Alcohol withdrawal in the acute care patient is complex, under-diagnosed, and often under or mistreated by utilizing mono-pharmacotherapy.
Alcohol withdrawal can begin from 6 to 24 hours following cessation of drinking or if a significant reduction in the usual alcohol consumption occurs .
Alcohol withdrawal delirium is typically experienced by the third day, and up to the fifth day of abstinence.
Seizures (usually grand-mal type) may occur in 5%–15% of patients during acute alcohol withdrawal and typically occur within 6 to 48 hours after alcohol cessation.
Delirium tremens occur in less than 5% of patients, usually 3 to 5 days after withdrawal, with mortality rates of 2%–10%. Hence ISPN (1) recommends all acute care patients who are at high risk(particularly trauma patients), or any patient who scores two positive answers on the CAGE screening tool should have blood alcohol concentration (BAC) determinations as well as urine toxicology screens performed on admission.and all acute care patients with either a positive CAGE or BAC should be assessed for the possibility of developing Alcohol Withdrawal Syndrome (AWS).
Management of patients with alcohol withdrawl symptom needs to me individualized and fixed dose regimens or PRN dosing without any mean of quantifying symptoms is not advisable.
Deficiency of GABA activity (enhanced by alcohol) with overactivity of certain NMDA receptors lead to symptoms of anxiety, disquiet, apprehension, motor hyperactivity, increased reaction to abrupt sensory stimuli, labile mood, insomnia etc. Benzodiazepines are the preferred therapy.
Increased epinephrine activity leads to adrenergic features of sweating, fever, hypertension, muscle tremors, mydriasis, nausea and vomiting, tachycardia and palpitations etc. These are best treated with a betablocker like propranolol/atenolol etc.
Increased glutamate related NMDA activity( suppressed by alcohol) might lad to delirium tremens with disorientation, impaired short-term memory, impaired reasoning, agitation, visual, auditory or tactile hallucinations etc. These best respond to haloperidol/ neuroleptic therapy.
Alcohol withdrawal can begin from 6 to 24 hours following cessation of drinking or if a significant reduction in the usual alcohol consumption occurs .
Alcohol withdrawal delirium is typically experienced by the third day, and up to the fifth day of abstinence.
Seizures (usually grand-mal type) may occur in 5%–15% of patients during acute alcohol withdrawal and typically occur within 6 to 48 hours after alcohol cessation.
Delirium tremens occur in less than 5% of patients, usually 3 to 5 days after withdrawal, with mortality rates of 2%–10%. Hence ISPN (1) recommends all acute care patients who are at high risk(particularly trauma patients), or any patient who scores two positive answers on the CAGE screening tool should have blood alcohol concentration (BAC) determinations as well as urine toxicology screens performed on admission.and all acute care patients with either a positive CAGE or BAC should be assessed for the possibility of developing Alcohol Withdrawal Syndrome (AWS).
Management of patients with alcohol withdrawl symptom needs to me individualized and fixed dose regimens or PRN dosing without any mean of quantifying symptoms is not advisable.
Deficiency of GABA activity (enhanced by alcohol) with overactivity of certain NMDA receptors lead to symptoms of anxiety, disquiet, apprehension, motor hyperactivity, increased reaction to abrupt sensory stimuli, labile mood, insomnia etc. Benzodiazepines are the preferred therapy.
Increased epinephrine activity leads to adrenergic features of sweating, fever, hypertension, muscle tremors, mydriasis, nausea and vomiting, tachycardia and palpitations etc. These are best treated with a betablocker like propranolol/atenolol etc.
Increased glutamate related NMDA activity( suppressed by alcohol) might lad to delirium tremens with disorientation, impaired short-term memory, impaired reasoning, agitation, visual, auditory or tactile hallucinations etc. These best respond to haloperidol/ neuroleptic therapy.
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