Alcohol Flashcards
What does alcohol dependence involve
- Daily consumtpion
- Strong urges and cravings to drink
- difficulty controlling consumption
- Tolerance to side effects
- Withdrawal when stopping
What is alcohol’s mechanism of action
- Stimulates GABA receptors (relaxant)
- Inhibits NMDA glutamate receptors (excitatory)
Therefore alcohol = depressant
Uk recommendations for consumption
- 14 units/week
- Spready evenly over 3+ days
- No more than 5 units in a single day
Definition of binge drinking
- 6 units for women
- 8 units for men
In a single session
Alcohol in ealry pregnancy can lead to
- Miscarriage
- Small for dates
- Preterm delivery
- FAS
Complications of alcohol excess (9)
- Alcohol related liver disease
- Cirrhosis
- Alcohol dependence
- Wernicke-Korsakoff
- Pancreatitis
- Alcoholic cardiomoypathy
- Alcoholic proximal myopathy
- CVD
- Cancer (breast, mouth, throat, hepatocellular)
When is an AUDIT used
- Alcohol Use Disorders Identification Test
- Screens for harmful alcohol use
- Harmful use with scores of 8+
What can be used to screen for harmful alcohol use in a history?
* C – CUT DOWN? Do you ever think you should cut down?
** A – ANNOYED? **Do you get annoyed at others commenting on your drinking?
** G – GUILTY? **Do you ever feel guilty about drinking?
*** E – EYE OPENER? **Do you ever drink in the morning to help your hangover or nerves?
Examination findings indicating excessive alcohol use include
- Smelling of alcohol
- Bloodshot eyes
- Slurred speech
- Dilated capillaries on the face (telangiectasia)
- Tremor
Blood test results that may occur with alcohol excess
- Raised mean corpuscular volume (MCV)
- Raised alanine transaminase (ALT) and aspartate transferase (AST)
- AST:ALT ratio above 1.5 particularly suggests alcohol-related liver disease
- Raised gamma-glutamyl transferase (gamma-GT) (particularly notable with alcohol-related liver disease)
Timeline of withdrawal symptoms
-
6-12 hours: tremor, sweating, headache, craving and anxiety
** 12-24 hours: **hallucinations
** 24-48 hours: seizures
** 24-72 hours: delirium tremens
Mortality of delirium tremens if untreated
35%
How does delirium tremens present (9)
ASD TT HH AA
§* Acute confusion
* Severe agitation
* Delusions and hallucinations
* Tremor
* Tachycardia
* Hypertension
* Hyperthermia
* Ataxia (difficulties with coordinated movements)
* Arrhythmias
What hallucinations may be seen in DT
Visual or tactile (e.g., formication – the sensation of crawling insects on or under the skin)
Patient presents with DT, what investigations are you ordering?
- B12, Folate, Thyroid Function
- Infection screen: Chest Xray, Urine dip, Blood Cultures
- CT Head
- Lumbar Puncture if meningitis or encephalitis are suspected
Acute management of DT
- Oral lorazepam
- If declined, parenteral lorazepam or haloperidol
- Proceed to long term management
Long term/maintenance management of alcohol
- Administer Chlordiazepoxide. Eventually this can be tapered according to Clinical Institute Withdrawal Assessment for Alcohol **(CIWA) **scoring
- Ensure adequate hydration with fluids
- Provide anti-emetics to manage nausea
- Pabrinex to replenish vitamins
- Refer the patient to local drug and alcohol liaison teams for further support and management
What is in pabrinex
High dose B1 (thiamine), other B vitamins and vitamin C
Oral thiamine given long term to prevent Wernickes
What can be done to help maintain abstinence
- Oral thiamine
- Psychological therapy (CBT)
- Acamprosate, naltrexone, disulfram
- Inform DVLA
Driving license revoked until extended period of abstinence
Features of Wernicke’s
- Ataxia
- Confusion
- Oculomotor disturbance
Feature of Korsakoff
- Antero/retrograde amneisa
- Behavioural changes
- Confabulations
Often irreversible and results in needing full time care
