Alcohol Withdrawal Assessment & Management

Question 1

What assessment tool is used?

Answer 1

Clinical institute withdrawal assessment for alcohol (CIWA-Ar)

Question 2

What is CIWA-Ar? (9)

Answer 2

Scoring system (1-7) for:
N&V
Anxiety
Headache 
Agitation 
Orientation
Tremor
Tactile disturbances
Auditory disturbances
Visual disturbances

Question 3

What is the maximum score you can achieve?

Answer 3

67

Question 4

CIWA-Ar score <10?

Answer 4

Mild alcohol withdrawal

Question 5

CIWA-Ar score 10-20?

Answer 5

Moderate alcohol withdrawal

Question 6

CIWA-Ar score >20?

Answer 6

Severe alcohol withdrawal

Question 7

Mx of CIWA-Ar score <10? (2)

Answer 7

small doses of oral chlordiazepoxide

OR

no direct treatment just symptom relief e.g. paracetamol.

Question 8

Mx of CIWA-Ar score 10-20?

Answer 8

Chlordiazepoxide 10-20mg PO 4x day, reduced over 5 days

Question 9

Mx of CIWA-Ar score > 20?

Answer 9

20-40mg chlordiazepoxide PO, reduced over 5 days.

Question 10

What can be given if cannot tolerate oral treatment?

Answer 10

10mg slow IV diazepam or 500 micrograms/kg rectal diazepam solution

Question 11

What anion need to be monitored?

Answer 11

Phosphate

Question 12

How to prevent Wernicke’s?

Answer 12

oral thiamine + vitamin B

OR

Pabrinex IV 3-5 days

Question 13

Symptoms of Wernicke’s?

What can Wenicke’s lead to?

Answer 13

acute confusion, ataxia, ophthalmoplegia, nystagmus

Korsakoff’s psychosis

Question 14

Presentation of Korsakoff’s? (6)

Answer 14

There are six major symptoms of Korsakoff’s syndrome:

1. anterograde amnesia
2. retrograde amnesia, severe memory loss
3. confabulation, that is, invented memories which are then taken by the patient as true due to gaps in memory, with such gaps sometimes associated with blackouts
4. minimal content in conversation
5. lack of insight
6. apathy