Alcohol Withdrawal Flashcards
Define Alcohol Withdrawal:
The symptoms that may occur when a person who has been drinking too much on a regular basis suddenly stops drinking
Describe the pathophysiology of Alcohol Withdrawal:
Chronic alcohol consumption suppresses the activity of glutamate (excitatory neurotransmitter)
Body compensates by increasing sensitivity to glutamate
When consumption stops, increased glutamate activity leads to excitatory symptoms
(lack of alcohol also stops enhanced GABA activity)
What proportion of alcohol-dependent patients will clinically relevant Alcohol withdrawal symptoms?
6%
up to 10% will develop delirium tremens
What are the mild signs and symptoms of alcohol withdrawal?
Insomnia + fatigue
Tremor
Anxiety
Agitation/restlessness
Nausea/Vomitting
Headache
Sweating
Palpitation
Anorexia
Depression
Cravings
What are the severe symptoms of alcohol witdrawal?
Hallucinations
Withdrawal seizures (generalised tonic-clonic)
Delirium Tremens:
acute confusional state - vivid and terrifying visual and sensory hallucinations (often animals + insects) - can be fatal
What is the scoring system for determining and assessing Alcohol Withdrawal?
CIWA-Ar
What blood results might you expect to see in someone going through Alcohol Withdrawal?
Macrocytic anaemia
Derranged LFTs
What is the mortality of Alcohol Withdrawal if untreated and treated?
Delirium tremens has 35% mortality if untreated
<2% with early detection and treatment
What is the pharmaceutical management of Alcohol Withdrawal?
IV Chlordiazepoxide (benzo)
Lorazepam if significant Liver Failure (shorter half-life/no active metabolites)
Benzos stimulate GABA receptors and reduce the excitation caused by glutamate
IV Thiamine + B12 (Pabrinex) - prevents progression to Wernicke-Korsakoff syndrome
How do you manage Alcohol Withdrawal?
Pharmaceutical treatment
Monitor vitals 4hrly (beware drops in BP)
Patient Nil by mouth if severe (prevent aspiration)
Rehydration by IV
Nutrition - initially IV dextrose, full nutrition if still cant eat
