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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
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