day of the of Drink The ethanol that is consumed will be week was 6% and that for 4-5 times a absorbed by the stomach as much as 20% week was 8%. and the intestine as much as 80% which Respondents' Consumption Based on will then undergo metabolism in the liver. the Amount of Alcohol One Drink The concentration of ethanol present in The consumption of alcohol in low the blood determines the speed of the amounts will be broken down by the metabolic processes in the liver that enzyme alcohol dehydrogenase into produce astaldehyde. Acetaldehyde that acetaldehyde (almost 95% of ethanol in accumulates in the liver will cause the body will be oxidized to acetaldehyde damage to the liver, specifically damage and acetate, while the remaining 5% will to hepatocytes (hepatic cells) because be excreted with urine). However, if large acetaldehyde is a very reactive free amounts of alcohol are consumed, the radical. This means that the greater the dehydrogenase enzyme is not sufficient to concentration or alcohol content, the more metabolize all of the alcohol into it will affect the metabolic processes in acetaldehyde. Therefore, the greater the the liver and can cause damage to the liver volume of alcohol consumed will cause [16]. hepatocyte damage caused by the toxicity For the types of drinks that are often of alcohol metabolism end products such consumed, the first type of beer is the type as acetaldehyde which will accumulate so of beer where the abnormal bilirubin level that it triggers the enzyme microcosomal is 8% and the alcohol content of this type ethanol system (MEOS) to metabolize of beer is included in group A where the acetaldehyde [4]. levels start from 1-5%. Then the second For abnormal bilirubin levels in the type of drink that is often consumed is rat amount of alcohol one drink, between 4-6 stamp, where the abnormal bilirubin level glasses is more dominant, which is 58%. is more dominant, which is 53%. The Then for abnormal bilirubin levels in the alcohol content of stamp rat drinks is amount of alcohol one drink between 2-3 around 45% or is included in class C and glasses as much as 36% and those> 6 the highest group so that the stamp rat glasses as much as 6%. drink affects bilirubin levels more because Variable Bilirubin Levels in Alcohol its levels are higher than that of beer [18]. Consumers

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Alcohol is a liquid that is clear in only a little if exposure to alcohol in the color and contains ether in the form of body is only a little too. Then there will be liquid or liquefied through the an increase in metabolic rate if the level of fermentation process. Commonly alcohol in the blood increases at a consumed alcohol is also known as ethyl moderate level, the maximum is 7-10 alcohol (ethanol) [10]. grams / hour or the equivalent of one Dependence on consuming alcohol is drink in one hour. The second stage of very dangerous for the health of the acetaldehyde is converted into acetate by human body, one of which is harmful to the enzyme aldehyde dehydrogenase. the health of the liver. The liver is the Acetaldehyde itself is normal in its normal largest and most metabolically complex state of metabolism and takes place organ in the body. The liver itself is quickly. But if large amounts of alcohol involved in the metabolism of food are consumed, this acetaldehyde will substances, as well as most drugs and cause symptoms such as headaches, toxins. The liver has the main task of gastritis, nausea, and dizziness. The third neutralizing toxins in the body, making stage or the final stage, wherein the the toxins that have been entering our acetate group is converted into fat or bodies from food or the environment able carbon dioxide and water. For chronic to be neutralized by the liver. There are alcohol consumption, fat accumulation many factors that can cause liver damage, may occur. Accumulation of fat will cause such as viruses, bacteria, toxicity from plugs in the capillaries surrounding the drugs and chemicals and excessive liver cells and can lead to cirrhosis of the alcohol consumption [6]. liver. After that, scar tissue forms in the Bilirubin examination is one of the liver which will cause blockage of parameters of laboratory tests, where this bilirubin in the bile (excretion process), so examination functions to detect damage to that the bilirubin again spreads to the liver function and bile ducts. For damage blood vessels and causes bilirubin to to liver function, several diseases can increase in the blood [5]. occur, including hemolytic anemia, liver Based on the results of research that cirrhosis, hepatitis, and hepatitis has been carried out on the description of carcinoma, where if some of these bilirubin levels in alcohol consumers with diseases occur it will be marked by a number of respondents as many as 36 increased levels of bilirubin in the body. people, the results are more dominant than So if the liver and bile function are in normal. For the results of abnormal good condition, the bilirubin levels in the bilirubin levels, there were 22 respondents body are also normal [5]. or 61% if a percentage was obtained. Alcoholic Fatty Liveris a disease that Meanwhile, normal bilirubin levels are 14 is reversible in which about 5-12% of or 39% if a percentage. people who consume heavy alcohol The results of bilirubin levels which experience this liver disease. Then if left were more dominant at high levels were untreated, it will develop into alcoholic also supported based on the length of time hepatitis to become cystic and liver failure consuming alcohol, the frequency of [8]. drinking during the week, the The primary metabolic process for consumption habits of most of the alcohol occurs in the liver through three respondents who consumed rat stamped stages. Where the initial stage starts from alcohol with a level of 45% where the the alcohol dehydrogenase (ADH) enzyme level was included in the highest category to oxidize alcohol and for this enzyme

