Alcohol withdrawal

Question 1

What is the progression of symptoms after alcohol withdrawal?

Answer 1

6-12hrs: tremor, sweating, headache, craving and anxiety

12-24hrs: hallucinations

36hrs: seizures

48-72hrs: delirium tremens

Question 2

What symptoms occur in delirium tremens?

Answer 2

Acute confusion
Severe agitation
Delusions and hallucinations
Tremor
Tachycardia
Hypertension
Hyperthermia
Ataxia 
Arrhythmias

Question 3

How is alcohol withdrawal managed?

Answer 3

Benzodiazepine - chlordiazepoxide or diazepam

IV pabrinex (thiamine) followed by regular oral thiamine

Question 4

What are the features of and treatment for Wernicke-Korsakoff Syndrome (WKS)?

Answer 4

Wernicke’s encephalopathy comes before Korsakoff’s syndrome

Features of Wernicke’s encephalopathy:
Confusion
Ophthalmoparesis with nystagmus
Ataxia

Features of Korsakoff’s syndrome:
Memory impairment
Behavioural changes
Often irreversible

Give IV pabrinex for Wernicke’s encephalopathy