Group 7 ppt.sem5.2024_20241212_124004_0000.pdf

Group 7 ppt.sem5.2024_20241212_124004_0000.pdf

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  IDENTIFICATION AND MANAGEMENT OFALCOHOL WITHDRAWAL SYNDROME Chhavi Mudgal 22/721 PMBD Govind Kumar 22/696 Mirijello, A., D’Angelo, C., Ferrulli, A., Vassallo, G., Antonelli, M., Caputo, F., ... & Addolorato, G. (2015). Identification and management of alcohol withdrawal syndrome. Drugs, 75, 353-365. 1
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  Table of Contents 2 PMBD Introduction Pathophysiology SymptomsIdentification Diagnosis Treatment 3 4 5 6 8 I II III IV V
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  2 Alcohol use disorder(AUD) affects around 18% of the population over a lifetime and 5% annually, with nearly 20% of emergency room patients suffering from it. Withdrawal symptoms occur in up to 50% of AUD patients, with alcohol withdrawal syndrome (AWS) developing 6–24 hours after reducing intake. Symptoms range from mild (tremors, anxiety) to severe (hallucinations, seizures), with treatment primarily involving benzodiazepines. AWS can lead to significant morbidity and mortality, making its identification and management crucial in clinical settings. I INTRODUCTION 3
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  2 Acute alcohol ingestionenhances GABAergic neurotransmission and inhibits glutamatergic activity, leading to CNS depression. This occurs through stimulation of GABAa receptors and inhibition of NMDA receptors. Chronic alcohol exposure induces adaptive changes, including down-regulation of GABAA receptors and up-regulation of NMDA receptors, resulting in tolerance. Upon abrupt cessation, the balance shifts, causing decreased GABA activity and increased glutamatergic action, which can lead to alcohol withdrawal syndrome (AWS) symptoms. "Kindling" may increase neuronal excitability after repeated AWS episodes, contributing to more severe withdrawal experiences. Pathophysiology 4
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  2 Stage Time ofOnset after last drink Signs and Symptoms Minor Withdrawal Symptoms 6-12 hours Tremors, diaphoresis, nausea/vomiting, hypertension, tachycardia, hyperthermia, tachypnea Alcoholic Hallucinosis 12-24 hours Dysperceptions: Visual (zoopsy), auditory (voices) and tactile (paresthesia) III Alcohol Withdrawal Seizures 24-48 hours Generalized tonic-clonic seizures (with short or no postictal period) Delirium Tremens 48-72 hours delirium, psychosis, hallucinations, hyperthermia, malignant hypertension, seizures and coma 5
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  2 IDENTIFICATION OF SYMPTOMS 6 AlcoholWithdrawal Syndrome (AWS) is a spectrum of symptoms that can arise after abrupt cessation of alcohol in dependent individuals. Symptoms typically begin 6-12 hours after the last drink and can escalate from mild (tremors, anxiety) to severe (delirium tremens, seizures) within days. Monitoring is crucial for at-risk patients, especially those with altered consciousness. Screening tools like CAGE and AUDIT are effective for identifying alcohol use disorders. The severity of AWS can be assessed using the Clinical Institute Withdrawal Assessment for Alcohol (CIWA-Ar) scale.
