Alcoholism Flashcards
What is the derilium tremens, DT? When is the onset? How long does it last?
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
Examination of this patient includes identifying what?
Applications of chronic alcohol use : Malnutrition, liver disease, pancreatitis and ruling out altered mental status: infection, trauma, Hepatic encephalopathy, drug overdose, metabolic derrangements
Explained neuropsychiatric examination for this patient?
Confused, disoriented, and combative
For a patient with confusion secondary chronic alcoholism (DT) what should be done in emergency care?
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
What order should be done for this patient at the floor?
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
Why is CBC done?
Macrocytosis, thrombocytopenia, elevated white blood cells secondary to infection
Why do we draw blood for patients who have DT?
Infection may be associated with DT
Why is a lumbar puncture done for this patient?
Exclude meningitis but is not needed unless signs of infection are present including fever leukocytosis meningeal
Why is a chest x-ray done for this patient?
To rule out associated chest infection and possibility of aspiration and a patient who has altered mental status
Why is a ABG done for this patient?
To rule out alcoholic keto acidosis
What are the lab results?
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
We should be recommended in patients who have chronic alcoholism?
Rehabilitation, alcoholics anonymous, counsel about safe sex, limiting alcohol intake, smoking cessation, GW’s, safety
When is the onset for DT? Mild with drawl?
48 hours; Six hours to 24 hours
When is the earliest a patient can have seizures
12 hours
What are the symptoms for minor withdrawl symptoms? What does withdraw and chronic users affect on the CNS?
G.I. upset, headache, palpitations, anxiety, insomnia, diaphoresis, tremors; Hyperactivity of parts of the CNS especially sympathetic nervous system
Generalized tonic clonic seizures can occur when? When does this become suspicious to investigate other causes?
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
What is alcoholic hallucinosis?
Visual hallucinations typically, can be tacked out or auditory, patients have intact orientation and normal vital signs. This can happen 12 to 48 hours
How is delirium tremens defined and what effect does it have on pH?
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
What is severe alcohol withdrawal?
Fluid and electrolyte disturbances such as hypovolemia, hypokalemia, hypomagnesiumemia (dysrhythmias, seizures), hypophosphatemia (cardiac failure, rhabdomyolysis)
Benzodiazepines are use for what reason?
Psychomotor agitation and with drawl symptoms
Why should Thiamine be given before Glucose?
To reduce risk of precipitating Warnicke encephalopathy and Korsakoff syndrome
What are the indications for placing alcohol withdrawal patients in the ICU?
Marked acid-based disturbances, respiratory insufficiency, persistent hyperthermia, cardiac or liver disease, or the need for high doses of sedatives
How is DT treated?
Initially with IV lorazepam, once vital signs are stable the patient is given PO Chlordiazepoxide (Librium)
How should haldol be used?
PRN in combination with benzodiazepines for agitated patient
What drug should not be used as an antipsychotic in DT patients?
Phenothiazine because they may lower seizure threshold