34 Overview of Testing Bilirubin Levels in Alcohol Consumers in the village of East Pohuwato, Pohuwato Regency group C. Alcohol consumption for more [1]. Gorontalo Province Central Bureau of than a year can affect liver function [2]. Statistics. 2019. National Socio- The consumption habits of most of Economic Survey 2019. Gorontalo. the respondents who consume rat stamp [2]. ConrengD BJ, Waleleng, and S Palar. type alcohol with a level of 45% where 2014. Relationship between Alcohol the level is included in the highest Consumption and Impaired Liver category or group C, so that it can affect Function in Young Adult Male liver function and result in most of the Subjects in Tateli Village and Tering respondent’s high bilirubin levels. Atas. North Sulawesi. Consumption of alcohol with types of tuak [3] Djuma WA and Kapa WY 2017. which are included in class B and arak in Comparison of Directed Bilirubin class C can cause chronic liver disease, Levels for Alcohol Consumers and one of which is cirrhosis of the liver [6]. Non-Alcohol Consumers. Health The results of this study are also analyst. Poltekkes Kemenkes supported by the results of previous Kupang. Vol 15, No.2, December research conducted by Djuma and Kapa 2017, pp. 428-434 P-ISSN 0216- (2017) that the results of their study 504X, E-ISSN 2620-536X. regarding the comparison of direct [4]. Ekawati. 2017. Description of Serum bilirubin levels in alcoholic users and Glutamate Oxaloacetic Transaminase those who do not consume alcohol (SGOT) and Serum Glutamate showed that direct bilirubin levels in the Pirufate Transaminase (SGPT) in alcohol consuming group were alcohol drinkers in the Karang Pule significantly different from the non- Environment, Karang Pule Village, consuming group. alcohol. Where the Mataram. Medica Farma Husada average result of direct examination of Mataram Journal, Vol 3 No. 1 bilirubin levels in alcohol consumers is Mataram. 0.2230 mg / dL and those who do not [5] Fadhilah F, Ana BS, Fajar M. 2019. consume alcohol are 0.1450 mg / dL with The Effect of Long Exposure on Total a P value <0.05. These results indicate Bilirubin Levels in the Diazo that there is a significant difference in Colorimetric Method. Health analyst. direct bilirubin levels between the case Bakti Asih College of Analysts, and control groups. Bandung. Journal of Clinical Health Analyst Science 7 (1) (2019). CONCLUSION [6]. Mastra N PDTD Ribs, Merta Based on the research that has been WI2016. Serum Glutamate Pyruvat done, it can be concluded that the results Transaminase Levels of Liquor of the examination of bilirubin levels on Addicts Payed by Ambengan Desa alcohol consumers in Pohuwato Timur Sayan Ubud, Gianyar. Meditory Village, Pohuwato Regency are more Journal 4 (2): 82-93. dominant in abnormal bilirubin levels than [7]. Joyce, LK 2014. Laboratory normal bilirubin levels. Where the Examination Guidelines, 9. EGC. abnormal bilirubin levels were 61% and Jakarta. normal bilirubin levels were 39%. [8] Katzung BG, Masters SB, and Trevor AJ2014. Basic & clinical pharmacology. 12th edition. ECG. Jakarta. [9]. Ministry of Health of the Republic of REFERENCES Indonesia. 2018. Indonesian Health

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