26537599
Descripción
Fichas por Jenna Paterson, actualizado hace más de 1 año
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Creado por Jenna Paterson
hace alrededor de 4 años
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| Pregunta | Respuesta |
| What is alcohol withdrawal syndrome? | Characterised by signs of overactivity of the sympathetic nervous system which leads to the development of clinical signs and symptoms. Caused by alcohol abstinence in a person with dependence. |
| What are the common symptoms of acute alcohol withdrawal | N&V Tremor Sweating Tachycardia Palpitations Insomnia Anxiety |
| What are less common symptoms that are seen more in severe alcohol withdrawal? | Seizures Delirium tremens Psychiatric disturbance (agitation, hallucination, altered cognition) Coarse tremor Fever/hypothermia |
| What causes alcohol withdrawal seizures, and what type of seizures are they typically? | Develop due to changes in alcohol concentration - can occur before blood alcohol level is zero. But usually clear history of recent abstinence (typically within first 12-24 hours after last drink). Usually generalised tonic-clonic seizures. Note: Several legal or illegal pharmacological agents which may induce seizures could complicate the clinical picture and should be considered in the diagnosis of alcohol related seizures. |
| What is delirium tremens? | Very severe alcohol withdrawal. Presents with rapid onset symptoms which are difficult to control. |
| What are the symptoms of delirium tremens? | Profound confusion or delirium Visual, auditory and tactile hallucinations (lilliputian hallucinations - seeing little people) Pins and needles, burning and numbness Coarse tremor Features of clinical instability (tachycardia, fever, ketoacidosis and circulatory collapse). If untreated, seizures can occur. |
| How is delirium tremens managed? | Treat with benzodiazepine (e.g. chlordiazepoxide, diazepam, lorazepam) for the agitation and to prevent seizure occurrence. Give IV pabrinex to help prevent Wernicke's and irreversible Korsakoff psychosis from developing. |
| What bloods are important in someone with acute alcohol withdrawal? | FBC (may have increased MCV or thrombocytopenia) Glucose (hypos are common due to poor nutrition or heavy alcohol use) LFTs (increased risk of chronic liver disease - AST:ALT>2) U&Es and bone profile (electrolyte disturbances can cause life-threatening arrhythmias) Coag screen - significant risk of CLD (may have prolonged PT and INR) Ammonia if altered consciousness as in acute liver failure. |
| What are some first line investigations of someone with acute alcohol withdrawal? | Bloods ECG (if tachycardic/bradycardic to look for arrhythmias) CXR - high risk of aspiration pneumonia CT head - rule out intracranial bleed/fractures/underlying brain lesion causing seizure. |
| What assessment tool can be used to screen for alcohol misuse? What are the cutoffs for this? | FAST Screening Tool >=3 is FAST +ve - consistent with hazardous drinking. |
| What is the GMWAS and what does information does it provide? | Glasgow Modified Alcohol Withdrawal Scale Screens for alcohol misuse and dependence Gives guidance for fixed dose or symptom-triggered treatment of alcohol withdrawal syndrome Gives a simple score to assess patients for alcohol withdrawal syndrome Gives guidance for vitamin prophylaxis of Wernicke-Korsakoff syndrome |
| How should alcohol withdrawal be managed? | First, determine if high or low risk of withdrawal syndrome. Then treat with oral benzodiazepines ± symptom control, plus IV Pabrinex. Important to correct any electrolyte disturbances and to contact the addiction liaison services. |
| What makes someone high risk of alcohol withdrawal syndrome? | If 2 or more of the following: - Current or previous presentation with withdrawal seizures - Previous severely agitated withdrawal or delirium tremens - High alcohol screening score (FAST>12) - High initial symptom score (GMAWS >8) |
| What benzodiazepines should be given? | Diazepam Symptom triggered lorazepam if 'exceptional patient group', i.e. risk of complications associated with benzodiazepines. This includes the elderly, head injury, evidence of liver disease, especially jaundice/encephalopathy and patients with other significant comorbidity i.e. COPD, pneumonia, cerebrovascular disease, reduced GCS) |
| What can be given in extreme alcohol withdrawal? | Parenteral administration of IV benzodiazepines or haloperidol. |
| What are the driving laws following an alcohol withdrawal seizure for group 1 and group 2 licenses? | These are provoked seizures Group 1: Don't drive for 6 months and must notify DVLA Group 2: Don't drive for 5 years and must notify DVLA |
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