Alcohol withdrawal

Question 1

Alcohol withdrawal definition

Answer 1

• symptoms due to abstaining from alcohol in a person with dependence
• overactivity of the sympathetic nervous system

Question 2

Alcohol withdrawal pathophysiology

Answer 2

• chronic alcohol use upregulates NMDA and downregulates GABA receptors
• fall in blood ethanol concentration causes relative increase in stimulatory NMDA in the CNS
• excessive stimulatory effect

Question 3

Alcohol withdrawal signs and symptoms

Answer 3

• often autonomic symptoms at 6-12 hours - tremor, sweating, tachycardia, anxiety
• seizures at around 36 hours
• delirium tremens 48-72 hours - coarse tremor, confusion, fever, delusions, hallucinations, increased heart rate

Question 4

Glasgow modified alcohol withdrawal score

Answer 4

0, 1 or 2 points for each:
- tremor
- hallucinations
- agitation
- orientation
- sweating
CIWA-Ar scale is more detailed

Question 5

Alcohol withdrawal management

Answer 5

• admit under medics for complicated withdrawal
• long-acting benzo e.g. chlordiazepoxide, diazepam
• 2nd line - lorazepam if liver failure
• 3rd line - carbamazepine
• thiamine/Pabrinex to prevent Wernicke’s, Korsakoff