Alcohol withdrawl

Question 1

mechanism

Answer 1

chronic alcohol consumption enhances GABA mediated inhibition in the CNS (similar to benzodiazepines) and inhibits NMDA-type glutamate receptors
alcohol withdrawal is thought to be lead to the opposite (decreased inhibitory GABA and increased NMDA glutamate transmission)

Question 2

features

Answer 2

1. symptoms start at 6-12 hours: tremor, sweating, tachycardia, anxiety
2. peak incidence of seizures at 36 hours
3. peak incidence of delirium tremens is at 48-72 hours: coarse tremor, confusion, delusions, auditory and visual hallucinations, fever, tachycardia

Question 3

management

Answer 3

1. first-line: benzodiazepines e.g. chlordiazepoxide. Typically given as part of a reducing dose protocol
2. carbamazepine also effective in treatment of alcohol withdrawal ( anti seizure med)

phenytoin is said not to be as effective in the treatment of alcohol withdrawal seizures

Question 4

delirium tremens

Answer 4

is a rapid onset of confusion usually caused by withdrawal from alcohol. When it occurs, it is often three days into the withdrawal symptoms and lasts for two to three days