Acute alcohol withdrawal

Question 1

Describe alcohol withdrawal?

Answer 1

• Starts 10-72hrs after last drink
• Tachycardia, hypotension, tremor, confusion
• Delirium tremens (hallucinations)
  
  • Visual or tactile

Question 2

Describe the management of alcohol withdrawal?

Answer 2

• Benzodiazepines
  
  • Dizepam or lorazepam
  • Work out need using GMAWS
• Disulfiram - aversion therapy
• Baclofen - reduced cravings

Question 3

What medication can be used to treat Chronic alcohol dependence?

Answer 3

• Disulfiram
  
  • Causes acetaldeyhyde build up
  • Unpleasant side effects to alcohol consumption
    
    • Flushing, headache, palpitations
  • Even reacts with alcohol in toiletries and medicines

Question 4

How can unhealthy alcohol use be screened for?

Answer 4

• How many times int he past year have you had five or more drinks in a day?
• Then CAGE questions:
  
  • Ever felt like you should cut down your drinking?
  • Have people annoyed you by criticising your drinking?
  • Ever felt guilty about your drinking?
  • Ever had an eye-opener in the morning?
• >= 2 may be an indication of dependence

Question 5

What signs from biochemistry can indicate unhealthy alcohol abuse if the CAGE questions are not convincing?

Answer 5

• Raised γGT, ALT and MCV
• AST:ALT >2
• Low urea, platelets

Question 6

Describe the mechanism of alcohol withdrawal?

Answer 6

• Chronic alcohol consumption:
  
  • Enhances GABA mediated inhibition in the CNS
  • Inhibits NMDA-type glutamate receptors
• Alcohol withdrawal results in the opposite happening

Question 7

Describe the features of alcohol withdrawal?

Answer 7

• 6-12hrs: STAT tremor, sweating, tachycardia, anxiety
• 36hrs: peak seizure incidence
• 48-72hrs: peak delirium tremens incidence

Question 8

How many units are in a 750ml bottle of red wine with an alcohol by volume of 12%?

Answer 8

• 9 units
  
  • Alcohol units = volume (ml) x (ABV(%) / 1000)

Question 9

Why do people who drink excessive amounts of alcohol develop polyuria?

Answer 9

• Ethanol inhibits ADH secretion
  
  • ADH is produced by the hypothalamus
  • ADH is stored in the posterior pituitary

Question 10

Symptoms of alcohol withdrawal?

Answer 10

• Anxiety, panic, paranoid delusions
• Visual and auditory hallucinations

Question 11

Clinical signs of alcohol withdrawal?

Answer 11

• Agitation
• Delirium
• Tremor, tachycardia
• Seizures

Question 12

Peak incidence of delirium tremens following alcohol withdrawal?

Answer 12

72 hours

Question 13

Peak incidence of seizures following alcohol withdrawal?

Answer 13

36 hours

Question 14

Criteria for alcohol dependence?

Answer 14

• Narrowing of the drinking repertoire
• Piority of drinking over other activities
• Tolerance of the effects of alcohol
• Repeated withdrawal symptoms
• Subjective compulsion to drink
• Reinstatement of drinking behaviour after abstinence