Alcohol withdrawal

Question 1

how does alcohol withdrawal present acutely?

Answer 1

• 6-12hrs: tremor, sweating, headache, craving & anxiety
• 12-24hrs: hallucinations
• 24-48hrs: seizures
• 24-72hrs: delirium tremens

Question 2

what is delirium tremens?

Answer 2

medical emergency associated w alcohol withdrawal

• confusion
• agitation
• hallucinations/delusions
• tremor
• tachycardia
• HT
• hyperthermia
• ataxia
• arrhtyhmias

Question 3

pathophysiology behind DT?

Answer 3

Alcohol stimulates GABA receptors (relaxing effect on brain) and inhibits Glutamate receptors (excitatory)

chronic alcohol use –> GABA upregulation and glutamate down regulation

so in withdrawal scenario: GABA underactivity and glutamate overactivity

Question 4

Mx of alcohol withdrawal?

Answer 4

• Benzos
  
  • chlordiazepoxide or diazepam
• Pabrinex
  
  • IV high dose
• Fluids

Question 5

how do benzos work and what do you give if they are not enough?

Answer 5

• act on same receptor alcohol does
• Haloperidol- greater degree of sedation

Question 6

Options of medications to encourage withdrawal NOT for the acute setting?

Answer 6

1. Anti-craving medication
   
   • acamprostate
2. Aversion/deterrent medication
   
   • Disulfiram
3. Baclofen

Question 7

Describe how Wernicke Korsakoff’s comes about

Answer 7

• alcohol excess leads to thiamine (Vit B1) deficiency
• thiamine deficiency–> Wernicke’s encephalopathy –> Korsakoff Syndrome if untreated

Question 8

Presentation of Wernicke’s encephalopathy?

Answer 8

Triad of…

• Confusion
• Wide-based gait ataxia
• Ophthalmoplegia
  
  • nystagmus, conjugate gaze & bilateral rectus palsies

Question 9

Mx of Wernicke’s?

Answer 9

IV/IM Thiamine

*high mortality if left untreated*

Question 10

Presentation of Korsakoff’s Syndrome?

Answer 10

• memory impairment (retograde and anterograde)
• behavioural changes

*irreversible*

Question 11

Mx of Wernicke-Korsakoff’s Syndrome?

Answer 11

abtinence + pabrinex