Emergency Strategy - How to treat alcohol withdrawal
Emergency strategy - How to treat alcohol withdrawal
Alcohol withdrawal syndrome are presented with clinical features such as delirium tremens, minor clinical cases of withdrawal or “ rum fits” /withdrawal seizures. Delirium tremens are characterized by agitation, hallucinations, tremulousness, disorientation, confusion, profuse perspiration, hypertension, tachycardia and fever. Delirium tremens commonly associates with over activity of the autonomic nervous system. Mortality from delirium tremens are 5%. Delirium tremens are commonly seen in 5% - 10% of cases of alcohol withdrawal. Symptoms of delirium tremens will start 48 - 96 hours after cessation of alcohol intake. The symptoms will resolve 3- 5 days later.
Minor withdrawal symptoms are characterized by dysfunctional of the autonomic nervous system and gastrointestinal symptoms as well as changes in behavior and impairment of the normal function. Common autonomic nervous dysfunction are characterized by tremulousness , tachypnea, tachycardia, diaphoresis, hypertension and fever. Vomiting, nausea and anorexia are the common gastrointestinal symptoms. Agitation, irritability and restlessness are the common behavioral changes. Functional impairment include poor memory and distractibility. Other common features are anxiety, nightmares, insomnia and weakness. Isolated generalized tonic - clonic seizures may occur 12 - 48 hours later after cessation of the intake of any alcohol. Chronic alcoholism is associated with the isolated generalized tonic- clonic seizures.
The form of investigations require are lumbar puncture and CT scan of the brain which is important in excluding any focal lesion or infection. Lumbar puncture and CT scan are performed in many cases of patient who suffer from recurrent seizures or status epilepticus.
Vitamin supplementation such as thiamine 50 - 100 mg IV or IM are given to the patient before glucose containing solution are given up to 3 days. Daily 100 mg oral thiamine are considered later. Other vitamins such as vitamin B complex, multivitamin and folate are also given.
Haloperidol and chlorpromazine are given as these antipsychotic medication is useful in treating hallucination and agitation. Special precaution should be taken as these antipsychotic medication may lower the seizures threshold. It is important to correct any imbalance of the electrolytes. Oral fluid is given. Consider maintenance IV fluid in case of the patient unable to tolerate oral fluid. Regular monitoring of blood glucose is required.
Sedative drugs such as benzodiazepine, diazepam, chlordiazepoxide and lorazepam are required. 5 - 20 mg of diazepam orally every 2- 6 hours depends on how severe the condition. 5- 10 mg IV diazepam is given every 5- 10 minutes until the patient has calm down and awake. The dose is taper gradually after over a period of 1- 2 weeks after the withdrawal symptoms have abated. 50 -100 mg chlordiazepoxide orally or IV is given. It is repeated every 6 hours until it achieve the maximum doses of 300 mg in 24 hours. The dose is halved over the next 24 hours and later reduced to 25- 50 mg / day. Oxazepam and lorazepam are given as an alternative to chlordiazepoxide and diazepam. Benzodiazepine are considered as bases and it does not lower the seizures threshold.
100mg of atenolol per day are given as an adjunct to benzodiazepine in treating of hyperactivity of the autonomic system. Seizures due to alcohol withdrawal can be treated with IV or oral benzodiazepine. In acute setting, consider barbiturates and phenytoin.
Other treatment include adequate nutrition, rest, abstinence from alcohol and careful management of the airway.
Alcohol withdrawal syndrome are presented with clinical features such as delirium tremens, minor clinical cases of withdrawal or “ rum fits” /withdrawal seizures. Delirium tremens are characterized by agitation, hallucinations, tremulousness, disorientation, confusion, profuse perspiration, hypertension, tachycardia and fever. Delirium tremens commonly associates with over activity of the autonomic nervous system. Mortality from delirium tremens are 5%. Delirium tremens are commonly seen in 5% - 10% of cases of alcohol withdrawal. Symptoms of delirium tremens will start 48 - 96 hours after cessation of alcohol intake. The symptoms will resolve 3- 5 days later.
Minor withdrawal symptoms are characterized by dysfunctional of the autonomic nervous system and gastrointestinal symptoms as well as changes in behavior and impairment of the normal function. Common autonomic nervous dysfunction are characterized by tremulousness , tachypnea, tachycardia, diaphoresis, hypertension and fever. Vomiting, nausea and anorexia are the common gastrointestinal symptoms. Agitation, irritability and restlessness are the common behavioral changes. Functional impairment include poor memory and distractibility. Other common features are anxiety, nightmares, insomnia and weakness. Isolated generalized tonic - clonic seizures may occur 12 - 48 hours later after cessation of the intake of any alcohol. Chronic alcoholism is associated with the isolated generalized tonic- clonic seizures.
The form of investigations require are lumbar puncture and CT scan of the brain which is important in excluding any focal lesion or infection. Lumbar puncture and CT scan are performed in many cases of patient who suffer from recurrent seizures or status epilepticus.
Vitamin supplementation such as thiamine 50 - 100 mg IV or IM are given to the patient before glucose containing solution are given up to 3 days. Daily 100 mg oral thiamine are considered later. Other vitamins such as vitamin B complex, multivitamin and folate are also given.
Haloperidol and chlorpromazine are given as these antipsychotic medication is useful in treating hallucination and agitation. Special precaution should be taken as these antipsychotic medication may lower the seizures threshold. It is important to correct any imbalance of the electrolytes. Oral fluid is given. Consider maintenance IV fluid in case of the patient unable to tolerate oral fluid. Regular monitoring of blood glucose is required.
Sedative drugs such as benzodiazepine, diazepam, chlordiazepoxide and lorazepam are required. 5 - 20 mg of diazepam orally every 2- 6 hours depends on how severe the condition. 5- 10 mg IV diazepam is given every 5- 10 minutes until the patient has calm down and awake. The dose is taper gradually after over a period of 1- 2 weeks after the withdrawal symptoms have abated. 50 -100 mg chlordiazepoxide orally or IV is given. It is repeated every 6 hours until it achieve the maximum doses of 300 mg in 24 hours. The dose is halved over the next 24 hours and later reduced to 25- 50 mg / day. Oxazepam and lorazepam are given as an alternative to chlordiazepoxide and diazepam. Benzodiazepine are considered as bases and it does not lower the seizures threshold.
100mg of atenolol per day are given as an adjunct to benzodiazepine in treating of hyperactivity of the autonomic system. Seizures due to alcohol withdrawal can be treated with IV or oral benzodiazepine. In acute setting, consider barbiturates and phenytoin.
Other treatment include adequate nutrition, rest, abstinence from alcohol and careful management of the airway.
