Exam 4: ETOH Flashcards
Onset of EtOH withdrawal s/s
- tremulousness: 6-36 hrs post drink
- hallucnations: 12-48 hrs post drink (usually non-threatening and mainly auditory - but if this is present, pt is going through major withdrawal)
- seizures: 6-48 hrs post drink (Gengo says 72)
- delirium tremens: 48-96 hours post drink
Most serious complication of EtOH withdrawal
delirium tremens
management/ppx of EtOH withdrawal
- thiamine
- D5W and NaCl 0.45%
- multivitamin
- standing orders for clonidine (anxiety), benzodiazepine (usually lorazepam)
EtOH sobriety meds (ranked by gengo bias)
- acamprosate - decreases craving
- naltrexone - decreases craving but you’re fucked if u need opioid pain meds
- disulfiram - punishes you
not a med, but we like our support groups :)
Why do alcoholics drink?
To keep from feeling bad
* anxious
* jittery
* sweaty
“relief is just a sip away”
Withdrawal criteria is defined as 2+ of the following:
occurs hrs-days after:
* Autonomic hyperactivity (sweat, tachy)
* hand tremor
* insomnia
* N/V
* transient visual/tactile
* Auditory hallucinations!!!!
* psychomotor agitation, anxiety
* GRAND MAL SEIZURES!!!!
Clinical signs of delirum tremens
HTN
tachycardia
fever
Sx of delirium tremens
Confusion, disoreiented
hallucinations (auditory>visual)
hyperresponsiveness
Risk factors for delirum tremens development
- Acute/concurrent mental illness
- history of siezure or DT
- longer hx/heavier drinking
- Age > 60
- elevated BAL on admit (0.30) or >300g/dL
If a patient in alcohol withdrawal presents with seizures, do we treat with antiepileptic drugs?
No, they are not diagnosed with epilepsy
How does seizure risk correlate with alcohol amount?
51-100g = 3x risk
101-200 = 8x risk
201-300 = 20x risk
Alcohol CNS depresssant MOA
Gaba inhibiton theory: etoh enhance inhibitory CL influx mediated by GABA = sedation
* Chronic use: tolerance develops, GABA function is downregulated
NMDA receptor inhibited: diminish excitatory effect of glutamate
* Chronic use: NMDA upregulation long term
Sudden withdrawal: hyperexitable neurons
* GABA a activation is low
* NMDA activation is high
* = sx of withdrawal
The more you drink the ___ you ____ hepatic metabolism of alcohol
More induction
increases capacity of etoh dehydrogenase = not much left by morning = withdrawal sx, need another drink
What type of benzos generally preferred for hospital inpatient tx of withdrawal?
Long acting benzos
- diazepam
- chlordiazepoxide
maybe intermediate: alprazolam
