Alcohol withdrawal

Alcohol withdrawal

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  Alcohol withdrawal
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  Alcohol withdrawal (NICE Pathways2015) • Someone who has been drinking alcohol heavily for a considerable period of time (i.e. several days), or has been drinking heavily and then ‘topped up’ over a period of time without respite, is in danger of alcohol withdrawal syndrome when their blood alcohol returns to minimum level. • Alcohol withdrawal syndrome is a life-threatening condition. • Immediate care is required for someone who is likely to experience seizures or delirium tremens. • Anyone at high or medium risk should be assessed in A&E. • High risk individuals and those under 16 years should be admitted to hospital.
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  Alcohol withdrawal symptoms (Guys& St. Thomas’ NHS Foundation Trust (2012) Symptoms and signs of alcohol withdrawal syndrome can be:  Anxiety  Agitation  Irritability  Nausea  Vomiting  Diarrhoea  Convulsions  Insomnia Absence of any of these does not exclude withdrawal symptoms.  Tremor of hands, tongue, eyelids  Hallucinations  Sweating fever with or without infection  Delirium  Tachycardia  Hypertension
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  Alcohol withdrawal syndrome (Guys& St. Thomas NHS Foundation Trust (2012) • Symptoms will present within 6 – 8 hours of the last drink. • These include epileptiform seizures within 12 to 48 hours of alcohol cessation. • Fits are rare beyond 48 hours following alcohol cessation. • People with known alcohol dependency should also be given prophylactic vitamin B supplement (Pabrinex). Alcohol related seizures
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  • Delirium tremens(DTs) occurs in about 5% of patients undergoing alcohol withdrawal. • Untreated, DTs is fatal in 15-20% of patients whilst early detection and prompt initiation of treatment usually prevents onset. • Onset of DTs is 2-5 days (most commonly at 2-3 days) following cessation and represents a medical emergency. • If untreated, death may result from respiratory and cardiovascular collapse or cardiac arrhythmias. • Patients most at risk are those with a high fever (>104°F/39.9°C), tachycardia, dehydration and an associated illness (e.g. pneumonia or pancreatitis), general debility or where the diagnosis is delayed. Delirium tremens (DTs) Alcohol withdrawal syndrome (Guys & St. Thomas NHS Foundation Trust (2012)
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  Delirium tremens (DTs)symptoms • Severe tremor • Clouding of consciousness • Delusions • Confusion and disorientation • Tachycardia • Agitation or violent behaviour • Delirium • Fever, with or without infection: temperature > 101°F/38.3°C • Severe hallucinations, often evoke extreme fear (mainly visual, may be tactile or auditory) Alcohol withdrawal syndrome (cont.) (Guys & St. Thomas NHS Foundation Trust (2012)
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  Immediate management ofalcohol withdrawal syndrome (NICE Pathways 2015) • Alcohol withdrawal syndrome is commonly managed in hospital through a reducing dose of benzodiazepines (diazepam or chlordiazepoxide). Clormethiazole may be prescribed for admitted inpatients. • Delirium tremens should be treated firstly with a quick-acting benzodiazepine (lorazepam) and psychotic symptoms should be managed with haloperidol or olanzapine. • Symptoms should be observed and recorded to determine the effectiveness of the treatment.
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  References • Guys andSt Thomas NHS Foundation Trust (2012) Clinical Guideline. DTC Reference 10052a. Available at: http://www.guysandstthomas.nhs.uk/resources/our- services/acute-medicine-gi-surgery/elderly-care/alcohol-withdrawal-syndrome.pdf • NICE Pathways (2015) Acute alcohol withdrawal. Accessed 28.7.15. Available at: http://pathways.nice.org.uk/pathways/alcohol-use-disorders/acute-alcohol-withdrawal