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AIP: Acute confusional state > Alcohol intoxication/withdrawal > Flashcards

Alcohol intoxication/withdrawal Flashcards

1
Q

What are 4 ways that patients suffering from alcoholism may present?

A
  1. Acute intoxication
  2. Withdrawal syndromes
  3. Nutritional deficiency syndromes
  4. Chronic toxicity (liver, CNS, peripheral neuromyopathy etc.)
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2
Q

What are 6 ways that acute alcohol intoxication can present?

A
  1. Disinhibition
  2. Euphoria
  3. Incordination
  4. Ataxia
  5. Stupor
  6. Coma
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3
Q

How should a history be obtained in acute alcohol intoxication?

A

obtain history from friends or relatives

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4
Q

What are 3 things to look for on examination in acute alcohol intoxication?

A
  1. Signs of chronic liver disease
  2. Trauma
  3. Signs of infection
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5
Q

What are 7 complications of alcohol toxicity?

A
  1. Acute gastritis causing nause and vomiting, abdo pain, GI bleeding
  2. Respiratory depression and arrest, inhalation of vomit (with ARDS) and hypothermia may accompany profound sedation
  3. Hypoglycaemia
  4. Alcoholic ketoacidosis
  5. Accidental injury, particularly head injury (subdural)
  6. Rhabdomyolysis and ARF
  7. Infection (sepsis, meningitis)
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6
Q

What are 3 presentations of acute gastritis in acute alcohol toxicity?

A
  1. Nausea and vomiting
  2. Abdominal pain
  3. GI bleeding
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7
Q

What are 3 features which may accompany profound sedation in acute alcohol intoxication?

A
  1. Respiratory depression and arrest
  2. Inhalation of vomit (with ARDS)
  3. Hypothermia
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8
Q

Which type of injury should you be wary of in acute alcohol intoxication?

A

head injury → subdural haemorrhage

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9
Q

What is the usual management of mild to moderate alcohol intoxication?

A

usually no specific treatment; need for admission for rehydration and observation depends on inidividual

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10
Q

Which patients should always be admitted with acute alcohol intoxication?

A

admit all patients with stupor or coma

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11
Q

What does the A part of ABCDE assessment in acute alcohol intoxication involve?

A

check airway clear of vomitus and patient able to protect their airway

nurse in the recovery position

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12
Q

What is the guidance on gastric lavage or charcoal in acute alcohol intoxication?

A

not indicated

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13
Q

What are 7 blood tests to consider in acute alcohol intoxication?

A
  1. U+Es
  2. CPK (creatine kinase aka phosphokinase)
  3. Glucose
  4. Amylase
  5. Ethanl levels
  6. ABG (acidosis)
  7. Other drug overdose - consider
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14
Q

What are 4 effects of acute alcohol intoxication that you should monitor closely for when treating a patient?

A
  1. Respiratory depression
  2. Hypoxia
  3. Hypotension
  4. Withdrawal syndromes
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15
Q

What is the management of a comatose patient with hypoglycaemia?

A

25-50mL of 50% glucose followed by IVI of 10% glucose if necessary

ideally give bolus of thiamine 1-2 mg/kg IV before glucose

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16
Q

Why is a thiamine bolus ideally given before glucose is given in hypoglycaemia in acute alcohol intoxication?

A

in malnourished individuals, the glucose may precipitate Wernicke’s encephalopathy

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17
Q

In general what is the management of patients with severe alcohol intoxication?

A

rehydrate with IV fluids and monitor usrine output

rarely - haemodialysis if intoxication very severe or in presence of acidosis

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18
Q

What must you be careful of when rehydrating patients with acute alcohol intoxication with IV fluids?

A

avoid excessive saline if signs of chronic liver disease

19
Q

When is haemodialysis indicated in acute severe alcohol intoxication?

A

if very severe or presence of acidosis (rare)

20
Q

What should be arranged for a patient after recovery from an acute episode of acute alcohol intoxication?

A

psychiatric or medical assessment and follow-up and referral to an alcohol rehabilitation programme if appropriate

21
Q

What is thought to be the mechanism of alcohol withdrawal symptoms?

