Wednesday, June 29, 2016

Alcohol withdrawal

emDocs - June 28, 2016 - Authors: Long D  and Long B - Edited by: Koyfman A & Bright J
"Alcohol use is extremely widespread throughout developed countries. It is estimated that 8 million people in the US are alcohol dependent.1 Approximately 20% of men and 10% of women will at some point in their lives have an alcohol-use disorder.2 About half of people with alcohol-use disorders will have symptoms of withdrawal when they cut down or stop their alcohol consumption.3 Extreme complications, including seizures and/or delirium tremens, will occur in 3-5% of these people...
  • Even in AWS patients who develop DT, early symptoms may be mild.
  • In the tachycardic alcoholic patient, be sure to consider PE, myocardial infarction, sepsis, dehydration, and other potential diagnoses other than AWS.
  • Alcoholics commonly present with a range of metabolic abnormalities, some of which can be life-threatening. Be sure to check for these abnormalities and correct as appropriate.
  • The presence of confusion or altered mentation in a patient with AWS may be due to DT and warrants admission to a higher level of care such as an ICU.
  • AWS is a diagnosis of exclusion: consider structural CNS pathology, metabolic abnormalities, infection, other toxicologic causes, and other conditions before diagnosing AWS.
  • A seizure in a patient with AWS who has never had a previous seizure warrants a complete neurological work-up and cranial imaging.
  • Patients with alcohol use disorder commonly minimize their alcohol consumption, often understating the true degree of how much alcohol they consume on a daily basis.
  • Benzodiazepines are always your first line treatment for alcohol withdrawal syndromes."