Alcohol Withdrawal Lecture

Question 1

insomnia, tremulousness, mild anxiety, GI upset, diaphoresis, anorexia, palpitations are symptoms of what?

Answer 1

acute alcohol withdrawal syndrome

Question 2

treatment for acute alcohol withdrawal syndrome? (3)

Answer 2

1) banana bag (IVF, dextrose, vitamins, thiamine)
2) electrolytes (will be hypoeverything)
3) benzos - valium (most often PO administration in inpatient behavioral health)

Question 3

what is the CIWA? what it is used for?

Answer 3

clinical institute withdrawal assessment

helps you assess and figure out how to manage withdrawal

Question 4

delirium tremens consists of the common alcohol withdrawal symptoms plus what?

Answer 4

delirium (encephalopathy), hallucinations

Question 5

what will vitals of a patient in DT look like?

Answer 5

tachycardia, hypertension, hyperthermia

Question 6

when does DT set in? how long can it persist?

Answer 6

48-96 hours after the last drink; can last 5 days

Question 7

risk factors for developing DT?

Answer 7

sustained drinking
prior DT episodes
over age 30
concurrent illness
significant withdrawal symptoms even in presence of elevated BAL

Question 8

mortality rate of DT?

Answer 8

5 percent

Question 9

where do we manage DTs? how do we treat them?

Answer 9

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

Question 10

wernicke’s encephalopathy is an ACUTE brain disorder that causes what in the midline brain structures?

Answer 10

petechial hemorrhages and necrosis in the midline brain structures

Question 11

clinical triad of wernicke’s?

Answer 11

encephalopathy/delirium
gait ataxia
oculomotor dysfunction

Question 12

you aren’t quite sure if your patient has wernicke’s. should you treat them anyways?

Answer 12

YES

always treat – can lead to coma and death if untreated

Question 13

true or false – get a thiamine blood level to diagnose wernicke’s

Answer 13

FALSE – a normal serum thiamine doeS NOT exclude wernicke’s encephalopathy

Question 14

administration of what can precipitate WE?

Answer 14

glucose administration

watch for this during early stages of recovery (due to banana bag)

Question 15

how do we treat wernicke’s encephalopathy?

Answer 15

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

Question 16

what is the chronic consequence of untreated or repeated episodes of wernicke’s?

Answer 16

korsakoff’s syndrome

Question 17

what are 3 characteristics of korsakoff’s syndrome?

Answer 17

1) cognitive impairment
2) retrograde and anterograde amnesia
3) brain atrophy seen on imaging

Question 18

which three brain structures appear atrophied on imaging of a patient’s brain who has korsakoff’s?

Answer 18

thalamus
corpus callosum
mammillary bodies

Question 19

what do we need to confirm our DX of korsakoffs?

Answer 19

specialized neurocognitive testing – specialty referral

Question 20

gait ataxia, poor motor coordination, inability to hand write, dysarthria (speech difficulty) make you think what?

Answer 20

cerebellar degeneration

Question 21

what causes cerebellar degeneration?

Answer 21

nutritional deficiency and neurotoxic effects of chronic alcohol use

Question 22

is the cognitive capability intact in cerebellar degeneration?

Answer 22

yes

Question 23

what is the prognosis for cerebellar degeneration?

Answer 23

may improve slightly with abstinence and good nutrition but is largely irreversible

Question 24

when do alcoholic hallucinations present? how long do they last?

Answer 24

24 hours after last drink

usually self-limited and gone by 3rd day

Question 25

are alcoholic hallucinations typically auditory or visual?

Answer 25

visual

Question 26

chronic alcoholic presents with jerky muscle spasms and loss of their reflexes … whats up?

Answer 26

peripheral neuropathy

Question 27

how do we treat peripheral neuropathy?

Answer 27

abstinence, ongoing thiamine PO, maximize nutrition

Question 28

acutely, myopathy can be associated with what three threatening conditions?

Answer 28

1) rhabdomyolysis
2) dysphagia
3) heart failure

Question 29

which of our alcohol disorders presents with a high aspiration risk, creating the need for a speech therapy evaluation before feeding?

Answer 29

myopathy