Acute alcohol withdrawal
| Essentially, sympathetic overactivity | |
|---|---|
| Etiology | Occurs after hours/days of abstinence. Psych s/s tend to appear 12-24h after last drink; delirium tremens after 48-72h |
| Epidemiology | |
| Clinical presentation | U+Es, glucose, ketones. Consider other diagnoses if the patient has consumed alcohol in the last 6 hours |
| Pathogenesis | Up-regulation of NMDA receptors and down-regulation of GABA receptors |
| Diagnostic investigations | Complications of alcohol excess - U+E, Mg, Phos Glucose |
| Management | • Monitor Mg, K, glucose • Thiamine/B1 (IV Pabrinex/Thiamine if there's still a UK shortage) • Seizures: IV loraz + check glucose • chlordiazepoxide = long-acting, ↓ potential for abuse ➥ should be dosed based on CIWA score (see local guidelines) • Chronic encephalopathy: Korsakoff’s psychosis (confabulation, anterograde amnesia) |
Consider sinister differentials:
- Vascular:
- Infective: CNS infection - Meningitis/herpes encephalitis
- Traumatic: Head injury
- Autoimmune???
- Metabolic: Hypoglycaemia, Diabetic ketoacidosis (or alcoholic ketoacidosis)
- Iatrogenic???
- Neoplasm: I guess
- Primary psychiatric presentation