● Tremor (0-7) ● Visual disturbances (0-7) Scores correlate to general level of withdrawal as follows: Score Withdrawal Level ≤8 Absent or minimal withdrawal 9-19 Mild to moderate withdrawal ≥20 Severe withdrawal tremens should be considered a medical emergency and can be fatal if not managed aggressively. The main objectives of treatment for alcohol withdrawal are controlling agitation, lowering seizure risk, and reducing morbidity and mortality. Benzodiazepines such as diazepam and lorazepam are first-line treatment for all alcohol withdrawals. Barbiturates and propofol can be used for those patients who are refractory to benzodiazepines. 26 Hospital protocols vary, but admission to monitored or intensive care settings is warranted for significant withdrawal symptoms. ● Increased risk of injury : due to dangerous behavior. Wernicke-Korsakoff syndrome (WKS) is one of the best-known neurologic complications of thiamine (vitamin B1) deficiency that is frequently associated with long-term alcohol use. Thiamine is involved in the conduction of axon potential and synaptic transmission. WKS refers to two different syndromes, each representing a different stage of the disease. Wernicke encephalopathy (WE) is an acute syndrome requiring emergent treatment to prevent death and neurologic morbidity. Korsakoff syndrome (KS) refers to a chronic neurologic condition that usually occurs as a consequence of WE. Wernicke encephalopathy (alcoholic encephalopathy) is characterized by ataxic gait, vestibular dysfunction, confusion, horizontal nystagmus, lateral orbital palsy, and gaze palsy. WE is reversible with acute treatment including replacement of thiamine and other deficient vitamins such as folic acid. Korsakoff syndrome is a chronic amnestic syndrome which follows Wernicke encephalopathy in which the main feature is anterograde amnesia, with possible confabulation. If left untreated, thiamine deficiency can eventually lead to neuronal death, and lesions can be identified on radiographic imaging and autopsy. 28 Vitamin deficiencies must be considered during the evaluation and treatment of all patients with a history of chronic alcohol use.
The CIWA-AR score requires evaluation of each symptom rated on a 0-7 score for all except evaluation of orientation and clouding of sensorium, which is on a 0-4 score. Maximum score is 67: ● Agitation (0-7) ● Anxiety (0-7)
● Auditory disturbances (0-7) ● Clouding of sensorium (0-4) ● Headache (0-7) ● Nausea/vomiting (0-7) ● Paroxysmal sweats (0-7) ● Tactile disturbances (0-7)
Delirium Withdrawal delirium, also commonly referred to delirium tremens or “DTs,” is the most dangerous withdrawal syndrome associated with alcohol. This spectrum of symptoms that includes confusion, disorientation, hallucinations, and delusions along with autonomic hyperactivity, anxiety, and fluctuating levels of psychomotor activity has a modern mortality of under 5% if treated as opposed to mortality rates greater than 25% early in the 20th century. 24 Withdrawal delirium typically begins between 72 and 96 hours after the patient’s last drink and has been reported to occur in 1 to 4 percent of patients hospitalized for alcohol withdrawal. 25 Delirium conditions. Alcohol is characterized as a Group 1 carcinogen along with tobacco, radiation, and asbestos. It is associated with bowel and breast cancer and although previously thought to be safe in light and moderate consumption, the World Health Organization (WHO) has now published a statement in The Lancet Public Health that when it comes to alcohol consumption, there is no safe amount of alcohol that does not affect health. 27 Chronic alcohol use is commonly associated with many health issues as follows: Complications of chronic alcohol use Chronic alcohol use is associated with many ● Gastrointestinal : hepatic steatosis, hepatitis and cirrhosis, gastritis, and ulcer disease leading to GI bleeding and pancreatitis. ● Cardiac : cardiomyopathies, hypertension, heart failure, and arrhythmias leading to stroke. ● Metabolic : electrolyte derangements, including hypoglycemia and hyponatremia and hypomagnesemia, thrombocytopenia, osteopenia, folate and thiamine deficiencies. ● Genitourinary : chronic alcohol use contributes to erectile dysfunction and dysfunctional uterine bleeding. ● Immunologic : increased risk of infection through effects on lymphocyte response. ● Long term alcohol use : associated with increased frequency of many malignancies. ● Psychologic : depression and anxiety.
Antidipsotropic medications for treatment of alcohol use disorder Acamprosate appears to be one of the most effective medications for maintaining abstinence in alcohol use disorder. Acamprosate is thought to target GABA and N-methyl-D-aspartate glutamatergic receptor
activity, thereby decreasing cravings and relapse. The individual must be alcohol free at initiation, and use is contraindicated in severe renal disease. Side effects
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Book Code: MDCO1025
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