(!) Alcohol withdrawal

Question 1

Define alcohol withdrawal

Answer 1

alcohol withdrawal occurs in pt depend on alcohol (regular drinkers). Sx occurs often within 6-12h of last drink-
can progress to delirium tremens

Question 2

aetiology and risk factors of alcohol withdrawal

Answer 2

Chronic alcohol usage upregulate NDMA (glutamate receptors) expression and down GABA. -> GABA NDMA balance achieved
As remove EToH, imbalance-NMDA overpresent and GABA under-and w/o EToH-excessive Glut stimulation-> alcohol withdrawal syndrome (AWS) (ANS hyperactivity, seizures, tremors, hallucinations)
Multiple AWS increase the severity of the next one

Risk factors:
Chronic alcohol use
Previous AWS
Alcohol withdrawal

Question 3

Epidiemology of alcohol withdrawal

Answer 3

43% of world uses alcohol, and 20% of those use it a LOT

5.1% of drinkers seem dependent

Question 4

Signs and Sx of alcohol withdrawal

Answer 4

3 fast test for alcohol use
AUDIT-C (score >5 bad)
FAST-for ED
PAT-even faster

Dependence-SAD-Q or CAGE questionnaires (do you feel like you need to cut down, , annoyed som1 critic ur drinking , guilty about drinking, ever drank 1st thing in morn

Less common:
Seizures, 
Tremors
Delirium tremens (fever, tachycardia, dehydration, hallucinations, profound confusion, parasthesia)
Agitation, altered thinking
Hyper or hypotension
Fever
N&V

Question 5

Investigations of alcohol withdrawal

Answer 5

VBG-can be
Resp alkalosis if delirium tremens (increase O2 use->hyperventilate)
metabolic acidosis-with vom
Metabolic acidosis with high anion gap-alcohol ketoacidosis

Glucose-low (poor nutrition)
FBC-high MCV, low Plt
U&E-low Mg, K and Phos
LFT-AST/ALT/GGT high
Coag-INR high, PT high

Differential-meningitis, wernickes encelopathy
alcohol ketoacidosis (poor nutrition)

Question 6

Management of alcohol withdrawal

Answer 6

CIWA score -

Correct medical issues (give missing electrolytes (Mg, K, Ca, Glucose), FLUIDS
care for other pathology associated (pancreatitis, gastritis, pneumonia)
ALWAYS EYE for decompensated liver disease (late stage liver fail signs (caput medusa, spider naevi, jaundice, encelopathy)
Give Benzodiazepam for tremors/agitation + antipsychotics
Thiamine (vit B1)
secure airways

Monitor with CIWA longer term
Alcohol clinic as outpatients

Question 7

Complications of alcohol withdrawal

Answer 7

Delirium tremens
Decompensated liver disease
head trauma from EToH
Electrolyte imbalances causing cardiac arrest 
over sedation from treatment
Status epilepticus

Question 8

Prognosis of alcohol withdrawal

Answer 8

Delirium tremens is fatal in 15-20% of pt untreated
but with early management -1%

insomnia and ANS disturbance can last 6 months
50% don’t redrink after AWS