Substance Abuse

Question 1

What are the early & late physical exam findings seen in patients with alcohol withdrawal?

Answer 1

With Alcohol there is no predictor of who will go into DTs

Early symptoms of withdrawal

• Hallucinations: Auditory hallucinations are the most common EARLIEST type of hallucinations secondary to alcohol withdrawal.
• Elevated temperature, blood pressure, pulse
• Anxiety
• Diaphoresis

Late symptoms of withdrawal

• Seizures
• Death

Question 2

What lab/diagnostic tests are done for patients in alcohol withdrawal?

Answer 2

• Toxicology- Urine/serum drug screen
• Alcohol level: people who have abuse etoh for years may normally have high blood alcohol levels, yet still go into withdrawal if they experience a sudden drop in their usual alcohol intake/blood alcohol level
• Liver function studies, including ammonia level
• Electrolytes
• Serum amylase – r/o pancreatitis
• CBC with differential – MCV is elevated with chronic alcoholism
• Serum Carbohydrate-deficient transferrin (CDT) – detects longstanding ingestion of high amounts of alcohol; MOST SPECIFIC lab test confirming alcohol abuse