P1: SBT
0521779407-02 CUNY1086/Karliner 0 521 77940 7 June 7, 2007 19:18
Alcohol Abuse, Dependence, and Withdrawal 87■Alcohol withdrawal seizures:
➣Generalized motor seizures occurring w/ no underlying seizure
disorder
➣Onset: first day, peak 12–48 h after cessation
➣Associated w/ hypomagnesemia, respiratory alkalosis, hypo-
glycemia, & increased intracellular sodium
➣Its presence has important prognostic value in predicting a com-
plicated withdrawal period: 1/3 of patients go on to develop DTs
■Alcohol withdrawal delirium:
➣Also known as delirium tremens (DTs)
➣Onset 1–3 d after abstinence, peak on 4–5th d
Mortality rate:
1% treated
15% untreated
➣Confusion, disorientation, clouded consciousness, perceptual
disturbances, agitation, insomnia, fever, autonomic hyperactiv-
ity
➣Terror, agitation, & visual hallucinations can occur
➣In 50% of cases, delirious states may alternate w/ lucid intervals
➣Uncomplicated course: symptoms subside after 3 d of full-blown
DTs
■Minor symptoms may last as long as 4–5 wk
■When complicated by medical conditions, mortality rate increases
to 20%
■Causes of death: infections, cardiac arrhythmias, fluid & electrolyte
abnormalities, hyperpyrexia, poor hydration, hypertension, or sui-
cide
tests
■CAGE inventory:
➣Have you ever felt the need to CUT DOWN on drinking?
➣Have you ever felt ANNOYED by criticisms of drinking?
➣Have you ever had GUILT about drinking?
➣Have you ever taken a morning EYE OPENER?
➣A score of 2 or higher indicates possible alcohol problem (eg,
alcoholism)differential diagnosis
■Intoxication: abuse of any CNS depressant
■Withdrawal: withdrawal of selected CNS depressants, incl benzodi-
azepines & barbiturates