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Z Year3 Acute Med > Alcohol Withdrawal > Flashcards

Alcohol Withdrawal Flashcards

(47 cards)

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1
Q

What is the defintion of alcohol withdrawl?

A

physical and psychological symptoms occurring when any patient who is alcohol dependent has stopped or reduced alcohol intake within hours or days of presentation

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2
Q

What two receptors are involved in alcohol?

A
  1. NMDA Receptors

2. GABA (Type A) receptors

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3
Q

What are NMDA receptors usually?

A

excitatory

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4
Q

What are GABA (type A) receptors usually?

A

inhibitory

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5
Q

What is the normal homestasis of these receptors?

A

homeostasis between the excitatory effects of NMDA receptors and inhibitory effects of GABA receptors

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6
Q

What happens to the receptors in acute alcohol drinking?

A
  1. ethanol predominantly targets the GABA (type A) receptor

2. inhibits the NMDA receptor though competitive binding

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7
Q

What happens to the receptors in chronic alcohol use?

A
  1. alcohol predominantly targets GABA type A receptors
  2. so body adapts by downregulating GABA type A receptors (this contributes to development of tolerance)
  3. alcohol inhibits NMDA receptors
  4. so the body adapts by upregulating NMDA receptors on the post-synaptic membrane
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8
Q

What happens when an alcohol-dependent person stops drinking alcohol?

A
  1. excess excitatory effect from the upregulation of NMDA receptors
  2. downregulation of inhibitory GABA (type A) receptors
    - use to steady state of ethanol concentration
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9
Q

What are RF for alcohol withdrawal?

A
  1. Alcohol use of disorder
  2. History of alcohol withdrawal
  3. Acute illness e.g. pneumonia
  4. Poor Physical Health
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10
Q

How do you identify alcohol use disorder?

A
  1. AUDIT-C
  2. FAST
  3. PAT
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11
Q

What can poor nutrition lead to?

A

thiamine deficiency which leads to Wernicke’s encephalopathy

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12
Q

What are signs of chronic or decompensated liver disease?

A
  1. Hepatooemgalsy
  2. Jaundice
  3. Ascites
  4. Caput medusa
  5. Palmar erythema
  6. Hepatic encephalopathy
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13
Q

What does ammonia cause?

A

encephalopathy

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14
Q

What does the albumin cause?

A

ascites and peripheral oedema

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15
Q

What does the bilirubin cause?

A

jaundice

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16
Q

What does blood factors cause?

A

brusing

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17
Q

How do you remember the effects of liver disease?

A

AABB

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18
Q

What does thiamine B1 def cause?

A

Wernicke’s encephalopathy

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19
Q

What are signs of WE?

Study These Flashcards
A
  • CAN
    1. Confusion
    2. Ataxia
    3. Nystagmus
  • Risk of irreversible brain damage
20
Q

What are the symptoms of 6-12 hr withdrawal: minor withdrawal symptoms?

Study These Flashcards
A
  1. Anxiety/agitation
  2. Palpitations
  3. GI upset
  4. Sweating/tremor
21
Q

What are the symptoms of 12-24hr withdrawal: alcoholic hallucinosis?

Study These Flashcards
A

hallucinations

22
Q

What are symptoms of 24-48hr: withdrawal seizures?

Study These Flashcards
A

generalised tonic-clonic seizures

23
Q

What are the symptoms of 48-72hr: withdrawal delirium?

Study These Flashcards
A
  1. Delirium Tremens
  2. Severe tremor
  3. Fever
  4. High BP + HR
24
Q

How do you remeber a surgical sieve?

Study These Flashcards
A

VITAMIN C DEF

25
What is the surgical sieve?
``` Vascular Infective/inflammatory Trauma Autoimmune Metabolic Iatrogenic Neoplastic Congenital Degenerative Endocrine/environment Functional ```
26
What are possible DDx for alcohol withdrawal?
1. Hypoglycaemia 2. Hepatic encephalopathy 3. Meningitis
27
What are hypoglycaemia symptoms?
1. Tremors 2. anxiety 3. palpitations 4. seizures 5. drowsiness
28
What are hepatic encephalopathy symptoms?
1. Tremors 2. Anxiety 3. Palpitations 4. Seizures 5. Drowsiness
29
What are features of meningitis?
1. Fever and altered mental status | 2. Nuchal rigidity makes up the last part of the triad but not all patients present with this triad
30
What bedside tests are done for alcohol withdrawal?
1. Screen for alcohol-use disorder 2. ECG 3. VBG
31
How do you screen for alcohol use disorder?
- CAGE/AUDIT-C | - CIWA-AR scale to assess severity
32
Why do you do an ECG for alcohol withdrawal?
- Electrolyte deficiencies are common and can cause arrhythmias
33
What do you look for on VBG?
1. Respiratory alkalosis (due to hyperventilation in delirium tremens) 2. Hypochloraemic metabolic acidosis (due to vomiting) 3. Metabolic acidosis with high anion gap (alcoholic ketoacidosis)
34
What bloods are done?
1. Glucose 2. FBC 3. U+E 4. LFTs 5. Coagulation studies
35
Why is glucose done for alcohol withdrawl?
- hypoglycaemia | - common due to poor nutrition or secondary to hepatic failure
36
What does FBC show on alcohol withdrawal?
1. increased MCV due to chronic alcohol use 2. thrombocytopenia due to splenomegaly 3. folate deficiency and a direct toxic effect of alcohol on their production
37
What does U+Es show in alcohol withdrawal ?
1. hypomagnesaemia (1/3 of people) 2. hypokalaemia (50% of hospitalised patients) 3. hypophosphataemia
38
What does LFTs show in alcohol withdrawal?
- elevated liver enzymes (AST, ALT, GGT) | - ALT higher than AST
39
What do coagulation studies show in alcohol withdrawal?
INR and PT are prolonged in chronic liver disease, correlated with severity
40
Why do you do a CT head?
- Suspected head injury (e.g. alcohol-related seizure) | - Altered cognition
41
Why is a CXR done?
- co-existing pneumonia is common | - Aspiration: reduced consciousness or seizures
42
What is the urgent management for alcohol withdrawal?
1. Benzodiazepine 2. CT head: suspected head injury, altered cognition or seizures 3. Detect and treat co-existing illness
43
How would you treat sizures?
ensure patent airway and give IV benzo
44
How would you treat delirium tremens?
oral benzos and IV if symptoms persists
45
What is the suportive management for alcohol withdrawal?
1. Rehydrate: IV fluid 2. Pabrinex (Vit B) 3. Glucose 4. Electrolyte imbalances
46
When can glucose be given for alcohol withdrawal?
- if hypoglycaemia: After thiamine! But don’t delay glucose for life-threatening hypoglycaemia - after thiamine to prevent WE
47
How could you manage alcohol dependent LT?
DALS, Community Services, Therapy

Z Year3 Acute Med (11 decks)

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