Alcohol withdrawal resident survival guide: Difference between revisions
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:* 9 to 15 points - Moderate withdrawal <br> | :* 9 to 15 points - Moderate withdrawal <br> | ||
:* > 15 points - Severe withdrawal (Associated with increased risk of delirium tremens and seizures) | :* > 15 points - Severe withdrawal (Associated with increased risk of delirium tremens and seizures) | ||
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==Management== | ==Management== | ||
Shown below is an algorithm summarizing the approach to <nowiki>[[Alcohol withdrawal]]</nowiki>. | Shown below is an algorithm summarizing the approach to <nowiki>[[Alcohol withdrawal]]</nowiki>. | ||
{{familytree/start |summary=PE diagnosis Algorithm.}} | {{familytree/start |summary=PE diagnosis Algorithm.}} | ||
{{familytree | | | | | | | | | {{familytree | | | | | | | A01 | |A01=<div style="float: left; text-align: left; line-height: 150% ">'''Characterize the symptoms:'''<br> Minor withdrawal symptoms: 6-12 hours | ||
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Revision as of 17:38, 9 January 2014
Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Vidit Bhargava, M.B.B.S [2]
Definition
Alcohol withdrawal is defined as an array of signs and symptoms that a chronic alcoholic presents with, when he abruptly ceases alcohol intake. It occurs within 6-48 hours after cessation of alcohol intake.
Diagnostic criteria
A. Sudden reduction/termination in chronic alcohol intake.
B. Two (or more) of the following, developing within several hours to a few days after criterion A:
C. The symptoms in criterion B causing clinically significant impairment of patients social, occupational or other aspects of life.
D. The symptoms cannot be better explained by a general medical condition or other mental disorder.
Assessment of severity of alcohol withdrawal
It is based on "The revised Clinical Institute Withdrawal Assessment for Alcohol (CIWA-Ar)" scale, and is a 10 item assessment tool that is used to monitor as well as treat patients undergoing withdrawal.
CIWA-Ar scores:
- ≤ 8 points - Mild withdrawal
- 9 to 15 points - Moderate withdrawal
- > 15 points - Severe withdrawal (Associated with increased risk of delirium tremens and seizures)
- ≤ 8 points - Mild withdrawal
Index of severity | Score 0 | Score 1 | Score 2 | Score 3 | Score 4 | Score 5 | Score 6 | Score 7 |
---|---|---|---|---|---|---|---|---|
Nausea & vomiting | None | Mild nausea, no vomiting | - | - | Intermittent nausea, dry heaves | - | - | Constant nausea, frequent dry heaves, vomiting |
Hand tremors | None | Tremor not visible but felt | - | - | Moderate tremor with arms extended | - | - | Severe tremors |
Paroxysmal sweats | None | Barely perceptible, palms moist | - | - | Beads of sweat on forehead | - | - | Drenching sweats |
Anxiety | None | Mild | - | - | Moderate | - | - | Equivalent to acute panic state |
Agitation | None | Somewhat more than normal | - | - | Moderately fidgety and restless | - | - | Paces back and forth most of the time |
Tactile disturbances (Pins & needles) (Bugs crawling under skin) |
None | Very mild itching, pins & needles, burning or numbness | Mild itching, pins & needles, burning or numbness | Moderate itching, pins & needles, burning or numbness | Moderately severe hallucinations | Severe hallucinations | Extremely severe hallucinations | Continuous hallucinations |
Auditory disturbances | None | Very mild harshness or ability to frighten | Mild harshness or ability to frighten | Moderate harshness or ability to frighten | Moderately severe hallucinations | severe hallucinations | Extremely severe hallucinations | Continuous hallucinations |
Visual disturbances | None | Very mild sensitivity | Mild sensitivity | Moderate sensitivity | Moderately severe hallucinations | severe hallucinations | Extremely severe hallucinations | Continuous hallucinations |
Headache, fullness in head | None | Very mild | Mild | Moderate | Moderately severe | Severe | Very severe | Extremely severe |
Orientation and clouding of sensorium | Oriented, can do serial additions | Cannot do serial additions/ uncertain about date | Date disorientation by no more than 2 calendar days | Date disorientation by more than 2 calendar days | Disorientated for place and/or person |
Management
Shown below is an algorithm summarizing the approach to [[Alcohol withdrawal]].
Characterize the symptoms: Minor withdrawal symptoms: 6-12 hours ❑ Anorexia ❑ Anxiety/Palpitations ❑ Diaphoresis ❑ Gastrointestinal upset ❑ Headache ❑ Insomnia ❑ TremulousnessAlcoholic hallucinosis: 12-24 hours ❑ Visual hallucinations ❑ Auditory hallucinations ❑ Tactile hallucinationsWithdrawal seizures: 24-48 hours ❑ Generalized tonic-clonic seizures Alcohol withdrawal delirium (delirium tremens): 48-72 hours ❑ Hallucinations (predominately visual) ❑ Disorientation ❑ Tachycardia ❑ Hypertension ❑ Low-grade fever ❑ Agitation ❑ Diaphoresis | |||||||||||||||||||||||||||||||||
Elicit detailed history:
❑ Amount of alcohol intake per day ❑ Duration of alcohol use ❑ Time since last drink ❑ Previous alcohol withdrawals if any ❑ Presence of concurrent medical or psychiatric conditions ❑ Abuse of other agents Examine the patient: ❑ Arrhythmias ❑ Signs of congestive heart failure ❑ Signs of coronary artery disease ❑ Signs of gastrointestinal bleeding ❑ Signs of liver disease ❑ Nervous system impairment ❑ Signs of pancreatitis | |||||||||||||||||||||||||||||||||
Order labs:
❑ Complete blood count ❑ Liver function tests ❑ Urine drug screen ❑ Blood alcohol levels ❑ Electrolyte levels | |||||||||||||||||||||||||||||||||
Consider alternative diagnosis:
❑ Thyrotoxicosis ❑ Anticholinergic drug poisoning ❑ Amphetamine or cocaine abuse ❑ Withdrawal from other sedative-hypnotic agents ❑ Central nervous system infections/Haemorrhage | |||||||||||||||||||||||||||||||||