PACES Cases

Question 1

Traditional history of alcohol withdrawal?

Answer 1

Sweating, nausea, hands shaking (tremor), headache

Symptoms worse in the morning, relieved by alcohol intake

Question 2

What are especially relevant questions to ask a patient worried about alcohol withdrawal?

Answer 2

CAGE - do you feel you should cut down, do you feel angry when criticised, do you feel guilty about drinking, do you feel you need an eye opener

Question 3

When do you provide inpatient management of alcohol detoxification?

Answer 3

At risk of suicide
Lack social support
History of severe withdrawal symptoms

Question 4

What are the 4 drugs used in alcohol detoxification?

Answer 4

Thiamine (oral 50mg BD for 3 weeks)
Chlordiazepoxide (10mg QDS) for withdrawal
Disulfiram (stay sober)
Acamprosate (reduce craving)

Question 5

What is delirium tremens?

Answer 5

48-72 hrs after last drink
Severe withdrawal syndrome
Agitation, confusion, visual and auditory hallucinations, paranoia, TREMOR