Alcohol Withdrawal Syndrome Flashcards
The DSM-5 describes alcohol withdrawal syndrome (AWS) as…
2+ symptoms after a decrease in heavy + prolonged drinking, causing significant distress or impairment in social, occupational, or other important areas of functioning
Not attributable to another medical condition
A mnemonic for the symptoms of alcohol withdrawal symptom is…
HAS A PINT
H - hallucinations/illusions/DTs
A - autonomic hyperactivity (sweats, HR)
S - seizures
A - anxiety
P - psychomotor agitation
I - insomnia
N - N/V
T - tremor of the hand
AWS symptoms can manifest as early as…
4-12 hours after the last drink, usually around 6-24h. Peaks on day 2-3.
Seizure risk with AWS is greatest…
In the first 72 hours
Symptoms of delirium tremens (DTs) involves…
Severe confusion, disorientation, and/or hallucinations, with clouding of global sensorium and severe autonomic hyperactivity
Loss of consciousness
Severe autonomic hyperactivity = tachycardia, HTN, hyperthermia, agitation, sweating
DTs is the most serious complication of alcohol withdrawal since its mortality rate is…
~5%
DTs usually begins after ____ and lasts for _____
48-96hr after the last drink, lasts for 1-5 days
The two notable neurotransmitters involved in AWS is…
GABA (inhibitory) and Glutamate (excitatory)
The balance between inhibitory and excitatory states in a non-alcoholic is…
Balanced
The balance between inhibitory and excitatory states in intoxication in an occasional user is…
Increased inhibitory - GABA + alcohol
Relaxed, sleepy state
The balance between inhibitory and excitatory states in someone with chronic and regular alcohol use is…
Balanced - glutamate is upregulated to compensate for inhibitory effect of alcohol
The balance between inhibitory and excitatory states in someone in alcohol withdrawal is…
Excitatory - glutamate is upregulated
Risk factors for AWS include…
Increased quantity, frequency, and duration lf alcohol use
Previous/family hx of alcohol withdrawals
Concurrent medical conditions
Consumption of sedatives/hypnotics/anxiolytics
Complications of AWS include…
Relapse
Aspiration
Arrhythmias
Seizures, DTs
Prolonged hospitalization
Brain damage
Death
The most useful screening tool for predicting a patient’s risk of developing severe complications related to alcohol withdrawal is…
PAWSS - Prediction of Alcohol Withdrawal Severity Scale
The most commonly used medications for AWS are…
Benzodiazepines
Reduce risk of seizure and DTs
This medication is often used in addition to benzos, because…
Clonidine - suppress noradrenergic symptoms that do resolve with benzos (anxiety, HTN, tachycardia)
“symptomatic relief”
Adjunctive/alternative therapies for AWS may include…
Carbamazepine
Gabapentin
Baclofen
Beta-blockers
Haloperidol
GABA activity
CNS depression
Helping with withdrawal activity
BZD’s are most effective for AWS due to their MOA, which involves…
Binding to BZD binding site on GABA receptors, increasing GABA binding affinity and increase inhibitory action of GABA
The BZD’s used for AWS are ____, and the difference between them is…
Lorazepam and diazepam; difference in their half-life. Lorazepam is shorter and has inactive metabolites
This scale measures the severity of alcohol withdrawal symptoms:
CIWA - Clinical institute Withdrawal Assessment for Alcohol
The purpose of CIWA is to measure severity of…
Withdrawal symptoms, and give certain dose of BZD to balance treating sx’s and avoiding too much CNS depression
Often used with an order set to help with dosing
Lorazepam can be given…
PO, IM, SC, or IV
Diazepam can be given…
PO or IV
o
Supportive care that is given for AWS patients include…
Thiamine
Folate
Multivitamin
Electrolyte (if needed for correction)
Fluids
Thiamine is given to AWS patients to help with…
Preventing Wernicke-Korsakoff’s syndrome, peripheral neuropathy, and cardiomyopathy
Folate is given to AWS patients to help with…
Preventing and correcting anemia
Multivitamins are given to AWS patients to help with…
Preventing and correcting micronutrient deficiency
Electrolytes may be given to AWS patients to help with…
Preventing electrolyte imbalances and life-threatening complications (such as arrhythmia, coma)
Fluids are given to AWS patients to help with…
Correcting hypovolemia and dehydration from sweating, vomiting, diarrhea, and fever
Evidence for supportive care in AWS is…
Limited/RCT data insufficient, but is often the standard of care