A
  • chronic alcohol consumption enhances GABA mediated inhibition in the CNS (similar to benzos) and inhibits NMDA-type glutamate receptors
  • withdrawal thought to lead to the opposite: decreased inhibitory GABA and increased NMDA glutamate transmission
22
Q

At what time frame do the symptoms of alcohol withdrawal typically start?

A

6-12 hours

23
Q

What are 4 initial symptoms of alcohol withdrawal?

A
  1. Tremor
  2. Sweating
  3. Tachycardia
  4. Anxiety
24
Q

What time is the peak incidence of seizures from alcohol withdrawal?

A

36 hours

25
Q

What time is the peak incidence of delirium tremens following alcohol withdrawal?

A

48-72 hours

26
Q

What are 8 features of delirium tremens?

A
  1. Coarse tremor
  2. Confusion
  3. Delusions
  4. Auditory and visual hallucinations
  5. Fever (/hyperthermia)
  6. Tachycardia
  7. Seizures
  8. Hypertension
27
Q

Which patients should be admitted to hospital to manage alcohol withdrawal? 7 indications

A
  1. Patients with a history of complex withdrawal from alcohol - delirium tremens, seizures, blackouts, or history of epilepsy (high risk for seizures)
  2. drinking >30 units per day
  3. Scoring over 30 on SADQ score
  4. Concurrent withdrawal from benzodiazepines
  5. Significant medical or psychiatric comorbidity
  6. Vulnerable patients
  7. Patients under 18
28
Q

What is the first line management of alcohol withdrawal?

A

long-acting benzodiazepines e.g. chlordiazepoxide or diazepam

29
Q

In patients with hepatic failure, which benzodiazepine may be best to manage alcohol withdrawal?

A

lorazepam

30
Q

What are 3 considerations of the psychosocial side of alcohol withdrawal?

A
  1. Associated health and psycho-social problems of patient
  2. Severity of alcohol misuse using e.g. AUDIT questionnaire and SADQ questionnaire
  3. Whether any risk to self or others
31
Q

What number of units of alcohol consumption per day usually requires assisted alcohol withdrawal?

A

>15 units per day

32
Q

What AUDIT score usually requires assisted alcohol withdrawal?

A

>20 on questionnaire

33
Q

What should chlordiazepoxide be prescribed for alcohol withdrawal in accordance with?

A

CIWA (Clinical Institute Withdrawal Assessment) score and local protocol

34
Q

What is the management of an alcohol withdrawal seizure?

A

rapid acting benzodiazepine (e.g. IV lorazepam)

35
Q

What is the management to prevent Wernicke’s encephalopathy?

A

Pabrinex: 1 pair of ampoules once daily to prevent

36
Q

What is the management to treat Wernicke’s encephalopathy?

A

2 pairs of ampoules TDS

37
Q

What are 4 signs of Wernicke’s encephalopathy?

A
  1. Confusion
  2. Ataxia
  3. Ophthalmoplegia
  4. Nystagmus
38
Q

What is first line treatment for delirium tremens (visual hallucinations and confusion 48-72h after last drink)?

A

oral lorazepam

IV if symptoms persist/patient declines

39
Q

What are 2 investigations to perform in Wernicke’s encephalopathy?

A
  1. Decreased red cell transketolase
  2. MRI
40
Q

What is the cause of Wernicke’s encephalopathy in alcoholics?

A

thiamine deficiency

41
Q

What are 3 additional causes of Wernicke’s encephalopathy?

A
  1. Persistent vomiting
  2. Stomach cancer
  3. Dietary deficiency
42
Q

What is the pathophysiology of Wernicke’s encephalopathy in the brain?

A

petechial haemorrhages occur in variety of structures in brain including mamillary bodies and ventricle walls

43
Q

What is the treatment of Wernicke’s encephalopathy?

A

urgent replacement of thiamine

44
Q

What is the relationship between Wernicke’s encephalopathy and Korsakoff’s syndromes?

A

if Wernicke’s is untreated, Korsakoff’s can develop which has the 2 additional features of:

  1. Amnesia (antero + retrograde)
  2. Confabulation

AIP: Acute confusional state (14 decks)

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