Alcohol withdrawal Flashcards
What is alcohol dependence?
3 or more of:
WITHDRAWAL on cessation of alcohol
TOLERANCE
COMPULSION to drink, difficulty controlling termination/ levels of use
TIME is spent obtaining, using, or recovering from alcohol
NEGLECT other interests (social, occupational)
CONTINUED use despite physical + psychosocial problems
Describe the aetiology of alcohol withdrawal
Alcohol enhances inhibitory GABA activity + inhibits excitatory glutamate transmission
Chronic use results in compensatory reduction in GABA receptor function + upregulation of glutamate NMDA receptors
Abrupt cessation leads to over activation of excitatory NMDA relative to GABA
List 5 risk factors for alcohol dependence
FH Cultural, parental + peer influences Availability of alcohol Occupation Depression/ anxiety states
What screening questions are used to detect alcohol dependence?
C: Felt the need to CUT down on your drinking?
A: Felt ANNOYED by someone criticising your drinking?
G: Felt bad or GUILTY about your drinking?
E: Ever had an EYE-OPENER; a drink 1st thing in the morning to steady your nerves?
List 7 signs of acute intoxication
Amnesia Ataxia Dysarthria Disorientation Palpitations Flushing Coma
List 7 symptoms of withdrawal
Nausea Sweating Tremor Restlessness/ agitation Visual hallucination Confusion Seizures
List 9 signs of chronic alcohol misuse
Dupuytrens contracture Palmar erythema Bruising Spider navei Gynaecomastia Telangiectasia Facial mooning Bilateral parotid enlargement Smell of alcohol
What bloods are performed in suspected alcohol dependence?
High MCV High GGT High ALT + AST High uric acid High triglycerides Markers of end organ damage e.g. high BR
What investigations are performed in suspected acute overdose of alcohol?
Blood alcohol Glucose ABG (risk of ketoacidosis) U+Es Toxic screen e.g. barbiturates, paracetamol
How is acute intoxication managed?
Monitor + support ABC
Intubation + ventilation if severe respiratory depression
IV fluids
Monitor urine output, BG, U+Es + blood gases
How is alcohol withdrawal managed?
IV Vit B complex (Pabrinex)
Reducing doses of chlordiazepoxide
Monitor dehydration, electrolyte imbalances + infections
Nutritional support
Lactulose + Phosphate enemas for encephalopathy
How is alcohol dependence managed?
Motivational interviewing, counselling, AA groups
Acamprosate reduces cravings
Naltrexone to support abstinence
Disulfiram causes vasomotor symptoms on drinking alcohol
List the complications of alcohol withdrawal
Fits Delirium tremens Cerebral atrophy + Dementia Cerebellar degeneration Optic atrophy Peripheral neuropathy Myopathy Hepatic encephalopathy Thiamine deficiency: Wernicke's encephalopathy or Korsakoffs psychosis
What GI, neurological, liver, haematological, respiratory and cardiac complications may arise from alcohol dependence?
GI: Oesophagitis, Mallory-Weiss tears, varices, peptic ulcers, pancreatitis
Liver: Fatty change, alcoholic hepatitis, cirrhosis
Neuro: Acute intoxication
Haem: Anaemia, thrombocytopenia, abnormal platelet function
Resp: Depression, inhalation of vomitus
Cardiac: HTN, cardiomyopathy, arrhythmias
What broader complications may arise from alcohol dependence?
Drug interactions; alcohol is a liver enzyme inhibitor acutely + inducer chronically
Teratogenicity: foetal alcohol syndrome
