Alcohol withdrawal

Question 1

What are the features of early alcohol withdrawal?

Answer 1

Tremor (fine, bilateral), nausea, insomnia, agitation, anxiety, cravings, pyrexia, sweating, tachycardia

Question 2

What are the features of delirium tremens?

Answer 2

Hallucinations - formication/Lilliputian, acute confusional state, seizure, course tremor, tachycardia pyrexia

Question 3

How do you manage DTs?

Answer 3

Chlordiazepoxide PO- reducing regimen (or loraz IV if contraindicated or can’t tolerate oral)

Pabrinex = vit B6+B12 - IV - prevents wernickes (ophthalmoloplegia - abducens palsy; ataxia, acute confusional state) and korsakoffs (Wernickes + memory changes/confabulation)

Test for and correct other nutritional deficiencies

Private room, well lit, big clocks, continuity of staff and family presence

See what social care may be available, possible outpatient alcohol service referral