Alcohol Withdrawal Lecture Flashcards
insomnia, tremulousness, mild anxiety, GI upset, diaphoresis, anorexia, palpitations are symptoms of what?
acute alcohol withdrawal syndrome
treatment for acute alcohol withdrawal syndrome? (3)
1) banana bag (IVF, dextrose, vitamins, thiamine)
2) electrolytes (will be hypoeverything)
3) benzos - valium (most often PO administration in inpatient behavioral health)
what is the CIWA? what it is used for?
clinical institute withdrawal assessment
helps you assess and figure out how to manage withdrawal
delirium tremens consists of the common alcohol withdrawal symptoms plus what?
delirium (encephalopathy), hallucinations
what will vitals of a patient in DT look like?
tachycardia, hypertension, hyperthermia
when does DT set in? how long can it persist?
48-96 hours after the last drink; can last 5 days
risk factors for developing DT?
sustained drinking prior DT episodes over age 30 concurrent illness significant withdrawal symptoms even in presence of elevated BAL
mortality rate of DT?
5 percent
where do we manage DTs? how do we treat them?
manage in the CCU
1) aggressive administration of IV benzos (IV diazepam) 5-10g q5-10 minutes – might get as high as 2000 mg/48 hours
might need aggressive TX with phenobarbital, intubation
wernicke’s encephalopathy is an ACUTE brain disorder that causes what in the midline brain structures?
petechial hemorrhages and necrosis in the midline brain structures
clinical triad of wernicke’s?
encephalopathy/delirium
gait ataxia
oculomotor dysfunction
you aren’t quite sure if your patient has wernicke’s. should you treat them anyways?
YES
always treat – can lead to coma and death if untreated
true or false – get a thiamine blood level to diagnose wernicke’s
FALSE – a normal serum thiamine doeS NOT exclude wernicke’s encephalopathy
administration of what can precipitate WE?
glucose administration
watch for this during early stages of recovery (due to banana bag)
how do we treat wernicke’s encephalopathy?
parenteral thiamine IV 500 mg TID for 2 days
then 250 mg daily IV for 5 days
then PO as long as patient is at risk
what is the chronic consequence of untreated or repeated episodes of wernicke’s?
korsakoff’s syndrome
what are 3 characteristics of korsakoff’s syndrome?
1) cognitive impairment
2) retrograde and anterograde amnesia
3) brain atrophy seen on imaging
which three brain structures appear atrophied on imaging of a patient’s brain who has korsakoff’s?
thalamus
corpus callosum
mammillary bodies
what do we need to confirm our DX of korsakoffs?
specialized neurocognitive testing – specialty referral
gait ataxia, poor motor coordination, inability to hand write, dysarthria (speech difficulty) make you think what?
cerebellar degeneration
what causes cerebellar degeneration?
nutritional deficiency and neurotoxic effects of chronic alcohol use
is the cognitive capability intact in cerebellar degeneration?
yes
what is the prognosis for cerebellar degeneration?
may improve slightly with abstinence and good nutrition but is largely irreversible
when do alcoholic hallucinations present? how long do they last?
24 hours after last drink
usually self-limited and gone by 3rd day
are alcoholic hallucinations typically auditory or visual?
visual
chronic alcoholic presents with jerky muscle spasms and loss of their reflexes … whats up?
peripheral neuropathy
how do we treat peripheral neuropathy?
abstinence, ongoing thiamine PO, maximize nutrition
acutely, myopathy can be associated with what three threatening conditions?
1) rhabdomyolysis
2) dysphagia
3) heart failure
which of our alcohol disorders presents with a high aspiration risk, creating the need for a speech therapy evaluation before feeding?
myopathy
