Alcohol Flashcards
Alcohol intoxication (A, B, C 6, D)
A. Recent use of alcohol B. Problem behaviour/psychological disturbances develop shortly after ingestion C. Presence of one or more a. Slurred speech b. Incoordination c. Nystagmus d. Unsteady gait e. Impaired attention f. Coma/stupor D. Not due to other substance/other medical condition
Alcohol withdrawal (A, B 8, C, D)
A. Cessation of heavy alcohol use B. Presence of two or more a. Autonomic hyper-reactivity b. Hand tremor c. Nausea/vomiting d. Insomnia e. Auditory/tactile hallucinations f. Psychomotor agitation g. Anxiety h. Tonic-clonic seizures C. Cause clinically significant impairment D. Not due to other substance/medical condition
Social complications of alcohol use
Love Livelihood Law Homelessness Financial Absenteeism, poor work performance
Nervous system complications
Alcohol intoxication/withdrawal Dementia Cerebellar degeneration Hemorrhagic stroke Neuropathy Wernickes/Korsakoffs
Gastrointestinal complications
Gastritis/ulcers
Hepatitis/Chronic liver
Chronic/acute pancreatitis
Cancer: oro/larynx, esophageal, hepatic
Cardiovascular system complications
Hypertension
IHD
Arrythmias
Cardiomyopathy
Metabolic/endocrine complications
Hypoglycemia
Hyponatremia
Hyperlipids/TAG
Hypomagnesium
Hematological complications
Red cell macrocytosis
Anaemia
Neutropenia
Thrombocytopenia
MSK, reproductive and other complications
Acute/chronic myopathy Osteoporosis IUGR/FAS Impotence, erectile dysfunction Trauma, fracture, violence
Wernicke’s triad
Delirium
Opthalmoplegia
Ataxia
Etiology / risk factors of alcohol dependance
Genetic
+With family history
Positive reinforcement
Negative reinforcement
Modelling behaviour
Psychiatric illness coexisting
Antisocial and borderline + risk->attempts to self medicate, maladaptive coping, lack support, impulsivity
Social and cultural factors influincing acceptability
Particular occupation, unskilled and unemployed
General assessment
General Assessment
• When was your last drink?
• Do you have to drink more to get the same effect?
• Do you get shaky or nauseous when you stop drinking?
• Have you ever had a withdrawal seizure?
• How much time and effort do you put into obtaining alcohol?
• Has your drinking affected your ability to work, go to school, or have relationships?
• Have you suffered any legal consequences?
• Has your drinking caused any medical problems?
Stages of alcohol withdrawal
stage 1 (onset 12-18 h after last drink): “the shakes” tremor, sweating, agitation, anorexia,
cramps, diarrhea, sleep disturbance
stage 2 (onset 7-38 h): alcohol withdrawal seizures, usually tonic-clonic, nonfocal and brief
stage 3 (onset 48 h): visual, auditory, olfactory or tactile hallucinations
stage 4 (onset 3-5 d): delirium tremens, confusion, delusions, hallucinations, agitation,
tremors, autonomic hyperactivity (fever, tachycardia, hypertension)
Investigations in withdrawal
None required for diagnosis
FBC, UEC, LFTs, glucose->to exclude hypoglycemia, electrolyte, infections associated with alcohol abuse.
CT/CXR may be used to exclude infection, bleeding that may mimic alcohol withdrawal
Management of withdrawal
Supportive care: information, monitoring, reassurance, low stimulus, fluids/nutrition
Consider admission->cute, high risk of seizures, delirium tremens, smoking (use nicotine replacement)
If medication required
1. diazepam 20 mg orally, every 2 hours until symptoms subside, usually 60 mg required. Should not go >100mg, or for >3-5 days
AND
1. Before glucose, thiamine 300 mg IM or IV, daily for 3 to 5 days then thiamine 300 mg orally, daily for several weeks
If antipsychotic required
- Haloperidol 0.5-2mg PO, every 2 hours (max 10mg/day
- Benztropine 1-2mg PO if EPSE