Alcohol Withdrawal

Question 1

Insomnia, tremulousness, mild anxiety, GI upset, anorexia, headache, diaphoresis, and palpitations are all symptoms of?

Answer 1

Mild to moderate alcohol withdrawal

Question 2

What is a banana bag? and what is in it that is extra important in alcohol withdrawal patients?

Answer 2

IVF, dextrose, vitamins, minerals, and THIAMINE

Question 3

What labs must we monitor during alcohol withdrawal?

Answer 3

CMP with magnesium and phosphorus levels!

Question 4

What will electrolytes look like during withdrawal?

Answer 4

Hypo everything

Hyponatremia, hypokalemia, hypomagnesemia, hypophosphatemia

Question 5

What class of medications are we going to give alcohol withdrawal patients?

Answer 5

BENZO’S!

Diazepam (Valium)

Question 6

What is Delirium tremens different than common alcohol withdrawal?

Answer 6

It has the symptoms of acute alcohol withdrawal PLUS

delirium (encephalopathy), hallucinations, tachycardia, hypertension, and hyperthermia

Question 7

How long after a patient’s last drink to DT’s set in?

Answer 7

48-96 hours

Question 8

How long can DT’s persist?

Answer 8

5 days

Question 9

Sustained drinking, prior DT episodes, age greater than 30, concurrent illness, positive significant withdrawal symptoms in presence of elevated blood alcohol level are all risk factors for?

Answer 9

DTs

Question 10

True or False

Sent DT patients to the behavioral health unit

Answer 10

FALSE

Question 11

What unit should we send DT patients to?

Answer 11

CCU

Question 12

What other specialists should be involved in a patient with DTs care?

Answer 12

Critical care, neurology, psychiatry

Question 13

Acute brain disorder causing petechial hemorrhaging and necrosis in midbrain structures?

Answer 13

Wernicke encephalopathy

Question 14

What is the classic triad of Wernicke’s?

Answer 14

Encephalopathy/delirium, gait ataxia, oculomotor dysfunction

Question 15

True or False

If you are unsure if a patient has Wernicke’s, we shouldn’t treat it because we could end up doing more damage

Answer 15

FALSE

When in doubt, TREAT.
Untreated can lead to coma and death.

Question 16

How do we treat Wernicke’s encephalopathy?

Answer 16

parenteral thiamine

Question 17

Administration of what can precipitate WE?

Answer 17

glucose

Question 18

Consequence of untreated or repeated episodes of WE; chronic, late neuropsychiatric disorder

Answer 18

Korsakoff’s

Question 19

What are 3 characteristics of Korsakoff’s?

Answer 19

Cognitive impairment, retrograde and anterograde amnesia, and brain imaging positive for atrophy

Question 20

Can we diagnose Korsakoff’s?

Answer 20

No – we need specialized neurocognitive testing – specialty referral and evaluation

Question 21

Caused by nutritional deficiency and neurotoxic effects of chronic alcohol use

Answer 21

Cerebellar deficiency

Question 22

Gait ataxia, poor gross motor coordination, inability to handwrite, dysarthria are all symptoms of?

Answer 22

Cerebellar deficiency

Question 23

Does cognitive capability remain intact in cerebellar deficiency?

Answer 23

Yes

Question 24

What is the prognosis of cerebellar deficiency?

Answer 24

May improve slightly with abstinence and good nutrition but is largely irreversible

Question 25

Alcoholic hallucinations usually occur in about how many hours after a patients last drink?

Answer 25

24 hours

Question 26

Numbness, paraesthesia, burning dysesthesia, loss of reflexes, and jerky muscle spasms are symptoms of?

Answer 26

Peripheral neuropathy

Question 27

How do we treat peripheral neuropathy?

Answer 27

Abstinence, thiamine PO, maximize nutrition

Question 28

Weakness, pain, tenderness, and swelling of affected muscles are symptoms of?

Answer 28

Myopathy

Question 29

What other medical issues is myopathy associated with?

Answer 29

Rhabdomyolysis, dysphagia, and heart failure