The clinician perspective Flashcards
Mild symptoms of alcohol withdrawal are how long after last drink?
12-36 h
Moderate symptoms
12h-5 days
when are the severe symptoms time frame
12h-7 days
What are the mild symptoms
Fien tremors, sweating, anxiety, hyperactivity, inc HR, inc BP, fever, anorexia, nausea, retching
What are the moderate symptoms?
Coarse tremor, shaking, agitation, confusion, disorient action, paranoia, seizures ( esp 24-48h), hallucinations
What are the severe symptoms?
More severe and prolonged, risk of DVTs around 48h, severe agitation, anxiety, confusion, delusions, hallucinations (tactile visual-crawling beasties). Circulating collapse and death can occur
What does an alcohol withdrawal seizure look like
Sudden cessation/ reduction in alcohol 2-24h previous
Generalised TC
Clustered over a few hours
What does epileptic seizures look like?
Alcohol ingestion precipitated seizures in susceptible individuals
Usually am, after acute intoxication
Any pattern- TC vs Focal
How might this affect the nerves and muscles
peripheral neuropathy- “glove and stocking”
What is compression neuropathy
Temporary damage to myelin sheath - radial nerve compression at humeral head
What is Wernickes encephalopathy
Thiamine deficiency and cytotoxic oedema in maxillary bodies
What is the treatment for Wernickes encephalopathy and how quickly do the symptoms resolve
thiamine replacement
results in resolution of symptoms within hours
What is Korsakoff syndrome?
Cerebral atrophy resulting from WE.
What are the three possible types of amnesia relating to Korsakoff syndrome?
- Profound anterograde amnesia(unable to retain new information)
- Variable retrograde amnesia- episodic memory
- Confabulation- replaces memory with information able to retain at that time- believe it to be true
Through what pathway and where is alcohol metabolised?
Metabolised through oxidative pathways in the liver
How quickly does holiday heart tend to resolve?
24 hours
What is the 5th most common cause of death in the UK
Liver
What is more important when it comes to alcohol related problems- type or amount?
amount
What results from regular heavy drinking
Regular heavy drinking Accumulation in hepatocytes Inflammation Fibrosis Cirrhosis
What is the most universal problem of heavy drinkers
Alcohol related steatosis
- hepatocytes swell with triglycerides
What is alcohol related hepatitis
Acute life threatening manifestation
What is alcohol related cirrhosis?
Progressive fibrosis
architectural distortion
cirrhosis +/- portal hypertension
What is the use of abstinence in alcohol related cirrhosis?
Absence can restore synthetic function even in decompensated cirrhosis
What are potential treatments?
Abstinence, vitamins, nutrition, endoscopic, pharmacological, rifaximin, radiological-TIPPS, surgical-treatment
How does acamprosate work?
reduce cravings
How does naltrexone work?
Reduces desire for alcohol
How does disulfiram work?
aversion drug therapy
How does Nalmefene work?
Opiod antagonist
