0071643192.pdf

PSYCHOBEHAVIORAL DISORDERS

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TABLE 16.2. Major Symptoms of Alcohol Withdrawal

ONSET AFTER

LASTDRINK SYMPTOMS/SIGNS TREATMENT

Mild withdrawal 6–8 hours Coarse tremors, nausea, anxiety, Supportive care, benzodiazepines.

tachycardia, hypertension, insomnia,

irritability.

Seizures 6–48 hours Brief generalized tonic-clonic seizures, Supportive care, benzodiazepines

no aura, can have 1–3 in a short Most resolve spontaneously. Can

postictal period; status epilepticus progress to delirium tremens (DTs).

can occur in about 3%

Hallucinations 24–48 hours Visual or tactile, sensorium can be Supportive care, benzodiazepines for

clear in early stagesbut accompanied hyperadrenergic signs and symptoms;

by disorientation/anxiety in late stages not necessarily followed by DTs but are

parts of the DT symptomatology

Delirium tremens 3–5 days Severe autonomic hyperactivity, Benzodiazepines (may need to start a

profound confusion, hallucinations, drip) admit to ICU

paranoid ideation, fever, diaphoresis,

incontinence, mydriasis.

An alcohol-abusing patient

with a first seizure should be

treated and evaluated as any

patient with a first-time seizure.

A 64-year-old man comes to the ED complaining of “feeling shaky.” He is

normotensive, HR is 104, and exhibits tremulousness. His last drink was

12 hours ago. How would you treat his symptoms?

IV/O 2 /monitor, banana bag, benzodiazepines, observe closely for seizures.

ALCOHOLWITHDRAWAL

SYMPTOMS/EXAM/DIAGNOSIS

■ Recent (few hours to few days) decrease or cessation of alcohol.

■ Two or more of the following:

■ Autonomic hyperactivity (increased BP, HR >100, sweating)

■ Tremulousness

■ Nausea/vomiting

■ Psychomotor agitation

■ Insomnia

■ Anxiety

■ Grand mal seizures (usually at least 24 hours after last drink)

■ Rule out other medical condition.

■ See Table 16.2 for major symptoms of alcohol withdrawal.

DIFFERENTIAL

For alcohol-related seizures: Acute intoxication, metabolic abnormalities

(hypoglycemia, hypo/hypernatremia, hypocalcemia), infections, trauma, cere-

brovascular accident (CVA), benzodiazepine/barbiturate withdrawal, non-

compliance with anticonvulsants