Alcohol withdrawal

Question 1

Define alcohol withdrawal syndrome

Answer 1

It is a series of signs and symptoms which occurs in patients with alcohol dependence or chronic alcoholism when their daily alcohol consumption is decreased or stopped.

Question 2

What is the aetiology of AWS? When does it start?

Answer 2

The decrease in blood ethanol below the level at which the patient is habituated triggers AWS. The syndrome typically begins within 4 to 12 hours after the patient’s last drink, and may progress to potentially fatal delirium tremens.

Question 3

What are the risk factors of AWS?

Answer 3

1. Abrupt alcohol withdrawal

2. Hx of AWS and delirium tremens

Question 4

What are the presenting symptoms of AWS?

Answer 4

1. Changed mental state; disorientated
2. Reducing conscious level/state
3. seizures
4. hallucinations
5. dellusions

others
Tremor, nausea, vomiting, HTN, tacchycardia, hyperthermia

Question 5

Signs of AWS?

Answer 5

Tacchycardia
HTN
Hyperthermia

Question 6

What are appropriate investigations for AWS?

Answer 6

1. U&Es; metabolic acidosis. hypokalaemia - delirium t. high lactic acid- alcoholic seizures
2. Bloods;
   - urea and creatinine; delirius patients can get dehydrated. elevated or normal.
3. Toxicology screen ; positive for ethanol perhaps drugs too
4. CT head; exclude intracranial causes
5. CXRay; exclude cardiopulm causes

Question 7

Management plan for AWS?

Answer 7

1ST line;

1. Bensodiazepine (Chlordiazepoxide or lorazepam etc)