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Question 1

what are the alcohol withdrawal syndromes

Answer 1

1. Uncomplicated alcohol withdrawal syndrome: N+V, coarse tremor, sweating, insomnia, tachycardia (>100), generalised anxiety, psychomotor agitation; OUTPATIENT
2. Complicated alcohol withdrawal syndrome (grand-mal seizures)
3. Delirium tremens

Question 2

Define delirium tremens

Answer 2

Acute confusional state secondary to alcohol withdrawal (good EXAM Q)

medical emergency

Question 3

Pathophysiology delirium tremens

Answer 3

When alcohol use ceases, the unregulated mechanisms result in hyper excitability of neurons as natural GABAergic systems are down regulated and excitatory glutamatergic systems are unregulated. This combined with increased noradrenergic activity results in the symptoms of delirium tremens

Question 4

CFs delirium tremens

Answer 4

the features of uncomplicated withdrawal (eg N+V, tachycardia)
o Clouding of consciousness, disorientation, amnesia for recent events, psychomotor agitation, visual/auditory/tactile hallucinations (Lilliputian hallucinations → seeing small people/animals/insects), fluctuations in severity
o Severe cases: heavy sweating, fear, paranoid delusions, agitation, suggestibility, raised temp., sudden CV collapse

Question 5

Rx delirium tremens

Answer 5

• INPATIENT
• Large dose BDZs to keep alive - they will be sedated (e.g. diazepam/lorazepam) → reducing regime
• Haloperidol (typical antipsychotic) for psychotic features
• IV Pabrinex (contains water soluble vitamins: inc. thiamine [B1]) – to prevent wernicke’s encephalopathy

Question 6

Wernicke’s encephalopathy - what is it

Answer 6

reversible acute encephalopathy due to thiamine deficiency

Question 7

Wernicke’s encephalopathy aetiology

Answer 7

• Alcoholism (poor intake)
• Anorexia nervosa
• Starvation
• Post-gastric resection

Question 8

Wernicke’s encephalopathy pathophysiology

Answer 8

Chronic alcohol consumption → Thiamine deficiency (B1)
o Decreased absorption GI tract
o Reduced intake
o Impaired thiamine utilisation by cells

Question 9

CFs Wernicke’s

Answer 9

TRIAD: Acute confusion (delirium), ataxia, nystagmus (PCP intoxication too)

Also: ophthalmoplegia [CN 6 palsy: paralysis of lateral gaze], hypothermia

Question 10

Rx Wernicke’s

Answer 10

Parenteral thiamine (IV Pabrinex)

Question 11

Korsakoff’s syndrome aetiology

Answer 11

Thiamine def. secondary to alcohol abuse

Question 12

Korsakoff’s syndrome pathophysiology

Answer 12

Neuronal degeneration secondary to thiamine deficiency

Question 13

Korsakoff’s syndrome CFs

Answer 13

Short-term memory loss, confabulation (unconscious filling of gaps in memory w/ imaginary events), disorientation to time, retrograde amnesia, inability to lay down new memories

Question 14

Korsakoff’s syndrome Rx

Answer 14

• Oral thiamine + vit supplementation (2yr)
• Rx psychiatric comorbidity
• Continuous assessment: OT + cognitive rehabilitation

Question 15

Korsakoff’s syndrome prognosis

Answer 15

• 20% complete recovery

* 50% improvement