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M104 Symposia > M104 Alcohol symposia inpatients > Flashcards

M104 Alcohol symposia inpatients Flashcards

1
Q

What does ABCDE stand for?

A

Airway, Breathing, Circulation, Disability, Exposure

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2
Q

What does AVPU stand for?

A

Alert, Verbal, Pain, Unresponsive

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3
Q

What conditions is diazepam used to treat?

A

anxiety, alcohol withdrawal symptoms

muscle spasms, seizures

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4
Q

What are examples of alcohol withdrawal symptoms?

A

sweating, difficulty sleeping
tachycardia, intense anxiety, agitation
nausea, vomiting
shaky hands, seizures, hallucinations

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5
Q

What are the two types of alcohol withdrawal?

A

planned (in liasion with alcohol services, an arranged for community detox under supervision)
unplanned (when a patient with an unknown alcoholism develops withdrawal symptoms while in hospital admission due to lack of access)

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6
Q

Why is it important to get an alcohol history from all inpatients?

A

bc if they have an alcohol problem we don’t know about, 2 or 3 days into hospital admission they could develop unplanned alcohol withdrawal symptoms

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7
Q

What questionaires can be used to get an alcohol history from inpatients?

A

AUDIT

CAGE

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8
Q

What are the CAGE questions?

A

Have you ever thought you need to Cut down on your consumption?
Has anyone ever Annoyed you by suggesting that you’re drinking too much?
Have you ever felt Guilty about your drinking?
Have you had need to have a drink Early in the morning to prevent withdrawal symptoms?

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9
Q

What percentage of people dependent on alcohol will also have chronic liver disease?

A

about 20%

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10
Q

What is a key syndrome of alcohol withdrawal?

A

a delirium

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11
Q

What are the core features of a delerium?

A 
Disturbance of consciousness
Change in cognition or a hallucination
Tendency to fluctuate
Behaviour overactive or underactive
Disorganized thinking, poor memory, delusions and mood lability
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12
Q

What is a hallucination otherwise known as?

A

a perceptual disturbance

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13
Q

With the exception of alcohol withdrawal symptoms, what are other examples that cause derlerium and are associated with drugs?

A

Drug side effect
Drug overdose
Alcohol intoxication

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14
Q

With the exception of alcohol withdrawal symptoms, what are other examples that cause derlerium and are associated with age?

A 
Any infection (esp. in elderly)
Constipation (elderly)
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15
Q

With the exception of alcohol withdrawal symptoms, what are other examples that cause derlerium and are associated with medical conditions?

A 
Hypoxia
Wernicke encephalopathy
Hypoglycaemia
Meningitis / encephalitis
Psychiatric illness
Head injury
Hepatic encephalopathy
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16
Q

What is Fluoxetine otherwise known as?

A

Prozac

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17
Q

How does Temazepam work?

A

by slowing down the CNS (brain), causing drowsiness which helps patients fall asleep

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18
Q

What are warnings associated with Temazepam?

A

it can slow / stop breathing, especially if you have recently used an opioid medication, alcohol, or other drugs that can slow your breathing

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19
Q

What are spider naevi otherwise known as?

A

spider angiom

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20
Q

What does a low albumin level indicate?

A

that the liver is not working well and there might be liver failure

21
Q

What is the relationship between low albumin levels and liver function?

A

all proteins that create blood clots are made in the liver, so the combination is low albumin and prolonged clotting time indicates the liver is not working well

22
Q

What are the dietary sources of thiamine?

A

Wheat, Yeast, Oatmeal
Nuts
Potatoes, Pork
Marmite

23
Q

What is the daily nutrient requirement of thiamine?

A

approx. 1mg

24
Q

How much thiamine is stored by the body?

A

approx. 30mg

25
Q

How long after a thiamine free diet will a deficiency start?

A

after about 1 month

26
Q

What are the roles of thiamine as a co-enzyme?

A

involved in glucose and lipid metabolism
involved in the production of amacs
involved in the production of glucose derived NTs

27
Q

What is the most common cause of a thiamine deficiency?

A

alcoholism bc alcohol has calories but none of the nutrients or protein etc, including thiamine
alcohol can also inhibit active intestinal absorption, as can malnutrition, which is why these patients frequently are malnourished

28
Q

What is a cause of thiamine deficiency globally?

A

famine

29
Q

What is a cause of thiamine deficiency in the UK specifically?

A

hyperemesis gravidarum

30
Q

How are vitamin deficiencies in patients with hyperemesis gravidarum treated?

A

adequate replacement with IV vitamins

31
Q

What are the classic triad features of Wernicke’s Encephalopathy?

A

Confusion
Eye Signs - opthalmoplegia and nystagmus
Ataxia

32
Q

In what percentage of Wernicke’s Encephalopathy cases is the classic triad seen in?

A

only in 10% of cases

so the condition is underdiagnosed

33
Q

How does a thiamine deficiency affect the brain?

A

multiple small haemorrhages form, especially in upper brainstem, hypothalamus and thalamus, mamillary bodies

34
Q

What is the percentage mortality of neurological complications from a thiamine deficiency if left untreated?

A

20%

35
Q

What are the three features of Korsakoff’s Psychosis?

A

Permanent brain damage
Severe short term memory loss
Confabulation

36
Q

What happens if you give a patient who is nearly thiamine deficient a lot of glucose and why?

A

can cause absolute thiamine deficiency
bc thiamine being involved in the production of glucose derived NTs, any thiamine that they have available will be utilised with that glucose and then absolute deficiency can result

37
Q

What is done in hospitals to avoid precipitating a near-case of thiamine deficiency to an absolute case of thiamine deficiency?

A

the patient must have their glucose levels checked before feeding
parenteral thiamine must be administered before dextrose (a form of glucose that will exacerbate) is given

38
Q

How is thiamine deficiency treated?

A

pabrinex

Thiamine 250mg + others (very high dose)

39
Q

How often is thiamine deficiency treatment administered and how?

A

IV for 2-5 days depending on response

40
Q

After the cute phase of thiamine deficiency has been treated, how is the condition managed?

A

oral thiamine and other vitamins after initial treatment continuation
maintain good nutrition, no malnutrition

41
Q

What is the relationship between the alcohol by volume and the number of units in one litre of that drink?

A

the two are equal

42
Q

One litre of 4% Beer has how many units?

A

4 units

43
Q

How much pure alcohol is in 1 unit in grams?

A

8g pure alcohol

44
Q

How much pure alcohol is in 1 unit in mls?

A

10mls pure alcohol

45
Q

How many calories per gram of alcohol?

A

7 calories per gram

46
Q

How many calories per gram of carbohydrate?

A

4 calories per gram

47
Q

How many calories per gram of protein?

A

4 calories per gram

48
Q

How many calories per gram of fat?

A

9 calories per gram

49
Q

How many calories in one unit of alcohol?

A

1 unit = 8 grams = 56 calories!

M104 Symposia (11 decks)

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