Alcohol Withdrawal Flashcards
What is the mechanism of action in alcohol withdrawal?
- Prolonged use =develop tolerance
- chronic alcohol consumption enhances GABA mediated inhibition in CNS (like benzos) and inhibits NMDA receptors
- Cessation unmasks changes
- Alcohol withdrawal lead by opposite: decreased inhibition of GABA and increased NMDA glutamate transmission
What is the timeline of alcohol withdrawal?
- Usually commences 6hours after last drink
* worst at 24-72 hours after last drink
What are the common features of alcohol withdrawal?
- Insomnia and fatigue
- Tremor
- Anxiety
- Restlessness
- Shaking
- Sweating
- N&V
- Headache
- Palpitations
- Tachycardia
- Mild fever
What are the severe features of alcohol withdrawal?
- Seizures
- hallucination
- Delirium tremens
What is delirium tremens?
Peak onset? Lasts
- Coarse tremor
- Confusion
- Delusions
- Auditory/visual hallucination
- Fever
- Tachy
Peak incidence 48-72hours
LAst 2-3days
What is Wernicke-Korsakoff syndrome?
Alcohol excess causes thiamine vit b1 deficiency leading to this:
>Amnesia
>Confabulation
How does Wernicke Encephalopathy present? Cause?
Thiamine VitB1 deficiency
>nstagmus, ataxia, confusion, opthalmoplegia, peripheral sensory neuropathy
>If not treated korsakoff’s syndrome may develop as well
When should a patient be admitted for alcohol withdrawal?
- Delirium tremen
* Hx of delirium tremons, seizures, blackouts
What is the management of delirium tremens?
- A-E assessment
- Sedation with benzodiazepines e.g. chlordiazepoxide or lorazepam
- Carbamazepine can all be effective
What is the medication for acute alcohol withdrawal?
*Benzodiazepine for detox
>Reducing dose of chlordiazepoxide over 5-7days
>Thiamine parenteral high potency B complex vitamins
What is the treatment of Wernicke’s encephalopathy?
IV 500mg thiamine (pabrinex) TDS for 3 days
