Alcohol

Question 1

What are the clinical features of alcoholic ketoacidosis?

Answer 1

• Metabolic acidosis
• Elevated ketones
• Low or normal glucose conc

Question 2

What is the treatment for alcoholic ketoacidosis

Answer 2

IV infusion of saline and thiamin (to prevent Wernicke’s/ Korsakoff)

Question 3

What is the physiological mechanism behind alcohol withdrawal ?

Answer 3

1. Alcohol consumption causes GABA stimulation (depressive effects) and glutamate inhibition (stimulating effects) –> drunk feeling
2. Chronic alcohol use leads brain to believe more GABA is being produced and less glutamate is produced
3. To restore balance of brain chemistry, brain produces less GABA and more glutamate
4. If alcohol consumption occurs suddenly, this causes stimulation +++ due to increased glutamate and reduced GABA production –> WITHDRAWAL EFFECTS

Question 4

What are the features of alcohol withdrawal?

Answer 4

6-12 hours: tremor, sweats, tachycardia, anxiety
36 hours: withdrawal seizures
49-72 hours: delirium tremens, coarse tremor, confusion, delusions, auditory and visual hallucinations, fever

Question 5

Management of alcohol withdrawal

Answer 5

Patients with history of severe withdrawal effects should be managed in an inpatient setting
1st line= Long acting benzos e.g. diazepam/ chlordiazepoxide (Lorazepam in hepatic failure)
Carbamazepine used in treatment of alcohol withdrawal

Question 6

What is the UK guidance for alcohol consumption?

Answer 6

14 units of alcohol per week for BOTH men and women
If drinking as much as 14 units, this should be spread over at least three day

Question 7

What is needed for a diagnosis of alcoholism?

Answer 7

3 or more needed from:
- compulsion to drink
- difficulty controlling alcohol consumption
- physiological withdrawal
- tolerance to alcohol
- neglect of alternative activities to drink
- persistent alcohol consumption despite harm

Question 8

What are the questions of the FAST questionnaire?

Answer 8

1. Men = how often have you had more than 8 drinks on one occasion?
   Women = how often have you had more than 6 drinks on one occasion?
2. How often have you been unable to remember last night’s events because of drinking?
3. How often have you failed to do what is expected due to drinking?
4. In the last year, has a relative, friend or doctor been concerned about your drinking?

Question 9

What are the questions for CAGE questionnaire?

Answer 9

C = Have you considered Cutting down?
A = Have you been Annoyed by people telling you to cut down?
G = Have you felt Guilty about your drinking?
E = Have you needed a drink to open your Eyes?

Question 10

How is SBP diagnosed?

Answer 10

Paracentesis - aspirate shows neutrophil count > 250

Question 11

How is SBP managed?

Answer 11

IV cefotaxime

Question 12

What are the clinical features of alcoholic hepatitis?

Answer 12

• Presents between age of 40-50
• Heavy alcohol intake
• Presenting sx= RUQ pain, anorexia, weight loss, jaundice
• AST:ALT ratio >2 (>3 is strongly suggestive)

Question 13

What are the investigation findings for alcoholic liver disease?

Answer 13

• Raised Gamma GT
• AST:ALT ratio >2

Question 14

What is the management for alcoholic hepatitis?

Answer 14

• Glucocorticoids (e.g. prednisolone)
• Pentoxyphylline (glucocorticoids are preferred)