Internal Medicine

P1: SBT

0521779407-02 CUNY1086/Karliner 0 521 77940 7 June 7, 2007 19:18

Alcohol Abuse, Dependence, and Withdrawal Alcoholic Liver Disease 89

Average required doses range between 30–160 mg

For mild re-emergence of withdrawal symptoms or severe

insomnia, use small diazepam for 1–2 wk (e.g., Valium 10–20

mg PO q HS)

follow-up

■Long-term involvement in recovery program

complications and prognosis

■Medical syndromes:

➣Nutritional & vitamin deficiencies (ie, Korsakoff psychosis)

➣Gastritis

➣Respiratory suppression

➣Cardiomyopathy

➣CHF

➣Fatty liver

➣Hepatic cirrhosis

➣Impotence

➣Gynecomastia

■Neurologic syndromes:

➣Acute alcohol intoxication

➣Alcoholic dementia

➣Wernicke encephalopathy

Alcoholic Liver Disease (ALD)............................

RAMSEY C. CHEUNG, MD

history & physical

History

■Alcohol consumption & duration: threshold for ALD=40 g/d for

men, 10–20 g/d for women (10–12 g alcohol: 1.0 oz spirit, 12 oz beer,

4 oz wine)

■CAGE questionnaire for screening (2 or more suggests alcohol dep-

endence):

➣CUTTING DOWN on drinking

➣ANNOYANCE at others’ concern about drinking

➣Feeling GUILTY about drinking

➣Using alcohol as an EYE OPENER