Alcohol withdrawal Flashcards
Define alcohol withdrawal
Alcohol abuse as a result of decrease/cessation of alcohol drinking, resulting in blood alcohol levels to fall below their habituated level.
Begins 4-12h after last drink
Aetiology of alcohol withdrawal
Chronic alcohol use is associated with an up-regulation of post-synaptic glutamate receptors and a down-regulation of post-synaptic GABAG receptors
Alcohol-related seizures are likely a combination of brain pathology, irritability and trauma
Risk factors of alcohol withdrawal (3)
- Chronic heavy drinking
- History of generalised seizures
- History of delirium tremens
Epidemiology of alcohol withdrawal
- More common in men
- More common over the age of 20
- Prevalence is less than 5%
When does alcohol withdrawal present?
Symptoms appear within 6-12 hours after individuals cease alcohol
Relieved by drinking alcohol
Longer cessation = worse withdrawal
Symptoms of alcohol withdrawal? (6)
- Nausea and vomiting
- Insomnia
- Seizures
- Hallucinations
- Delusions
- GI upset
Signs of alcohol withdrawal (7)
- Change in mental status
- Tremor
- Hypertension
- Tachycardia
- Fever
- Hyperreflexia
- Diaphoresis (sweating)
Investigations for AW
• First line o Serum urea and creatinine o LFTs o Toxicology screen o Electrolyte panel( Metabolic acidosis) o CT head • History – CAGE, MMSE, CIWA-Ar (severity of AWS) • O/E – cardio, resp, neuro
Management plan for AW
• Benzodiazepine/clomethiazole o Mild – oral lorazepam/diazepam/chlordiazepoxide o Moderate/severe – IV lorazepam • Supportive care • Vitamin supplementation o Thiamine (B1), folic acid (B9), Mg
Complications of AW
• Over-sedation – from treatment • Delirium tremens • Seizures – self-limiting • Status epilepticus (less than 3%) • Mortality (1-5%) o Cirrhosis o Presenting in DT o Need for endotracheal intubation
Prognosis of AW
- Persistent insomnia and autonomic symptoms (6 months post withdrawal)
- 50% remain abstinent for a year
