I wonder whether healthcare providers are so focused on safety that they have forgotten about quality and the patient experience. Or have they simply been forced to just deprioritse those aspects of care?
- 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.
SIGNS AND SYMPTOMS
- The quantity of alcohol consumed does not necessarily dictate the severity of symptoms.
- Agitation or anxiety;
- Morning retching or vomiting;
- Sweating, particularly at night;
- Frequent loose bowel motions.
- Withdrawal convulsions;
- 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.
Removing bursaries for healthcare students could see the government “stumble into a disaster” of NHS recruitment problems, as potential nurses are put off by an average annual £900 paycut from loan repayments, MPs have claimed.
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