Alcohol withdrawal (psychoactive substance use)

Question 1

Who does alcohol withdrawal affect?

Answer 1

-If left untreated, 6% of alcohol-dependent patients develop clinical symptoms of withdrawal
-10% of these develop delirium tremens

Question 2

What causes alcohol withdrawal?

Answer 2

-Process of withdrawal can lead to:
–Delirium tremens
–Wernicke-Korsakoff syndrome (brain damage caused by severe vitB1 deficiency)
–Seizures
–Depression
–Electrolyte disturbance
–Associated liver disease complications

Question 3

What risk factors are there?

Answer 3

-Previous delirium tremens or seizures
-Presence of autonomic overactivity
-<18 y/o’s

Question 4

How does alcohol withdrawal present?

Answer 4

-Onset occurs 8h after significant fall in blood alcohol levels
-Peaks on day 2 and improve by day 4/5
-Minor symptoms:
–Insomnia, fatigue
–Tremor
–Anxiety / nervousness
–Restlessness
–N+V
–Headache
–Excessive sweating
–Palpitations
–Anorexia
–Depression
-More severe symptoms:
–Hallucinations can occur 12-24 hours after cessation (auditory, visual, tactile)
–Seizures can occur 24-48 hours after (generalised tonic-clonic)
-Delirium tremens can appear 48-72 hours after

Question 5

What are the differential diagnoses for alcohol withdrawal?

Answer 5

-Wernicke’s encephalopathy
-Korsakoff’s syndrome
-Psychosis(?)

Question 6

What treatment would you consider in someone with alcohol withdrawal?

Answer 6

-Hospital admission for those with severe RFs / any safety concerns
-Benzodiazepines are the recommended drugs for detoxification - slower onset so less chance of abuse
-Reducing dose of chlordiazepoxide over 5-7 days // diazepam as alternative
-Parenteral high-potency B complex vitamins (Pabrinex) is given as prophylaxis for WKS (caution risk of anaphylaxis)