Alcohol withdrawal

Question 1

What is the most commonly abused drug in the UK?

Answer 1

Alcohol

Question 2

What are the symptoms of alcohol withdrawal 6-12 hours after the last drink?

Answer 2

Insomnia
Tremor
Anxiety
Agitation
Nausea and vomiting
Sweating
Palpitations

Question 3

What are the symptoms of alcohol withdrawal 12-24 hours after the last drink?

Answer 3

Hallucinations of visual, tactile or auditory origin.

Question 4

What is delirium tremens?

Answer 4

A sign of alcohol withdrawal, often after 48-72 hours of abstaining

Question 5

What are the features of alcohol withdrawal?

Answer 5

Delusions
Confusion
Seizures
Tachycardia
Hypertension
Hyperthermia

Question 6

What are the indications for inpatient withdrawal?

Answer 6

Patients drinking >30 units per day
Scoring over 30 on the SADQ score
High risk of alcohol withdrawal seizures
Concurrent withdrawal from benzodiazepines
Significant medical or psychiatric comorbidity
Vulnerable patients
Patients under 18

Question 7

How would you manage someone who is withdrawing from alcohol?

Answer 7

Assisted alcohol withdrawal is required in patients drinking over 15 units per day or in those scoring over 20 on the AUDIT questionnaire.

Chlordiazepoxide prescribed in a reducing regimen in accordance with the CIWA-Ar score and local protocol.

Pabrinex (1 pair of ampoules once daily to prevent Wernicke’s encephalopathy).

Question 8

what would you give in an alcohol-withdrawal seizure?

Answer 8

Rapid-acting benzodiazepines such as lorazepam

Question 9

How would you manage delirium tremens?

Answer 9

Offer oral lorazepam as first line treatment

If this is declines or symptoms persist offer parenteral lorazepam.