- 12 – 48 hours post prolonged heavy drinking
- Signs and Symptoms
- Autonomic symptoms (tachycardia, HTN, diaphoresis, tremor, fever, respiratory distress)
- Sleep disturbance (latency/insomnia, less deep sleep, more REM)
- GI (anorexia, N/V)
- Neurologic (restless, generalized tonic-clonic seizures)
- Psychological (agitation, anxiety, irritability, poor concentration, impaired judgment, hallucination)
- Delirium Tremens
- 2-10 days post cessation
- Delirium
- Autonomic hyperactivity
- Perceptual distortions
- Fluctuation levels of psychomotor activity
- Reversible in young, remnant cognitive deficits in elderly
- Mortality 20%
- Treatment: chlordiazepoxide or lorazepam; supportive environment; maybe Haldol
- 2-10 days post cessation
- Management
- Diazepam (long acting benzodiazepines)
- Thiamine
- Supportive care – hydration and nutrition
- Wernicke-Korsakoff Syndrome
- Alcohol induced amnestic disorders due to thiamine deficiency
- Necrotic lesions – mammillary bodies, thalamus, brain stem
- Wernicke’s: ocular, ataxia, vestibular dysfunction, delirium (acute, reversible)
- Korsakoff’s: STM loss, unable to learn new information, anterograde amnesia, confabulations (Chronic, 20% recover with Tx)
- Treatment: thiamine (1-2wks, or up to 12 months)