The Problems
John Greene, Ian Bone in Understanding Neurology a problem-orientated approach, 2007
More correctly, this should really be ‘withdrawal from drugs and alcohol’. In the chronically habituated or addicted patient, the withdrawal from alcohol will produce an acutely delirious state, delirium tremens, as described earlier. (Although benzodiazepine withdrawal does not produce an acute confusional state remember that acute withdrawal in a chronically dependent patient can produce seizures.) The use of barbiturates is now rare. Acute withdrawal produces an initial improvement for 8–12 hours. This is rapidly followed by tremor, nervousness, and insomnia, but the initial improvement may last up to 2 or even 3 days in the chronically addicted patient. These symptoms can be associated with generalized seizures and these may be followed by a state very similar to delirium tremens. This though is variable and some patients have seizures without delirium while others develop delirium without seizures. Acute psychosis should make the clinician consider the possibility of drug abuse. Opiates in large doses can produce a clouded, agitated state of consciousness. Some of the drugs previously commonly prescribed for Parkinson’s disease, such as the anticholinergics, can cause confusion. Also, unfortunately some of the drugs which are currently used, such as L-dopa preparations and dopamine agonists, have similar side-effects.
Diseases Known to be Caused by the Diet
Stephen Seely, David L. J. Freed, Gerald A. Silverstone, Vicky Rippere in Diet-Related Diseases, 1985
In one respect, however, alcohol is the full equal of hard drugs: in the traumatic effect of its withdrawal symptoms. The cessation of taking addictive drugs is invariably followed by a withdrawal syndrome of greater or lesser severity, which may include trembling, convulsions, sleeplessness, psychotic effects, but few as severe as the delirium tremens of the alcohol addict. This can be fatal in otherwise healthy adults. The first stage of the alcohol withdrawal syndrome is tremulousness, weakness and profuse perspiration, which may be followed by epileptiform seizures after about 12 hours of abstinence. Delirium tremens usually begins a day (sometimes 2-3 days) after complete alcohol withdrawal. It is a state of agitated hallucinations, fever, sleeplessness, profuse sweating, sometimes complete disorientation. Death can occur from hyperthermia, vascular collapse or self-inflicted injury. In non-fatal cases delirium tremens can last for 5-7 days. In some cases recovery is not complete, the patient remains in a permanent psychotic state. The benzodiazepine drugs are now used with some success in calming such patients and alleviating the withdrawal symptoms.
Delirium
K. Rao Poduri in Geriatric Rehabilitation, 2017
Medications are a leading cause of delirium, especially in older adults. Older patients are often on multiple medications and are typically more at risk for adverse effects from medications. Both intoxication and withdrawal may lead to delirium. In patients who develop delirium, evaluation of medication lists for new or stopped medications is advised. Medications are often additive in effect, especially those with anticholinergic effects. Many over-the-counter cold medications, antihistamines, neuroleptics, and antidepressants have anticholinergic effects. Other medications associated with delirium include narcotic analgesics, sedative-hypnotics, especially longer-acting benzodiazepines, antiparkinsonian drugs, as well as corticosteroids. Withdrawal from several medications can lead to delirium. This includes barbiturates, benzodiazepines, amphetamines, as well as alcohol. Withdrawal from alcohol is always an important consideration as delirium tremens can be severe and life threatening. Withdrawal from antidepressants/SSRIs can lead to a discontinuation syndrome that can sometimes lead to delirium as well.
Impact of alcohol withdrawal training program on knowledge, attitude, and perception among healthcare providers in a hospital setting
Published in Journal of Substance Use, 2022
Padma Rani Kumar, Anne Yee, Benedict Francis
Globally, alcohol use contributed to 5.9% of mortality and up to 5.1% of disability-adjusted life years (Rosenberg et al., 2017). The prevalence of current alcohol binge-drinkers among the Malaysian population is fairly high at 11.8% (NHMS 2019). This finding reflected an increase from 2015, whereby only 8.4% of Malaysians were found to binge-drink alcohol (NHMS, 2015). The cutoff limit for safe consumption of alcohol for both women and men is set at 14 units or lesser per week, however, consumption is best spread over a duration of 3 days or more (Officers, 2016). When an individual’s alcohol use becomes heavier, compulsive, and there is a loss of control over the intake, harmful use may progress into an alcohol use disorder (Carvalho et al., 2019). Our study emphasizes on alcohol withdrawal, which is left untreated, has a 10% progression rate into delirium tremens (Rahman & Paul, 2019). Hence, assessment and management of alcohol withdrawal need imperative clinical attention (Pecoraro et al., 2012).
Person first and patient first: Tailoring language to individual patient needs
Published in Substance Abuse, 2019
Jasleen Salwan
Shortly after the panel discussion, my co-residents and I had the opportunity to speak with Mike (name changed), a patient with alcohol use disorder, as he served as a guest-in-recovery in one of our didactic ambulatory sessions. Mike had spent so much of the previous year in the hospital that most of my cohort of residents had cared for him before. Some of my co-residents had managed his delirium tremens in the intensive care unit (ICU); I had treated him for milder alcohol withdrawal on the general medicine wards. More recently, some of us had seen him in our addiction medicine clinic, which is embedded within our longitudinal primary care resident practice. Removed from the pressures of a busy workday, we sat in a circle with Mike and really heard his story.
Substance use disorders: diagnosis and management for hospitalists
Published in Journal of Community Hospital Internal Medicine Perspectives, 2020
Ahmed K. Pasha, Arnab Chowdhury, Sanah Sadiq, Jeremiah Fairbanks, Shirshendu Sinha
Often times, the initial encounter of an acutely intoxicated person is in the emergency department. The patient should be assessed for adequate airway, breathing and circulation, and intravenous fluids should be initiated. Concurrently a ‘banana bag’ (dextrose, thiamine, folic acid, multivitamin) should be administered. Once the patient is stabilized, he/she may be admitted to the hospital for further observation if appropriate. Alcohol withdrawal severity scale (PAWSS) predicts the severity of withdrawal and helps in determining the level of care needed by the patient [9]. As an inpatient, patients are usually managed symptomatically with intravenous fluids, anti-emetics as needed, thiamine, folic acid, multivitamins and use of restraints in agitated patients. Monitoring of the effects of alcohol on non-neurological organ systems is also an important task of the hospitalist. Attention should be paid to liver function tests (LFTs), electrolytes and blood glucose levels if patient is not eating well. Effort should be made to avoid letting a severely intoxicated patient to leave the hospital until their mentation improves as the patient is at high risk of self-harm in their altered state and physicians could be held responsible in case of harm to others or self- [8]. It is reasonable to put patients on a 72-h hold until the improvement of mentation. Intoxicated patients who have AUD have a high potential to undergo acute alcohol withdrawal as their blood alcohol level (BAL) decreases in the setting of abstinence. Severe alcohol withdrawal in the form of delirium tremens (DTs) could be life threatening and requires emergent treatment [10].
Related Knowledge Centers
- Alcohol Withdrawal Syndrome
- Cocaine
- Delirium
- Hallucination
- Palpitations
- Tremor
- Hyperthermia
- Barbiturate
- Seizure
- Benzodiazepine Withdrawal Syndrome