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Z Year3 Acute Med > Alcohol Withdrawal > Flashcards

Alcohol Withdrawal Flashcards

1
Q

What is the defintion of alcohol withdrawl?

A

physical and psychological symptoms occurring when any patient who is alcohol dependent has stopped or reduced alcohol intake within hours or days of presentation

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2
Q

What two receptors are involved in alcohol?

A
  1. NMDA Receptors

2. GABA (Type A) receptors

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3
Q

What are NMDA receptors usually?

A

excitatory

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4
Q

What are GABA (type A) receptors usually?

A

inhibitory

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5
Q

What is the normal homestasis of these receptors?

A

homeostasis between the excitatory effects of NMDA receptors and inhibitory effects of GABA receptors

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6
Q

What happens to the receptors in acute alcohol drinking?

A
  1. ethanol predominantly targets the GABA (type A) receptor

2. inhibits the NMDA receptor though competitive binding

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7
Q

What happens to the receptors in chronic alcohol use?

A
  1. alcohol predominantly targets GABA type A receptors
  2. so body adapts by downregulating GABA type A receptors (this contributes to development of tolerance)
  3. alcohol inhibits NMDA receptors
  4. so the body adapts by upregulating NMDA receptors on the post-synaptic membrane
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8
Q

What happens when an alcohol-dependent person stops drinking alcohol?

A
  1. excess excitatory effect from the upregulation of NMDA receptors
  2. downregulation of inhibitory GABA (type A) receptors
    - use to steady state of ethanol concentration
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9
Q

What are RF for alcohol withdrawal?

A
  1. Alcohol use of disorder
  2. History of alcohol withdrawal
  3. Acute illness e.g. pneumonia
  4. Poor Physical Health
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10
Q

How do you identify alcohol use disorder?

A
  1. AUDIT-C
  2. FAST
  3. PAT
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11
Q

What can poor nutrition lead to?

A

thiamine deficiency which leads to Wernicke’s encephalopathy

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12
Q

What are signs of chronic or decompensated liver disease?

A
  1. Hepatooemgalsy
  2. Jaundice
  3. Ascites
  4. Caput medusa
  5. Palmar erythema
  6. Hepatic encephalopathy
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13
Q

What does ammonia cause?

A

encephalopathy

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14
Q

What does the albumin cause?

A

ascites and peripheral oedema

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15
Q

What does the bilirubin cause?

A

jaundice

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16
Q

What does blood factors cause?

A

brusing

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17
Q

How do you remember the effects of liver disease?

A

AABB

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18
Q

What does thiamine B1 def cause?

A

Wernicke’s encephalopathy

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19
Q

What are signs of WE?

A
  • CAN
    1. Confusion
    2. Ataxia
    3. Nystagmus
  • Risk of irreversible brain damage
20
Q

What are the symptoms of 6-12 hr withdrawal: minor withdrawal symptoms?

A
  1. Anxiety/agitation
  2. Palpitations
  3. GI upset
  4. Sweating/tremor
21
Q

What are the symptoms of 12-24hr withdrawal: alcoholic hallucinosis?

A

hallucinations

22
Q

What are symptoms of 24-48hr: withdrawal seizures?

A

generalised tonic-clonic seizures

23
Q

What are the symptoms of 48-72hr: withdrawal delirium?

A
  1. Delirium Tremens
  2. Severe tremor
  3. Fever
  4. High BP + HR
24
Q

How do you remeber a surgical sieve?

A

VITAMIN C DEF

25
Q

What is the surgical sieve?

A 
Vascular 
Infective/inflammatory 
Trauma
Autoimmune
Metabolic
Iatrogenic
Neoplastic
Congenital
Degenerative
Endocrine/environment
Functional
26
Q

What are possible DDx for alcohol withdrawal?

A
  1. Hypoglycaemia
  2. Hepatic encephalopathy
  3. Meningitis
27
Q

What are hypoglycaemia symptoms?

A
  1. Tremors
  2. anxiety
  3. palpitations
  4. seizures
  5. drowsiness
28
Q

What are hepatic encephalopathy symptoms?

A
  1. Tremors
  2. Anxiety
  3. Palpitations
  4. Seizures
  5. Drowsiness
29
Q

What are features of meningitis?

A
  1. Fever and altered mental status

2. Nuchal rigidity makes up the last part of the triad but not all patients present with this triad

30
Q

What bedside tests are done for alcohol withdrawal?

A
  1. Screen for alcohol-use disorder
  2. ECG
  3. VBG
31
Q

How do you screen for alcohol use disorder?

A
  • CAGE/AUDIT-C

- CIWA-AR scale to assess severity

32
Q

Why do you do an ECG for alcohol withdrawal?

A
  • Electrolyte deficiencies are common and can cause arrhythmias
33
Q

What do you look for on VBG?

A
  1. Respiratory alkalosis (due to hyperventilation in delirium tremens)
  2. Hypochloraemic metabolic acidosis (due to vomiting)
  3. Metabolic acidosis with high anion gap (alcoholic ketoacidosis)
34
Q

What bloods are done?

A
  1. Glucose
  2. FBC
  3. U+E
  4. LFTs
  5. Coagulation studies
35
Q

Why is glucose done for alcohol withdrawl?

A
  • hypoglycaemia

- common due to poor nutrition or secondary to hepatic failure

36
Q

What does FBC show on alcohol withdrawal?

A
  1. increased MCV due to chronic alcohol use
  2. thrombocytopenia due to splenomegaly
  3. folate deficiency and a direct toxic effect of alcohol on their production
37
Q

What does U+Es show in alcohol withdrawal ?

A
  1. hypomagnesaemia (1/3 of people)
  2. hypokalaemia (50% of hospitalised patients)
  3. hypophosphataemia
38
Q

What does LFTs show in alcohol withdrawal?

A
  • elevated liver enzymes (AST, ALT, GGT)

- ALT higher than AST

39
Q

What do coagulation studies show in alcohol withdrawal?

A

INR and PT are prolonged in chronic liver disease, correlated with severity

40
Q

Why do you do a CT head?

A
  • Suspected head injury (e.g. alcohol-related seizure)

- Altered cognition

41
Q

Why is a CXR done?

A
  • co-existing pneumonia is common

- Aspiration: reduced consciousness or seizures

42
Q

What is the urgent management for alcohol withdrawal?

A
  1. Benzodiazepine
  2. CT head: suspected head injury, altered cognition or seizures
  3. Detect and treat co-existing illness
43
Q

How would you treat sizures?

A

ensure patent airway and give IV benzo

44
Q

How would you treat delirium tremens?

A

oral benzos and IV if symptoms persists

45
Q

What is the suportive management for alcohol withdrawal?

A
  1. Rehydrate: IV fluid
  2. Pabrinex (Vit B)
  3. Glucose
  4. Electrolyte imbalances
46
Q

When can glucose be given for alcohol withdrawal?

A
  • if hypoglycaemia: After thiamine! But don’t delay glucose for life-threatening hypoglycaemia
  • after thiamine to prevent WE
47
Q

How could you manage alcohol dependent LT?

A

DALS, Community Services, Therapy

Z Year3 Acute Med (11 decks)

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