what are the alcohol withdrawal syndromes
- Uncomplicated alcohol withdrawal syndrome: N+V, coarse tremor, sweating, insomnia, tachycardia (>100), generalised anxiety, psychomotor agitation; OUTPATIENT
- Complicated alcohol withdrawal syndrome (grand-mal seizures)
- Delirium tremens
Define delirium tremens
Acute confusional state secondary to alcohol withdrawal (good EXAM Q)
medical emergency
Pathophysiology delirium tremens
When alcohol use ceases, the unregulated mechanisms result in hyper excitability of neurons as natural GABAergic systems are down regulated and excitatory glutamatergic systems are unregulated. This combined with increased noradrenergic activity results in the symptoms of delirium tremens
CFs delirium tremens
the features of uncomplicated withdrawal (eg N+V, tachycardia)
o Clouding of consciousness, disorientation, amnesia for recent events, psychomotor agitation, visual/auditory/tactile hallucinations (Lilliputian hallucinations → seeing small people/animals/insects), fluctuations in severity
o Severe cases: heavy sweating, fear, paranoid delusions, agitation, suggestibility, raised temp., sudden CV collapse
Rx delirium tremens
- INPATIENT
- Large dose BDZs to keep alive - they will be sedated (e.g. diazepam/lorazepam) → reducing regime
- Haloperidol (typical antipsychotic) for psychotic features
- IV Pabrinex (contains water soluble vitamins: inc. thiamine [B1]) – to prevent wernicke’s encephalopathy
Wernicke’s encephalopathy - what is it
reversible acute encephalopathy due to thiamine deficiency
Wernicke’s encephalopathy aetiology
- Alcoholism (poor intake)
- Anorexia nervosa
- Starvation
- Post-gastric resection
Wernicke’s encephalopathy pathophysiology
Chronic alcohol consumption → Thiamine deficiency (B1)
o Decreased absorption GI tract
o Reduced intake
o Impaired thiamine utilisation by cells
CFs Wernicke’s
TRIAD: Acute confusion (delirium), ataxia, nystagmus (PCP intoxication too)
Also: ophthalmoplegia [CN 6 palsy: paralysis of lateral gaze], hypothermia
Rx Wernicke’s
Parenteral thiamine (IV Pabrinex)
Korsakoff’s syndrome aetiology
Thiamine def. secondary to alcohol abuse
Korsakoff’s syndrome pathophysiology
Neuronal degeneration secondary to thiamine deficiency
Korsakoff’s syndrome CFs
Short-term memory loss, confabulation (unconscious filling of gaps in memory w/ imaginary events), disorientation to time, retrograde amnesia, inability to lay down new memories
Korsakoff’s syndrome Rx
- Oral thiamine + vit supplementation (2yr)
- Rx psychiatric comorbidity
- Continuous assessment: OT + cognitive rehabilitation
Korsakoff’s syndrome prognosis
- 20% complete recovery
* 50% improvement
