Alcoholism

Question 1

What is the derilium tremens, DT? When is the onset? How long does it last?

Answer 1

Serious form of alcohol withdrawal presented with alto sensorium and autonomic instability. onset typically 2 to 3 days after last drink, symptoms may persist up to seven days

Question 2

Examination of this patient includes identifying what?

Answer 2

Applications of chronic alcohol use : Malnutrition, liver disease, pancreatitis and ruling out altered mental status: infection, trauma, Hepatic encephalopathy, drug overdose, metabolic derrangements

Question 3

Explained neuropsychiatric examination for this patient?

Answer 3

Confused, disoriented, and combative

Question 4

For a patient with confusion secondary chronic alcoholism (DT) what should be done in emergency care?

Answer 4

Cardio pulmonary monitoring, EKG, pulse oximetry, supplemental oxygen, IV access, buying me 100 mg, folic acid 1 mg daily, normal saline bolus and continuous, Lorazepam, blood glucose, NPO, seizure and aspiration precautions

Question 5

What order should be done for this patient at the floor?

Answer 5

Assessed for complications: CBC, BMP, Sarah and magnesium and phosphorus, LFTs, PTT, PT/INR, draw blood for culture lumbar puncture if fever, ABGs, chest x-ray, CT scan of head, urine toxicology, blood alcohol levels

Question 6

Why is CBC done?

Answer 6

Macrocytosis, thrombocytopenia, elevated white blood cells secondary to infection

Question 7

Why do we draw blood for patients who have DT?

Answer 7

Infection may be associated with DT

Question 8

Why is a lumbar puncture done for this patient?

Answer 8

Exclude meningitis but is not needed unless signs of infection are present including fever leukocytosis meningeal

Question 9

Why is a chest x-ray done for this patient?

Answer 9

To rule out associated chest infection and possibility of aspiration and a patient who has altered mental status

Question 10

Why is a ABG done for this patient?

Answer 10

To rule out alcoholic keto acidosis

Question 11

What are the lab results?

Answer 11

Macrocytosis, mild degree of hyponatremia, magnesium and phosphorus are low, blood glucose is low, LFTs are mildly elevated with mild hyperalbuminemia, Mild elevation of PT, ABG shows elevated pH with low PCO2

Question 12

We should be recommended in patients who have chronic alcoholism?

Answer 12

Rehabilitation, alcoholics anonymous, counsel about safe sex, limiting alcohol intake, smoking cessation, GW’s, safety

Question 13

When is the onset for DT? Mild with drawl?

Answer 13

48 hours; Six hours to 24 hours

Question 14

When is the earliest a patient can have seizures

Answer 14

12 hours

Question 15

What are the symptoms for minor withdrawl symptoms? What does withdraw and chronic users affect on the CNS?

Answer 15

G.I. upset, headache, palpitations, anxiety, insomnia, diaphoresis, tremors; Hyperactivity of parts of the CNS especially sympathetic nervous system

Question 16

Generalized tonic clonic seizures can occur when? When does this become suspicious to investigate other causes?

Answer 16

12 to 48 hours of withdraw, the presence of status epilepticus or prolong seizures are rare and ship pronto vesication for other causes such as CNS Mas or in

Question 17

What is alcoholic hallucinosis?

Answer 17

Visual hallucinations typically, can be tacked out or auditory, patients have intact orientation and normal vital signs. This can happen 12 to 48 hours

Question 18

How is delirium tremens defined and what effect does it have on pH?

Answer 18

Hallucination, disorientation autonomic instability and agitation begin 48 to 96 hours I can last up to seven days patients typically hyperventilate and have resultant respiratory alkalosis

Question 19

What is severe alcohol withdrawal?

Answer 19

Fluid and electrolyte disturbances such as hypovolemia, hypokalemia, hypomagnesiumemia (dysrhythmias, seizures), hypophosphatemia (cardiac failure, rhabdomyolysis)

Question 20

Benzodiazepines are use for what reason?

Answer 20

Psychomotor agitation and with drawl symptoms

Question 21

Why should Thiamine be given before Glucose?

Answer 21

To reduce risk of precipitating Warnicke encephalopathy and Korsakoff syndrome

Question 22

What are the indications for placing alcohol withdrawal patients in the ICU?

Answer 22

Marked acid-based disturbances, respiratory insufficiency, persistent hyperthermia, cardiac or liver disease, or the need for high doses of sedatives

Question 23

How is DT treated?

Answer 23

Initially with IV lorazepam, once vital signs are stable the patient is given PO Chlordiazepoxide (Librium)

Question 24

How should haldol be used?

Answer 24

PRN in combination with benzodiazepines for agitated patient

Question 25

What drug should not be used as an antipsychotic in DT patients?

Answer 25

Phenothiazine because they may lower seizure threshold