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FACTS - Alcohol Withdrawal

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VOL: 99, ISSUE: 23, PAGE NO: 31






- Physical dependence upon alcohol results in withdrawal symptoms if alcohol intake is suddenly stopped or reduced sharply.



- Withdrawal symptoms commence within 12 hours of stopping alcohol; these can be unpleasant even in their most minor forms.



- Most dependent drinkers will experience the minor forms of withdrawal, while some will suffer severe symptoms that require detoxification in an inpatient setting.



- Risks can include dehydration from vomiting or diarrhoea, convulsions, hallucinations and or confusion, leading to agitation and sometimes aggression.



- Minor withdrawal symptoms often peak between the second and fourth days of withdrawal and subside after this, disappearing by the eighth to tenth day.



- Major withdrawal symptoms can appear between the first and fifth days, with rapid onset. A previous history of these symptoms is the best predictor of their recurrence.






- The quantity of alcohol consumed does not necessarily dictate the severity of symptoms.



Minor symptoms



- Trembling;



- Agitation or anxiety;



- Insomnia;



- Morning retching or vomiting;



- Sweating, particularly at night;



- Frequent loose bowel motions.



Major symptoms



- Withdrawal convulsions;



- Hallucinations;



- Confusion, possible Wernicke’s encephalopathy or Korsakoff’s psychosis;



- Delirium tremens - a serious effect of withdrawal displaying many of the above symptoms, including sweating, tachycardia, tachypnoea and pyrexia. It may also include dehydration, concurrent infection, hepatic disease or Wernicke-Korsakoff syndrome. The patient is often disorientated, with agitation, marked tremor and vivid hallucinations. The condition can be fatal if untreated.






- The international criteria for psychiatric diagnosis classifies alcohol withdrawal as ICD-10 (F10.3). The number 10 indicates mental illness, F10 relates to mental disorders due to alcohol, and F10.3 refers to the withdrawal state.



- The ICD states that any three of the listed symptoms are useful in making a diagnosis of alcohol dependence, in conjunction with a verbal history from the patient or relatives, a previous medical history, high blood alcohol, alcohol on the breath and deranged liver function tests (LFTs).






- Sedation with appropriate benzodiazepines (often chlordiazepoxide). The regimen should dampen symptoms while avoiding over sedation and should be reduced to zero over eight to 10 days.



- Management of hallucinations with suitable neuroleptics.



- Maintenance of hydration.



- Vitamin treatment of dietary neglect, and as prophylaxis, to prevent Wernicke-Korsakoff syndrome. Where confusion is present, or if there is a history of dietary neglect, vitamins are given parenterally.



- Treatment of concurrent infections.






- The observation of symptoms and titration of medication accordingly (in collaboration with medical staff).



- Administration of parenteral vitamins and intravenous medications and fluids, particularly if delirium tremens is present.



- Management of confusion or hallucinations, orientation via explanation, liaison with specialist services and psychiatry regarding treatment and follow-up options.

















Royal College of Physicians (2001) Alcohol - Can the NHS Afford it? Recommendations for a coherent alcohol strategy for hospitals. London: RCP.
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