Alcohol Emergencies Flashcards
1
Q
Management of withdrawal seizures
A
Benzo titration: ativan 2 mg IV first dose
2
Q
Stages of Alcohol withdrawal
A
Stage 1: tremulousness 6-12 o Hypersympathetic state o Self limiting Stage 2: hallucinosis ( 1-2 days) o Visual hallucinations most common Stage 3: withdrawal seizures 1-2 days o Usually occur 6-48 hours after last drink o 1-6 brief seizures o Treat with Ativan Stage 4: DTs ( 48-100 hours) - 48-100 hours after last drink - htn, tachy, dehydration, hallucinations, paranoid ideation, can be febrile -seizures, arryhthmia, aspiration, respiratory failure
3
Q
Treatment of alcohol withdrawal in ED
A
Treatment:
- ABC, NGT, IVF, benzo ( valium or Ativan)
- 10-20 PO valium or 5-10 IV, or 1 mg IV Ativan
- If severe agitation use halodol ( 5mg IV)
- 200 cc/hr D5NS
- Thiamine 100 mg IV push
- Consider co-morbid conditions
4
Q
Treatment of DT
A
- secure ABC
- IVF
- glucose
- thiamin
- aggressive Benzo ( 30/ hour of ativan )
- ICU
- monitor vital signs
5
Q
Wernicke Encephalopathy Criteria
A
Two of the following:
- dietary deficiencies
- cerebellar dysfunction
- oculomotor abdnormalities
- altered mental status or mild memory impairment
Classic triad:
- ataxia, ocular findings, altered mental status
6
Q
Less common symptoms of wernicke
A
- coma
- miosis
- hypothermia
- hypotension
- bradycardia
7
Q
5 high risk groups for wernicke
A
- chronic etoh
- anorexia
- hyperemesis
- malabsorption
- extreme malnutrition
8
Q
Treatment of wernicke
A
- if high suspicion or risk: thiamine 100 mg IV, then 100 mg IV daily for 3 days
- if true wernicke: may require 1000 mg IV day one plus mag and other nutrients
9
Q
80 percent of Wernick survivors develop…
A
Korsakoff
10
Q
AKA physiology
A
- develops in malnourished alcohol abusers especially binge drinkers
physiology: heavy etoh + little food= decreased insulin, glucagon goes up but impaired gluconeo bc alcohol. so lypoloysis break down and ketoacid production= nausea, vomiting, abdominal pain over 24-72 hours–> tachypnea and tachycardia
11
Q
Lab studies in AKA
A
- elevated anion gap
- low bicarb
- low ph
- borderline glucose
- alcohol low or not present
- hypo electrolytes
12
Q
Treatment of AKA
A
- hydrate, carbs
- replete vitamins
- give K and mag
- treat underlying cause ( pancreatitis, cns, sepsis, pneumonia, gi bleed)
- if ph falls once treatment has begin ITS NOT JUST AKA
13
Q
methanol origins and symptoms
A
- found in windshield cleaner, canned fules and distilling misadventures
- formic acid is what is the problem
- 8-30 hour latent period followed by abdominal pain, blurry vision, metabolic acidosis
- LARGE osmolar gap
14
Q
Treatment for methanol overdose
A
- reverse acidosis with bicarb
- 1 amp bicarb for each .1 ph unit below 7.35
- fomepizole ( blocks alcohol dehydrogenase) 15 mg/kg iv then 10 mg/kg IV Q 12 h or leukovorin
- Use alcohol if you can’t find anything else BAL up to 100-150
- enhance elimination if in renal failure with hemodialysis
- admit to ICU
15
Q
Ethylene glycol physiology and presentation
A
- metabolized to glycoaldehyde, acidosis, ca oxalate crystals in kidney, brain and liver
- presents similar to etoh intoxication, followed by seizures, stupor, coma
- AG acidosis, pulm edema
- crystals cause severe hypocalcemia
- tx same way as methanol overdose but ADD thiamine and pyridoxine to reduce oxalic acid production
