Alcohol intoxication/withdrawal Flashcards
(44 cards)
What are 4 ways that patients suffering from alcoholism may present?
- Acute intoxication
- Withdrawal syndromes
- Nutritional deficiency syndromes
- Chronic toxicity (liver, CNS, peripheral neuromyopathy etc.)
What are 6 ways that acute alcohol intoxication can present?
- Disinhibition
- Euphoria
- Incordination
- Ataxia
- Stupor
- Coma
How should a history be obtained in acute alcohol intoxication?
obtain history from friends or relatives
What are 3 things to look for on examination in acute alcohol intoxication?
- Signs of chronic liver disease
- Trauma
- Signs of infection
What are 7 complications of alcohol toxicity?
- Acute gastritis causing nause and vomiting, abdo pain, GI bleeding
- Respiratory depression and arrest, inhalation of vomit (with ARDS) and hypothermia may accompany profound sedation
- Hypoglycaemia
- Alcoholic ketoacidosis
- Accidental injury, particularly head injury (subdural)
- Rhabdomyolysis and ARF
- Infection (sepsis, meningitis)
What are 3 presentations of acute gastritis in acute alcohol toxicity?
- Nausea and vomiting
- Abdominal pain
- GI bleeding
What are 3 features which may accompany profound sedation in acute alcohol intoxication?
- Respiratory depression and arrest
- Inhalation of vomit (with ARDS)
- Hypothermia
Which type of injury should you be wary of in acute alcohol intoxication?
head injury → subdural haemorrhage
What is the usual management of mild to moderate alcohol intoxication?
usually no specific treatment; need for admission for rehydration and observation depends on inidividual
Which patients should always be admitted with acute alcohol intoxication?
admit all patients with stupor or coma
What does the A part of ABCDE assessment in acute alcohol intoxication involve?
check airway clear of vomitus and patient able to protect their airway
nurse in the recovery position
What is the guidance on gastric lavage or charcoal in acute alcohol intoxication?
not indicated
What are 7 blood tests to consider in acute alcohol intoxication?
- U+Es
- CPK (creatine kinase aka phosphokinase)
- Glucose
- Amylase
- Ethanl levels
- ABG (acidosis)
- Other drug overdose - consider
What are 4 effects of acute alcohol intoxication that you should monitor closely for when treating a patient?
- Respiratory depression
- Hypoxia
- Hypotension
- Withdrawal syndromes
What is the management of a comatose patient with hypoglycaemia?
25-50mL of 50% glucose followed by IVI of 10% glucose if necessary
ideally give bolus of thiamine 1-2 mg/kg IV before glucose
Why is a thiamine bolus ideally given before glucose is given in hypoglycaemia in acute alcohol intoxication?
in malnourished individuals, the glucose may precipitate Wernicke’s encephalopathy
In general what is the management of patients with severe alcohol intoxication?
rehydrate with IV fluids and monitor usrine output
rarely - haemodialysis if intoxication very severe or in presence of acidosis
What must you be careful of when rehydrating patients with acute alcohol intoxication with IV fluids?
avoid excessive saline if signs of chronic liver disease
When is haemodialysis indicated in acute severe alcohol intoxication?
if very severe or presence of acidosis (rare)
What should be arranged for a patient after recovery from an acute episode of acute alcohol intoxication?
psychiatric or medical assessment and follow-up and referral to an alcohol rehabilitation programme if appropriate
What is thought to be the mechanism of alcohol withdrawal symptoms?
- chronic alcohol consumption enhances GABA mediated inhibition in the CNS (similar to benzos) and inhibits NMDA-type glutamate receptors
- withdrawal thought to lead to the opposite: decreased inhibitory GABA and increased NMDA glutamate transmission
At what time frame do the symptoms of alcohol withdrawal typically start?
6-12 hours
What are 4 initial symptoms of alcohol withdrawal?
- Tremor
- Sweating
- Tachycardia
- Anxiety
What time is the peak incidence of seizures from alcohol withdrawal?
36 hours
