Alcohol use disorders

Question 1

Name 2 questionnaires you could use to screen for alcohol misuse disorder.

Answer 1

1/ CAGE questionnaire

2/ AUDIT

Question 2

A 62yo man presents to ED with tremors, agitation, sweating + tachycardia. He has a history of alcohol dependence.

What is the likely diagnosis and how would you manage him?

Answer 2

Acute alcohol withdrawal.

1. CHLORDIAZEPOXIDE (benzodiazepine) PO 5-7/7
2. PABRINEX IM 5-7/7 for Wernicke’s prophylaxis

Question 3

A man presents in acute alcohol withdrawal. What features would suggest delirium tremens?

Answer 3

1. coarse tremor
2. confusion + delusions
3. visual + auditory hallucinations

Question 4

Describe the features of Wernicke’s encephalopathy. What is this caused by?

Answer 4

Caused by thiamine (vitB) deficiency. Features:

• confused/altered GCS
• ataxia
• nystagmus
• ophthalmoplegia
• peripheral sensory neuropathy

Question 5

How would you treat someone presenting with Wernicke’s encephalopathy?

Answer 5

1. THIAMINE IVI for 6-10/7

2. MAGNESIUM IV

Question 6

Why is it important to treat Wernicke’s encephalopathy?

Answer 6

Risk of Korsakoff syndrome:

• anterograde + retrograde amnesia
• confabulation