Alcohol withdrawal

Question 1

AW: Caused by

Answer 1

the overactivity of the autonomic nervous system

Question 2

AW: The signs and symptoms of AW typically appear between

Answer 2

6 and 48 hours after heavy alcohol consumption decreases.

Question 3

AW: Initial symptoms may include

Answer 3

headache, tremor, sweating, agitation, anxiety and irritability, nausea and vomiting, heightened sensitivity to light and sound, disorientation, difficulty concentrating, and, in more serious cases, transient hallucinations.

Question 4

AW: Initial symptoms may diminish in

Answer 4

24-48 hours

Question 5

AW: Seizures may occur in up to

Answer 5

25 percent of withdrawal episodes

Question 6

AW: Seizures may occur in up to 25 percent of withdrawal episodes, usually beginning within the first

Answer 6

24 hours after cessation of alcohol use

Question 7

Delirium Tremens: characterized by

Answer 7

severe agitation; tremor; disorientation; persistent hallucinations; and large increases in heart rate, breathing rate, pulse, and blood pressure

Question 8

Delirium Tremens: when does it appear

Answer 8

2 to 4 days after the patient’s last use of alcohol

Question 9

Delirium Tremens: What class of medication do you use for severe cases

Answer 9

antipsychotics

Question 10

Delirium Tremens: Which antipsychotics would you use

Answer 10

Newer antipsychotics like risperidone or olanzapine may have a better safety profile than haloperidol and may be preferred as adjuncts to benzodiazepines

Question 11

The most intense and serious syndrome associated with AW

Answer 11

Delirium Tremens

Question 12

Supportive Care: Hydration

Answer 12

Oral hydration may be sufficient if patient exhibits excessive sweating, vomiting, or diarrhea

IV hydration may be necessary in extreme cases

Caution in heart failure and comorbidities where fluid overload may be an issue

Question 13

Supportive Care: Electrolyte imbalances: Hypomagnesemia-

Answer 13

seizure, delirium, neuropathy

Question 14

Supportive Care: Electrolyte imbalances: Folic acid and thiamine-

Answer 14

possibly due to poor diet

Question 15

Supportive Care: Electrolyte imbalances: Thiamine deficiency can lead to

Answer 15

Wernicke’s

Question 16

Wernicke-Korsakoff syndrome consists of two neuropsychiatric disorders

Answer 16

Wernicke encephalopathy

Korsakoff psychosis

Question 17

Wernicke encephalopathy is usually

Answer 17

reversible

Question 18

Korsakoff psychosis is usually

Answer 18

not reversible

Question 19

Wernicke- Korsakoff Syndrome occurs due to

Answer 19

inadequate intake of thiamine, likely due to the poor dietary habits of patients with Alcohol Use Disorder.

Question 20

Thiamine deficiency, alone, can lead to

Answer 20

Wernicke-Korsakoff syndrome

Question 21

Wernicke-Korsakoff syndrome is characterized by

Answer 21

severe confusion, abnormal gait, and paralysis of certain eye muscles.

Question 22

Wernicke syndrome can progress to

Answer 22

an irreversible dementia

Question 23

Wernicke- Korsakoff Syndrome: treatment: Alcohol withdrawal:

Answer 23

at least 250 mg thiamine by the parenteral route

Question 24

Wernicke- Korsakoff Syndrome: Suspected Wernicke’s Encephalopathy: treatment

Answer 24

thiamine 500 mg/day

Question 25

Wernicke- Korsakoff Syndrome: Due to chronic malnutrition and gastric malabsorption that follows chronic alcohol abuse, many clinicians advise

Answer 25

multivitamin supplements (B1 + B2 + B6 + nicotinamide + Vitamin C) in parenteral form for the initial 3-5 days.

Question 26

AW: Treatment: Benzodiazepines:

Answer 26

Diazepam- 10 mg or more of diazepam (Valium®) or another longlasting BZ is administered every hour until either the symptoms are suppressed or the patient becomes excessively sedated.

Question 27

AW: Treatment: Diazepam- 10 mg or more of diazepam (Valium®) or another longlasting BZ is administered every hour until either the symptoms are suppressed or the patient becomes excessively sedated. Often only

Answer 27

1 to 2 days of medication are required under this regimen.

Question 28

Factors to consider when choosing a benzodiazepine:

Answer 28

patient’s age; occurrence of prior seizures; liver function.

Question 29

Factors to consider when choosing a benzodiazepine: In patients with impaired liver function,

Answer 29

longer lasting BZ’s may cause problems, ranging from oversedation to incoordination (i.e., ataxia) and confusion.

Question 30

Factors to consider when choosing a benzodiazepine: Why do you want a medication that gets metabolized rapidly

Answer 30

Alcoholics often have liver damage and therefore can’t tolerate meds that are difficult to metabolize

Question 31

Lorazepam vs diazepam: metabolism and duration

Answer 31

Lorazepam is readily metabolized and is shorter acting than diazepam

Question 32

Lorazepam vs diazepam: efficacy

Answer 32

Diazepam and lorazepam are equally effective, but diazepam has higher incidence of hypotension.

Question 33

Lorazepam vs diazepam: strength

Answer 33

lorazepam is 10x stronger

Question 34

AW: Treatment: Alpha 2 agonists

Answer 34

Decreases NE release and maybe useful in withdrawal symptom management

Question 35

AW: Treatment: What agent would you use for the BP

Answer 35

clonidine

Question 36

AW: Treatment: Anti Seizure

Answer 36

Valproate and carbamazepine used historically.

Benzodiazepines may be used as well.