ETOH WITHDRAWAL & COMPLICATIONS

Question 1

If you newly hospitalized patient is experiencing insomnia, tremulousness, mild anxiety, GI upset, HA, diaphoresis, and palpitations – what might be going on?

Answer 1

ACUTE alcohol withdrawal

Question 2

What are the 2 major components of alcohol treatment?

Answer 2

Repletion & Psychomotor Agitation

Question 3

What is involved in repletion treatment?

Answer 3

Banana Bag (IVF, dextrose, Vits/Minerals – especially THIAMINE!!)

Electrolytes (CMP, Mg, and Phos)

Question 4

What is involved in psychomotor agitation treatment?

Answer 4

BENZOS

Clinical institute Withdrawal Assessment (CIWA)

Question 5

What are our goals of treating acute alcohol withdrawal?

Answer 5

Symptom management

Observation

Bridging to long-term recovery

Question 6

When we are observing an acute alcohol withdrawal – what are we looking for?

Answer 6

Delirium tremens

Wernicke’s encephalopathy

Chronic conditions

Question 7

When does delirium tremens often appear?

Answer 7

48-96 hours after last drink

Question 8

If a patient is withdrawing from alcohol and now they have delirium, hallucinations, tachycardiac, HTN, and hyperthermia – what is going on?

Answer 8

Delirium tremens

Question 9

Why is it important that we recognize delirium tremens as its own diagnosis?

Answer 9

There is a mortality risk when delirium tremens sets in (5% nowadays)

Question 10

How do we treat delirium tremens?

Answer 10

Needs to be in a critical care unit!!
IV BENZOS (can be massive doses)

May need aggressive critical care intervention (phenobarbital for seizing)

Get specialists on board (neuro, psych)

Question 11

What is the triad of Wernicke encephalopathy?

Answer 11

Delirium

Gait Ataxia

Oculomotor Dysfunction
*****

Question 12

What causes WE? Is WE acute or chronic?

Answer 12

Cause = Thiamine deficiency

ACUTE!!

Question 13

If we don’t treat Wernicke encephalopathy – what can happen?

Answer 13

Leads to a coma and death

Question 14

Does a normal Thiamine level exclude WE?

Answer 14

Nope – we don’t even need thiamine levels if they have the triad of sxs!

Question 15

What can precipitate WE?

Answer 15

Glucose **AKA watch levels when you administer the Banana Bag

Question 16

How do we treat WE?

Answer 16

Thiamine (500mg x2 days → 250mg x5 days → PO supplementation – but ONLY if they’re still at risk)

Question 17

What is a consequence of untreated or repeated episodes of WE?

Answer 17

Korsakoff’s Syndrome → chronic, late, neuropsychiatric disorder

Question 18

What is Korsakoff’s syndrome characterized by?

Answer 18

Cognitive impairment, retrograde amnesia, and brain imaging for atrophy

Question 19

How do we confirm the diagnosis of Korsakoff’s syndrome?

Answer 19

Specialized neurocognitive testing

Question 20

If a patient has gait ataxia, poor gross motor coordination, and inability to hand write, dysarthria – what is occurring?

Answer 20

Cerebellar Degeneration

Question 21

How do we differentiate the gate ataxia with WE and cerebellar degeneration?

Answer 21

Look at the eyes = WE

Cognitive capability remains intact = Cerebellar

Question 22

If a patient withdrawing from alcohol has JUST hallucinations (no tachy or hyperthermia) – what are we concerned about?

Answer 22

Alcoholic Hallucinations

*Often confused with DT or WE

Question 23

When do alcoholic hallucinations present?

Answer 23

24 hours AFTER the last drink

Question 24

If a patient has little twitches or burning pains in the extremities – what is occuring?

Answer 24

Peripheral neuropathy (neuromuscular complication from long term alcohol use)

Question 25

If a chronic alcoholic and has developed myopathy – what do we need to watch out for?

Answer 25

Rhabdo, Dysphagia, and Heart Failure

Question 26

Your patient being treated in the hospital for alcohol withdrawal – you notice gait ataxia, nystagmus, and he’s unable to complete a MMSE – what diagnosis? Tx?

Answer 26

WE

Tx = IV Thiamine

Question 27

The same patient has shown improvement of his WE over the past couple days, but later in the day, he becomes hard to arouse and seems confused. The nurse gets new vitals: HR 120, BP 180/100, and T of 101 – what is going on? Tx?

Answer 27

DT’s

Tx = Diazepam and continue Thiamine