Alcohol Withdrawal Syndrome Flashcards
What is alcohol withdrawal syndrome?
Acute toxic state that happens with sudden stop of alcohol intake
- seventy depend on how long and how much ETOH ingested
- s/s develop hours after 1st drink
Stage I of Withdrawl
6-12 hours
- Mild anxiety
- Alcohol craving
Stage II of Withdrawal
24- 36 hours
- Immediate severity
- Excessive adrenergic effects (hallucinations)
Stage III of Withdrawal
12-48 hours
- Tonic Clonic Seizures
- once Seizures are experienced they’ll always have Seizures when withdrawing
Stage IV of Withdrawal
48-72 hours
- Delirium Tremens
- these occur after Seizure
Magnesium & ACh (acetylcholine) relationship
Mg+ suppresses ACh (acetylcholine)
- Mg+ levels in alcoholics are always low. Mg+ comes from food. They do not eat because of drinking.
Once drinking stops ACh is released with not enough Mg+ in the body to suppress it.
Seizures
Peaks 24 hours following recent ETOH ingestion
- Brief Tonic Clonic seizures w/o aura
- 1-3 seizures
- seizures usually progress onto DT’s (Delirium Tremens)
Delirium Tremens
Life- Threatening
- high mortality rate of left untreated
- Altered LOC - Anxiety
- shaking - confusion - tremors
- irritability - agitation - insomnia
Banana Bag
Folic Acid: regenerate & protect myelin sheath. ⬆️ RBC production
Vit B12: ⬇️ vit b12 damages myelin sheath. ⬇️ vit b12 can lead to peripheral neuropathy
Thiamine: synthesis of ACh. ⬇️ thiamine = Wernick
Magnesium: controls release and effects of ACh
Pharmacological management Alcohol Withdrawal
Benzodiazepines: Ativan
* given around the clock on time. Ativan 1 gm @6H*
Cardiovascular agent; Propranolol & Clonidine ⬇️HR ⬇️ RR
Anesthetics: Propofol
IV hydration
Therapeutic
- Place patient in calm non stressful environment
- lighted room to ⬇️ potential illusion or hallucinations
- dimly lit room can cause hallucinations/ illusions*
- Sitter 1:1
“Classic Hangover “
- Early Mild alcohol withdrawal symptoms
- relived by ingestion of Additional alcohol ingestion
