Alcohol Use Disorder Flashcards
what is the DSM-5 criteria for alcohol withdrawal syndrome?
2 or more of the following symptoms after a decrease in heavy and prolonged drinking and causing distress or impairment
HAS A PINT
Hallucinations/illusions/delirium tremens
Autonomic hyperactivity (sweats, HR >100)
Seizures
Anxiety
Psychomotor agitation
Insomnia
Nausea/vomiting
Tremor of the hand
when do symptoms of AWS start and how long does it last?
can appear as early as 4-12 hours after last drink, usually around 6-24h
peak on day 2-3, improved by day 5
may continue at low levels for 3-6 months
when is seizure risk at the highest in AWS?
first 72 hours
when is the peak of AWS?
day 2-3
what is the mortality rate of delirium tremens?
5%
what is delirium tremens?
severe confusion, disorientation, +/- hallucinations with clouding of global sensorium (decrease LOC) + severe autonomic hyperactivity (tachycardia, HTN, hyperthermia, agitation, sweating)
what is the most serious complication of AWS?
delirium tremens
how long does delirium tremens last for?
1-5 days
what 2 neurotransmitters are key to the pathogenesis of AWS?
GABA and glutamate
what does acute alcohol intoxication do to NT balance?
increases inhibitory effects of GABA and suppresses excitatory effect of glutamate
what does chronic and regular alcohol use to do NT balance? what are the consequences then in withdrawal?
brain develops tolerance and GABA receptors become less sensitive (downregulation) and glutamate receptors become more sensitive (upregulation), so that when alcohol is consumed, there is less overall suppression of the CNS
abrupt withdrawal of alcohol: downregulated GABA system cannot compensate for the rapid increase in glutamate activity resulting in a state of CNS hyper-excitation
what are risk factors for AWS?
increase quantity, frequency and duration of alcohol use
previous alcohol withdrawal
family history of alcohol withdrawals
concurrent medical conditions
consumption of sedatives/hypnotics/anxiolytics
what are complications of AWS?
death
brain damage
prolonged hospitalisation
delirium tremens
seizures
arrhythmias
aspiration
relapse
what scale is used to predict the risk of severe symptoms of AWS?
prediction of alcohol withdrawal severity scale (PAWSS)
what is the interpretation of PAWSS score?
a score of 3 or less indicates low risk and outpatient management is suitable
a score of 4 or more indicates a patient might be at high risk for developing complications of alcohol withdrawal and should be admitted to an inpatient setting
what is the first line treatment for AWS?
benzodiazepines: lorazepam or diazepam
when is clonidine used in AWS?
in addition to benzos
what is the role of clonidine in AWS?
suppress noradrenergic symptoms (anxiety, HTN, tachycardia) that do not resolve with benzos
used for symptomatic relief