Psychiatric & Obstetric Emergencies

Question 1

What are the symptoms of alcohol withdrawal?

Answer 1

Symptoms can include:
* Tremor
* Diaphoresis
* Anxiety
* Palpitations
* Alcohol craving

Symptoms can develop as soon as 4-12 hours after the last drink.

Question 2

When do seizures peak after stopping alcohol?

Answer 2

Seizures peak 24 hours after stopping alcohol.

This is a critical time for monitoring.

Question 3

What is delirium tremens and when does it peak?

Answer 3

Delirium tremens peaks 48-72 hours after withdrawal and includes:
* Autonomic instability
* Hallucinations

Hallucinations can occur in any modality, including Lilliputian or formication visual hallucinations.

Question 4

What are the key components of the Wernicke’s triad?

Answer 4

The Wernicke’s triad includes:
* Ataxia
* Ophthalmoplegia
* Global confusion

The full triad is only present in less than 10% of cases.

Question 5

What are the symptoms of Korsakoff’s syndrome?

Answer 5

Symptoms include:
* Ante and retrograde amnesia
* Confabulation
* Apathy

Patients with Korsakoff’s are notably apathetic to their other symptoms.

Question 6

What is Pabrinex used for?

Answer 6

Pabrinex is used to treat Wernicke’s syndrome and contains:
* B1 (thiamine)
* B2 (riboflavin)
* B3 (niacin)
* B6 (pyridoxine)
* Vitamin C
* Glucose

It comes in 2 vials which are made up into 1 dose.

Question 7

How is Pabrinex administered?

Answer 7

Pabrinex can be given IV or IM and is typically administered as:
* 3 doses OD for any suspicion of Wernicke’s
* 2 days, can continue for 4-5 days

It is painful if given IM due to large volume.

Question 8

What is the preferred drug for hepatic failure in alcohol withdrawal treatment?

Answer 8

Lorazepam is the drug of preference in hepatic failure.

Librium (chlordiazepoxide) has a half-life of approximately 2 days.

Question 9

What advice should be given regarding alcohol consumption after withdrawal?

Answer 9

Patients should be advised not to suddenly discontinue alcohol.

HSE safe alcohol limits are 17 units for men and 11 units for women.

Question 10

What tools are used for screening alcohol use disorder (AUD)?

Answer 10

Screening tools include:
* CAGE questionnaire
* AUDIT questionnaire
* Severity of alcohol dependence questionnaire (SADQ)

CAGE and AUDIT are considered pointless for known alcoholics.

Question 11

What are some physical consequences of alcoholism?

Answer 11

Consequences can include:
* Unintentional and intentional injuries
* GIT disease (oesophagitis, PUD, Mallory-Weiss tear)
* Hepatic disease (cirrhosis)
* Cardiovascular disease
* Erectile dysfunction
* Infections (Klebsiella pneumonia)
* Cancers (breast, liver, etc)
* Pregnancy complications (foetal alcohol syndrome, prematurity)

Foetal alcohol syndrome includes microcephaly, learning difficulties, cardiac malformations, thin vermillion border, and short palpebral fissure.