Alcohol Withdrawal Management

Question 1

What are the symptoms of alcohol withdrawal?

Answer 1

Symptoms can include:
* Tremor
* Diaphoresis
* Anxiety
* Palpitations
* Alcohol craving

Symptoms can develop as soon as 4-12 hours after the last drink.

Question 2

What is delirium tremens and when does it peak?

Answer 2

Delirium tremens peaks 48-72 hours after withdrawal and includes:
* Autonomic instability
* Hallucinations

Hallucinations can occur in any modality, including Lilliputian or formication visual hallucinations.

Question 3

What are the key components of the Wernicke’s triad?

Answer 3

The Wernicke’s triad includes:
* Ataxia
* Ophthalmoplegia
* Global confusion

The full triad is only present in less than 10% of cases.

Question 4

What are the symptoms of Korsakoff’s syndrome?

Answer 4

Symptoms include:
* Ante and retrograde amnesia
* Confabulation
* Apathy

Patients with Korsakoff’s are notably apathetic to their other symptoms.

Question 5

What is the preferred drug for hepatic failure in alcohol withdrawal treatment?

Answer 5

Lorazepam is the drug of preference in hepatic failure.

Librium (chlordiazepoxide) has a half-life of approximately 2 days.

Question 6

What advice should be given regarding alcohol consumption after withdrawal?

Answer 6

Patients should be advised not to suddenly discontinue alcohol.

HSE safe alcohol limits are 17 units for men and 11 units for women.

Question 7

What tools are used for screening alcohol use disorder (AUD)?

Answer 7

CAGE questionnaire :
* Have you ever felt you should cut down on your drinking?
* Have people annoyed you by criticizing your drinking?
* Have you ever felt bad or guilty about your drinking?
* Have you ever had a drink first thing in the morning to steady your nerves or to get rid of a hangover (eye-opener)?

Question 8

What are some physical consequences of alcoholism?

Answer 8

Consequences can include:
* Unintentional and intentional injuries
* GIT disease (oesophagitis, PUD, Mallory-Weiss tear)
* Hepatic disease (cirrhosis)
* Cardiovascular disease
* Erectile dysfunction
* Infections (Klebsiella pneumonia)
* Cancers (breast, liver, etc)
* Pregnancy complications (foetal alcohol syndrome, prematurity)

Foetal alcohol syndrome includes microcephaly, learning difficulties, cardiac malformations, thin vermillion border, and short palpebral fissure.