Alcohol Emergencies Flashcards
Management of withdrawal seizures
Benzo titration: ativan 2 mg IV first dose
Stages of Alcohol withdrawal
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
Treatment of alcohol withdrawal in ED
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
Treatment of DT
- secure ABC
- IVF
- glucose
- thiamin
- aggressive Benzo ( 30/ hour of ativan )
- ICU
- monitor vital signs
Wernicke Encephalopathy Criteria
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
Less common symptoms of wernicke
- coma
- miosis
- hypothermia
- hypotension
- bradycardia
5 high risk groups for wernicke
- chronic etoh
- anorexia
- hyperemesis
- malabsorption
- extreme malnutrition
Treatment of wernicke
- 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
80 percent of Wernick survivors develop…
Korsakoff
AKA physiology
- 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
Lab studies in AKA
- elevated anion gap
- low bicarb
- low ph
- borderline glucose
- alcohol low or not present
- hypo electrolytes
Treatment of AKA
- 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
methanol origins and symptoms
- 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
Treatment for methanol overdose
- 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
Ethylene glycol physiology and presentation
- 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
isopropanol ingestion symptoms and presentation
ketosis w/out acidosis
- twice as drunk
- no anion gap
- osmolar gap
- positive serum acetone
Holiday heart syndrome
- afib/ aflutter
2. may be early finding of alcohol cardiomyopathy