Alcohol related illness Flashcards
Define substance dependence?
Physical and psychological effects produced by the habitual taking of a drug
Characterised by a compulsion to continue taking the drug
Withdrawal occurs if they stop taking it
Define substance abuse?
Using a substance in excess, causing significant harm (physical, emotional, financial, career, relationships)
Not necessarily dependent
What is meant by dual diagnosis?
When a person has a mental illness alongside a substance abuse problem.
Usually depression
People with dual diagnosis do better than people who only have mental health problems. True or false? Why?
False.
People with dual diagnosis are more likely to be admitted to hospital and to self-harm and commit suicide
How many units a week can we have? How many glasses of wine or pints is that?
14 units
6 small glasses of wine or 6 pints
How do you calculate units?
(Strength (%) x volume(ml) )/1000 = units
How many units are in a 75cl bottle of 13.5% wine?
(13.5x 750) / 1000
= 10.1 units
How many units are in a 750ml bottle of 45% vodka?
(45x 750) / 1000
= 33.8 units
List the 7 phenomena associated with alcohol dependence?
- Primacy: alcohol is the most important thing in their life
- Tolerance: need more alcohol each time to get to same level of satisfaction
- Withdrawal: physical or mental symptoms happen when they don’t drink
- Relief drinking: drinking to calm down when stressed
- Narrowing of repertoire: drinking same things everyday
- Set drinking pattern: drinking at same times, places, situations
- Restarting after abstinence
What is a common alcohol misuse screening tool?
CAGE
Cutting down
Angry when others criticise drinking
Guilty about drinking
Eye opener in the morning
Also AUDIT
What are the stages of damage alcohol does to the liver?
At what stage does damage become irreversible?
- Fatty liver
- Hepatitis
- Cirrhosis
Once gets to cirrhosis becomes irreversible
Symptoms of cirrhosis?
Fatigue Malaise Weight loss Itching Palmar erythema Ascites Jaundice Cognitive problems
Which LFT is the best for detecting alcoholic liver disease? Why?
Gamma GT
It is the main enzyme involved in alcohol metabolism
Function of the liver?
Storing glycogen Processing fats Making proteins and clotting factors Metabolising drugs Removing poisons and toxins from blood
Describe the symptoms of uncomplicated alcohol withdrawal?
Do they need hospital admission?
Coarse tremor Sweating Headache Palpitations Nausea, vomiting Anxiety, agitation Insomnia
No, only if complications occur or mental health issues causing risk
Do hallucinations occur in uncomplicated alcohol withdrawal?
Occasionally, but not very common!
In uncomplicated alcohol withdrawal:
- How long after stopping drinking symptoms occur?
- When do symptoms peak?
- How long do they last?
- 4-12 hours after last drink
- peak at 48 hours
- usually last 2-5 days
What is delirium tremens?
Acute confusional state secondary to alcohol withdrawal
It is a medical emergency as can cause death
In delirium tremens:
How long after stopping drinking before symptoms occur?
When do symptoms usually peak?
1-7 days after last drink
48 hours after last drink
Which patients are at an increased risk of delirium tremens?
If severe dependence
Infection
Liver damage
Clinical features of delirium tremens?
Withdrawal symptoms PLUS altered mental state
Hallucinations (usually visual, Lilliputian) Confusion Delusions Severe agitation Seizures Tachycardia, fever, high BP
Why do patients with delirium tremens get tachycardia and raised BP?
Their CNS has been supressed for a long time while they have been drinking. When they stop, CNS goes into overdrive.
Why does delirium tremens cause death? How often does it cause death?
It is due to the CNS going into overdrive.
5-10% motality
Management of delirium tremens?
Supportive care: calm environment, fluids
Benzodiazepines:
- chlordiazepoxide
- lorazepam (in severe liver damage)
Zopiclone to help with insomnia
Buccal midazolam: in case of seizure
