Alcohol withdrawal

Question 1

Define alcohol withdrawal

Answer 1

Symptoms that may occur when person has been drinking too much alcohol on a regular basis & suddenly stops drinking

Question 2

Aetiology of alcohol withdrawal

2

Answer 2

Chronic alcohol consumption suppresses the activity of glutamate (excitatory neurotransmitter) so the body compensates by increasing sensitivity to glutamate
When consumptions stops —> increased glutamate activity —> excitatory symptoms

Question 3

Epidemiology of alcohol withdrawal

2

Answer 3

6% alcohol dependent patients develop clinically relevant symptoms of withdrawal if untreated
Up to 10% will develop delirium tremens

Question 4

Presenting symptoms & signs of alcohol withdrawal

3

Answer 4

History of high alcohol intake
Mild
Severe

Question 5

Management of alcohol withdrawal

3

Answer 5

Chlordiazepoxide - reduces symptoms
Barbiturates - if refractory to benzodiazepines
Thiamine (Pabrinex) - prevents progression to Wernicke-Korsakoff syndrome

Question 6

Complications of alcohol withdrawal

Answer 6

Patients can have seizures & die if untreated

Question 7

Prognosis of alcohol withdrawal

2

Answer 7

Delirium tremens has mortality of 35% if untreated

Mortality <2% w/ early detection & treatment

Question 8

Presenting symptoms & signs of alcohol withdrawal - mild

10

Answer 8

Insomnia & fatigue 
Tremor
Mild anxiety/nervousness
N&V
Headache
Sweating 
Palpitations 
Anorexia
Depression 
Craving alcohol

Question 9

Presenting symptoms & signs of alcohol withdrawal - severe

3

Answer 9

Hallucinations

Withdrawal seizures (generalised tonic clonic)

Delirium tremens
anxiety
tremor
sweating
vivid & terrifying visual & sensory HALLUCINATIONS (usually of animal & insects)
can be FATAL