Alcohol Withdrawal

  • 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
  • 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)

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