alcohol withdrawal

Question 1

wernickes encephalopathy

Answer 1

neuropsychiatric disroder caused by thiamine deficiency
- most commonly seen in alcoholics

Question 2

causes of wernickes encephalopathy

Answer 2

alcoholics !!

rarer -
- persistent vomiting
- anorexia nervosa
- stomach cancer
- dietary deficiency

Question 3

classic triad seen in wernickes encephalopathy + other features

Answer 3

• ophthalmoplegia/nystagmus
• ataxia
• encephalopathy - confusion, inattentiveness

peripheral senory neuropathy
petechial haemorrhages occur in many structures in brain including mamillary bodies + ventricle walls

Question 4

wernickes encephalopathy investigations + management

Answer 4

ix -
decreased red cell transketolase
MRI

mx = urgent replacement of thiamine

Question 5

Korsakoff syndrome

Answer 5

if wernickes left untreated, addition of antero- + retrograde amnesia + confabulation

Question 6

pathophys of alcohol withdrawal

Answer 6

chronic alcohol consumption
- enhances GABA mediated inhibition of CNS (similar to benzos)
- inhibits NMDA glutamate receptors

alcohol withdrawal (the opposite)
- decreased inhibitory GABA
- increased NMDA glutamate transmission

Question 7

alcohol withdrawal timing of symptoms, seizures + delirium tremens

Answer 7

sx start at 6-12hrs = tremor, sweat, tachycardia, anxiety

peak incidence of seizures = 36hrs

delerium tremens = 48-72hrs
- coarse tremor
- confusion, delusions
- auditory + visual hallucinations
- fever, tachycardia

Question 8

management of alcohol withdrawal

Answer 8

1st = long acting benzos - chlordiazepoxide or diazepam

if liver cirrhosis = lorazepam