L10: Substance Abuse Toxicity Flashcards
Difficulties arise in diagnosing the withdrawal syndrome due to …..
- Patients will deny significant ethanol and opioid abuse.
- Patients present with a spectrum of signs and symptoms that confused with other illnesses.
Withdrawal syndromes are most commonly seen in patients who use ……
- Ethanol
- Sedative-hypnotic agents
- Opioids on a chronic basis.
The most severe withdrawal symptoms are usually associated with …..
ethanol and other sedative-hypnotic agents.
- Withdrawal from these sedative agents can produce ……
- The withdrawal syndrome associated with opioid abstinence is ……
- life-threatening problems.
- generally not life threatening.
Factots affecting severity of withdrawl syndrome
Intro to AUD
Dx of AUD
DSM5 Creiteria of AUD
- Large Amount
- Persistent Desire
- Huge Time
- Strong Craving
- Multiple Troubles
- Decreased Activities
- Pesistent Use
- Tolerance
- Withdrawal
Large Amount
Take Alcohol in large amounts or for long duration.
Persistent Desire
To control alcohol with unsuccessful results
Huge Time
- Spent a huge time to obtain alcohol, use it or recover from its effects
Strong Craving
Continuous Craving “a strong desire” to use it.
Multiple Troubles
Reported major troubles at home, school, work & social relationship due to alcohol abuse.
Decreased Activities
Decrease social, occupational or recreational activities due to alcohol dependence.
Persistent Use
- Continuous use of Alcohol despite its exacerbation for recurrent medical problems.
- Continuous use of Alcohol despite its exacerbation for recurrent psychological problems.
Tolerance
Tolerance to alcohol occurs, which defining by one of the following:
- Incraesed Dose of alcohol to achieve same mental desired effect.
- Decreased Mental desired effect that obtain by alcohol in same persistent alcohol dose.
Withdrawl
- Presence of characteristic withdrawal manifestations to alcohol
- Subside of those alcoholic withdrawal manifestations by benzodiazepines given
Severity degrees of alcohol abuse
CP of AUD
CVS CP of AUD
- Atrial fibrillation
- Cardiomyopafhy
GIT CP of AUD
- Hepatitis
- Pancreatitis.
- Gastritis
- Cirrhosis
- Esophageal varices
- GIT hemorrhage
- Malabsorption
Malignancy in CP of AUD
- Breast
- Esophagus
- Larynx
- Oropharynx
- Hepatic
- Colorectal
Hematolgical CP of AUD
- Anemia
- Leucopenia
- Thrombocytopenia
- Coagulopathy
- Macrocytosis
Psychiatric CP of AUD
- Hallucination
- Delusions
- Depression and suicide
Endocrine CP of AUD
- Hypoglycemia
- Hypogonadism
- Osteoporosis
- Steatosis
Neurological CP of AUD
- Dementia
- Cerebellar degeneration
- Peripheral neuropathy
- Korsakoff’s syndrome
- Wernicke’s encephalopathy
Electrolytes CP of AUD
Decreased
- Ca
- Mg
- K
- PO4
Malnutrition in CP of AUD
- Stomatitis
Decreased Folate, Niacin (pellagra), Vitamin C (scurvy)
When does Alcohol withdrawal criteria start?
- The alcoho/ withdrawal syndrome usually develops within 6-24 hours of stop or reduction in alcohol consumption in dependent cases.
- It commonly develops in patients admitted to hospital.
Toxic action of Alcohol
CP of Alcohol Withdrawal
- Autonomic Excitation
- Neuro-Excitation
- Delirium Tremens
Onset & Peak of Autonomic Excitation of Alcohol Withdrawal
Starts within hours of cessation and peaks at 24-48 hours
Manifestations of Autonomic Excitation of Alcohol Withdrawal
Tremor & Asterixis
Anxiety & Agitation
Hyperthermia & Sweating
Hypertension & Tachycardia
Nausea & Vomiting
Onset & Peak of Neuro Excitation of Alcohol Withdrawal
Starts within 12-48 hours of alcohol cessation.
Manifestations of Neuro Excitation of Alcohol Withdrawal
- Hyperreflexia & Seizures “Generalized Tonic-Clonic”
- Nightmares & Hallucinations “Visual, Tactile & Occasionally Auditory”
Def of Delirium Tremens
It is a severe form of alcoholic withdrawal manifestations
Incidence of Delirium Tremens
Up to 20% of patients admitted to hospitals with alcohol withdrawal
Severity of Delirium Tremens
Up to 8% mortality rate
Criteria of Delirium Tremens
Associated with other medical co-morbidities and delayed presentation
Manifestations of Delirium Tremens
- Hallucinations & Confusion
- Disorientation & Clouding of consciousness
- Respiratory & Cardiovascular collapse
- Severe Autonomic hyperactivity & Death
Co-Morbidities of High alcohol intake
Manifestations of Wernike’s encephalopathy
TTT of Alcohol withdrawal
- Mild Forms of Alcohol Withdrawal
- Severe Forms of Alcohol Withdrawal
Managment of Mild Forms of Alcohol Withdrawal
Managment of Severe Forms of Alcohol Withdrawal
(Supportive & Emergency Care in an Inpatient Setting) “Minority of Cases”
- Site
- Indications
- Type
- Emergency TTT
- Maintenace TTT
Site of Managment of Severe Forms of Alcohol Withdrawal
They are managed in inpatient clinic setting
Indications of Managment of Severe Forms of Alcohol Withdrawal
As in cases with high risk of:
- Presence of significant medical co-morbidities,
- Presence of significant psychiatric co-morbidities.
- Presence of persistent abnormal vital signs
Type of managment of Severe Forms of Alcohol Withdrawal
Delirium tremens treatment
Emergency TTT in Managment of Severe Forms of Alcohol Withdrawal
Maintainence TTT in Managment of Severe Forms of Alcohol Withdrawal
Investigations in Alcohol Withdrawal
Disposition & Follow Up in Alcohol Withdrawal
- Referral to home detoxification and psychosocial support
- Once Acute Withdrawal is controlled or resolving.