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  2 The DSM-5 criteriafor Alcohol Withdrawal Syndrome (AWS) requires an abrupt reduction in alcohol intake, with at least two symptoms present, such as autonomic hyperactivity, tremors, insomnia, nausea, hallucinations, agitation, anxiety, or seizures. Differentiating AWS from other psychiatric disorders is crucial due to overlapping symptoms. The CIWA-Ar scale effectively assesses withdrawal severity, categorizing it as mild (<8), moderate (8-15), or severe (>15). High CIWA-Ar scores indicate a need for pharmacological intervention to prevent complications like seizures and delirium tremens. DIAGNOSIS 7
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  2 Alcohol Withdrawal Syndrome(AWS) can cause severe discomfort, with symptoms ranging from mild anxiety to life-threatening conditions like seizures and delirium. Effective treatment aims to alleviate these symptoms, preventing complications and enhancing quality of life. Patients with mild to moderate AWS can often be treated as outpatients, while severe cases require inpatient monitoring for safety. The establishment of Alcohol Addiction Units aids in managing AWS efficiently, reducing hospitalization costs. Long-term recovery efforts should focus on motivating patients to maintain abstinence and engage in relapse prevention programs II TREATMENT 8 Goals of Treatment
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  2 Non-pharmacologic interventions arethe primary treatment for Alcohol Withdrawal Syndrome (AWS), emphasizing reassurance, reality orientation, and supportive nursing care. A calm environment is crucial, avoiding excessive stimuli. Routine examinations should include assessing blood alcohol levels and various health metrics. General supportive care focuses on correcting fluid and electrolyte imbalances, with hydration and vitamin supplementation being vital. Thiamine is essential to prevent Wernicke's encephalopathy and should be administered before glucose infusions to avoid complications. Routine magnesium administration is not supported unless specific conditions are present II TREATMENT 9 General Treatment and supportive care
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  2 III TREATMENT 10 The treatmentof Alcohol Withdrawal Syndrome (AWS) typically involves long-acting medications that can be gradually tapered. The ideal drug should have a rapid onset, long duration of action, and simple metabolism, minimizing dependence on liver function. It must not interact with alcohol, suppress drinking behavior without causing cognitive or motor impairment, and have a low potential for abuse. Commonly used agents include benzodiazepines like chlordiazepoxide and diazepam, which effectively manage withdrawal symptoms and prevent complications such as seizures and delirium Drugs for Treatment of AWS
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  2 V TREATMENT 11 BENZODIAZEPINES Benzodiazepines (BZDs)are the "gold standard" for treating alcohol withdrawal syndrome (AWS), effectively reducing the incidence of seizures and delirium tremens (DT) by 84% and minimizing mortality risks. They work by stimulating GABAA receptors, mimicking alcohol's effects. Long-acting agents like chlordiazepoxide and diazepam are preferred for smoother withdrawal, while lorazepam and oxazepam are recommended for patients with liver impairment due to their lack of active metabolites. Treatment regimens can be fixed-dose or symptom-triggered, with no clear superiority among BZDs noted in studies
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  2 V TREATMENT 12 Barbiturates andPropofol Barbiturates, particularly phenobarbital, have limited use in treating alcohol withdrawal syndrome (AWS) due to their narrow therapeutic window and risk of excessive sedation. However, in ICU settings, they are indicated for patients requiring high doses of benzodiazepines (BZDs) or those developing delirium tremens (DT). The combination of BZDs and barbiturates can enhance GABAA receptor binding, improving treatment efficacy and potentially reducing the need for mechanical ventilation and ICU stay duration. Propofol is emerging as a valuable option for severe DT cases that are resistant to high BZD doses. It acts as a GABAA receptor agonist and NMDA receptor antagonist, allowing for rapid assessment of mental status post-discontinuation. Its short duration of action makes it suitable for managing refractory symptoms in AWS patients.
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  2 V TREATMENT 13 OTHER DRUGS Alpha2-agonists,beta-blockers, and neuroleptics are adjunctive treatments for Alcohol Withdrawal Syndrome (AWS), but not recommended as monotherapy due to risks of masking symptoms and potential complications. Beta-blockers like atenolol may help with hyperarousal in patients with coronary artery disease, while alpha2-agonists (e.g., clonidine) can reduce autonomic hyperactivity but may cause sedation. Neuroleptics (e.g., haloperidol) are contraindicated as monotherapy due to risks of seizures and prolonged delirium. Other alternatives like carbamazepine and sodium oxybate show promise but require further validation
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  CONCLUSION Alcohol Withdrawal Syndrome(AWS) is a serious condition that can arise in patients with Alcohol Use Disorder (AUD) upon abrupt cessation of alcohol. Diagnosis relies on the Clinical Institute Withdrawal Assessment (CIWA-Ar) scale, which helps gauge severity and guide treatment. Benzodiazepines (BZDs) are the primary treatment due to their efficacy in preventing complications like seizures and delirium tremens (DT) 15. However, their addictive potential limits long-term use. Alternative medications, such as carbamazepine and gabapentin, may support management and reduce BZD reliance, enhancing overall treatment outcomes for alcohol dependence. 14
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  Thank you for listening! PMBD