Alcohol withdrawal resident survival guide: Difference between revisions
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❑ Diaphoresis </div></div> | ❑ Diaphoresis </div></div> | ||
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{{familytree | | | | {{familytree | | | | | | | B01 | | | | | | | | |B01='''Elicit detailed history:''' | ||
{{familytree | | | | | ❑ Amount of alcohol intake per day | ||
{{familytree | | | | ❑ Duration of alcohol use | ||
❑ Time since last drink | |||
❑ Previous alcohol withdrawals if any | |||
❑ Presence of concurrent medical or psychiatric conditions | |||
❑ Abuse of other agents | |||
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'''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]] | |||
}} | |||
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{{familytree | | | | | | | C01 | | | | |!| |C01='''Order labs:''' | |||
❑ Complete blood count | |||
❑ Liver function tests | |||
❑ Urine drug screen | |||
❑ Blood alcohol levels | |||
❑ Electrolyte levels }} | |||
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{{familytree | D01 | | D02 | | | | | | D03 |D01= |D02= |D03= }} | {{familytree | D01 | | D02 | | | | | | D03 |D01= |D02= |D03= }} | ||
Revision as of 15:32, 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: 1. Autonomic hyperactivity (e.g., sweating or pulse rate > than 100/minute) 2. Hand tremors 3. Insomnia 4. Gastrointestinal upset (Nausea or vomiting) 5. Transient visual, tactile, or auditory hallucination s or illusions 6. Psychomotor agitation 7. Anxiety 8. Grand mal seizures 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.
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 | |||||||||||||||||||||||||||||||||