Alcohol Withdrawal Flashcards
Insomnia, tremulousness, mild anxiety, GI upset, anorexia, headache, diaphoresis, and palpitations are all symptoms of?
Mild to moderate alcohol withdrawal
What is a banana bag? and what is in it that is extra important in alcohol withdrawal patients?
IVF, dextrose, vitamins, minerals, and THIAMINE
What labs must we monitor during alcohol withdrawal?
CMP with magnesium and phosphorus levels!
What will electrolytes look like during withdrawal?
Hypo everything
Hyponatremia, hypokalemia, hypomagnesemia, hypophosphatemia
What class of medications are we going to give alcohol withdrawal patients?
BENZO’S!
Diazepam (Valium)
What is Delirium tremens different than common alcohol withdrawal?
It has the symptoms of acute alcohol withdrawal PLUS
delirium (encephalopathy), hallucinations, tachycardia, hypertension, and hyperthermia
How long after a patient’s last drink to DT’s set in?
48-96 hours
How long can DT’s persist?
5 days
Sustained drinking, prior DT episodes, age greater than 30, concurrent illness, positive significant withdrawal symptoms in presence of elevated blood alcohol level are all risk factors for?
DTs
True or False
Sent DT patients to the behavioral health unit
FALSE
What unit should we send DT patients to?
CCU
What other specialists should be involved in a patient with DTs care?
Critical care, neurology, psychiatry
Acute brain disorder causing petechial hemorrhaging and necrosis in midbrain structures?
Wernicke encephalopathy
What is the classic triad of Wernicke’s?
Encephalopathy/delirium, gait ataxia, oculomotor dysfunction
True or False
If you are unsure if a patient has Wernicke’s, we shouldn’t treat it because we could end up doing more damage
FALSE
When in doubt, TREAT.
Untreated can lead to coma and death.
How do we treat Wernicke’s encephalopathy?
parenteral thiamine
Administration of what can precipitate WE?
glucose
Consequence of untreated or repeated episodes of WE; chronic, late neuropsychiatric disorder
Korsakoff’s
What are 3 characteristics of Korsakoff’s?
Cognitive impairment, retrograde and anterograde amnesia, and brain imaging positive for atrophy
Can we diagnose Korsakoff’s?
No – we need specialized neurocognitive testing – specialty referral and evaluation
Caused by nutritional deficiency and neurotoxic effects of chronic alcohol use
Cerebellar deficiency
Gait ataxia, poor gross motor coordination, inability to handwrite, dysarthria are all symptoms of?
Cerebellar deficiency
Does cognitive capability remain intact in cerebellar deficiency?
Yes
What is the prognosis of cerebellar deficiency?
May improve slightly with abstinence and good nutrition but is largely irreversible
Alcoholic hallucinations usually occur in about how many hours after a patients last drink?
24 hours
Numbness, paraesthesia, burning dysesthesia, loss of reflexes, and jerky muscle spasms are symptoms of?
Peripheral neuropathy
How do we treat peripheral neuropathy?
Abstinence, thiamine PO, maximize nutrition
Weakness, pain, tenderness, and swelling of affected muscles are symptoms of?
Myopathy
What other medical issues is myopathy associated with?
Rhabdomyolysis, dysphagia, and heart failure
