Alcoholism

Question 0

Alcohol and lipid levels

Answer 0

modest alcohol intake (max 1-2 drinks per day) associated w increase in HDL; but alcohol use increased triglyceride levels!

Question 1

Alcoholism prevalence and screening

Answer 1

10-15% of ppl (alcohol abuse or dependence)
genetic component (esp sons at inc risk)

screening
CAGE

MAST

Question 2

Laboratory findings in alcoholism

Answer 2

• anemia
• macrocytic (most common): due to folate deficiency
• microcytic: due to GI bleeding
• LFTs: increased GGT; AST/ALT ratio is 2:1
• hypertriglyceridemia
• hyperuricemia, hypocalcemia
• thiamine deficiency (B1)
• decreased testosterone level

Question 3

Complications of alcoholism

Answer 3

1. GI: gastritis, esophagitis, peptic ulcer dz, alcoholic liver dz (alcoholic hepatitis, cirrhosis, portal htn), pancreatitis (acute and chronic), mallory-weiss tears
2. cardiac: alcoholic cardiomyopathy, essential htn (more than 3 drinks/day significantly increases bp)
3. CNS
   a. Wernicke’s encephalopathy: often reversible; caused by thiamine (B1) deficiency; manifests as nystagmus, ataxia, opthalmoplegia, confusion

b. Korsakoff’s psychosis: irreversible; caused by thiamine (B1) deficiency; alcohol-induced amnestic disorder; mostly affects short term memory; confabulation is common

4. pulmonary: pneumonia, aspiration
5. nutritional deficiencies: vitamins, minerals; esp thiamine deficiency, hypomagnesemia, and folate deficiency
6. peripheral neuropathy: due to thiamine deficiency
7. sexual dysfunction: impotence, loss of libido
8. psychiatric: depression, anxiety, insomnia
9. increased risk of malignancy: esophagus, oral, liver, lung
10. frequent falls, minor injuries, motor vehicle accidents

Question 4

Clinical pearl: alcohol withdrawal

Answer 4

features: tachycardia, sweating, anxiety, hallucinations
goal: prevent progression to delirium tremens (DT), a medical emergency (mortality rate 20%); DT occurs in 5% of alcoholic withdrawals

DT: delirium developing within a week of last alcoholic intake, usually 2-4 days after last drink; characterized by tactile hallucinations, visual hallucinations, confusion, sweating, increased tachycardia, elevated BP

risk factors: pancreatitis, hepatitis, other illnesses; DT rare in healthy ppl

treatment: benzodiazepenes if withdrawal sx present; prevention of DT is best treatment

diet important in treatment (high in calorie, high in carbohydrates, multivitamins)

Question 5

Treatment of alcoholism

Answer 5

1. AA
2. disulfiram (antabuse): pt experiences shortness of breath, flushing, palpitations, tachycardia within minutes of drinking alcohol; if more alcohol taken –> headache, nausea/vomiting ensue; sx last about 90 mins; appropriate for short term use, should not be taken chronically!
3. naltrexone (trexan): improve abstinence rates; reduces cravings for alcohol
4. drugs for withdrawal: benzodiazepenes (best to use long-acting agents like diazepam)
5. correction of fluid imbalance, vitamin supplementation (thiamine, folate, multivitamins)