Alcohol withdrawal

Question 1

What is alcohol withdrawal?

Answer 1

People who are alcohol dependent have a risk of developing withdrawal symptoms when alcohol use is stopped - ranges from mild, uncomfortable symptoms to delirium tremens = medical emergency

Question 2

When do symptoms start?

Answer 2

Any time between 10-72h after last drink

Question 3

Symptoms of alcohol withdrawal

Answer 3

6-12 hours: tremor, tachycardia, hypotension, sweating, headache, craving & anxiety
12-24hours: hallucinations
24-48hours: seizures
24-72 hours: delirium tremens

Question 4

What is the mortality associated with delirium tremens if left untreated?

Answer 4

3%

Question 5

What is delirium tremens?

Answer 5

Medical emergency associated with alcohol withdrawal

Question 6

How does delirium tremens present?

Answer 6

Ataxia, acute confusion, arrhythmias, severe agitation, fits/ seizures, delusions/hallucinations, HTN, hyperthermia, tremor, tachycardia

Question 7

When might you suspect alcohol withdrawal?

Answer 7

In a new hospital/ ward patient <3d with acute confusion

Question 8

What is a tool used to score patients on their withdrawal symptoms and guide treatment?

Answer 8

CIWA-AR - clinical institute withdrawal assessment - alcohol revised

Question 9

What is the management of alcohol withdrawal?

Answer 9

Chlordiazepoxide 10-40mg every 1-4 hours for 5-7days
given PO as a reducing regime depending on the local alcohol protocol
Alternative benzo = Diazepam or Lorazepam IM

Pabrinex –> high dose IV B vitamins –> followed by lower regular dose of thiamine to prevent Wernicke-Korsakoff syndrome