Cause
- Heavy habitual drinking combined with poor nutrition
Clinical features
Features of malnutrition
- Weight loss, dry scaly skin
- Brittle discolored hair, pale mucous membranes
Cerebral damage
- Memory loss, hallucinations, tremors
Liver disease
- Poor appetite
- Fluid in the abdomen (ascites) as a result of cirrhosis
Withdrawal
- Mild: 12-48 hours after the last drink, with anxiety, agitation, insomnia, tremors, palpitation, sweating. If not progressing it may resolve over 24-48 hours
- Severe: seizures, hallucinations (from 12 to 48 hours after
the last drink) - Very severe: delirium tremens characterized by hallucinations, disorientation, tachycardia, hypertension, hyperthermia, agitation, and diaphoresis In the absence of complications, symptoms of delirium tremens typically
persist for up to seven days
Wernicke encephalopathy
- Due to thiamine deficiency. Common in chronic alcohol abuse
- Characterized by acute mental confusion, ataxia (unstable gait) and nystagmus/ophthalmoplegia (abnormal eye movements)
Management
Withdrawal syndrome
- Supportive care (IV fluids, nutrition)
- Check and correct hypoglycaemia with Dextrose 50% 20-50 ml IV
- Give it via NGT or rectal if IV not available
- Maintain infusion of Dextrose until patient wakes up and can eat
- Diazepam 5-10 mg every 10 minutes until appropriate sedation is achieved
- Very high doses may be required
- Monitor respiration
- If not responsing, consider phenobarbital 100- 200 mg slow IV but it has a risk of respiratory depression and hypotension
- Thiamine IV 100 mg in 1 L of Dextrose 5%
- If delirium or hallucinations persist in spite of treatment, consider haloperidol 2.5-5 mg up to 3 times a day
If Wernicke encephalopathy
- Thiamine 100 mg IV or IM every 8 hours for 3-5 days
Note
- See general management of alcohol use disorders