Introduction...
Alcohol is primarily a depressant to the central nervous system. Following a single dose, peak levels are reached within one hour, persist for two hours, and gradually decline.
After consuming an appreciable quantity of alcohol (tolerance varies markedly from person to person), there is the release of inhibitions resulting in a state of exhilaration and euphoria. Further doses of alcohol produce dizziness, slurred speech, ataxia, tremors, confusion, nausea, vomiting, and increasing mental faculties' impairment until stupor and coma supervene.
Physical examination at this stage reveals the skin to be hot and flushed or pale and sweating, deep reflexes are exaggerated with bilateral extensor planters, pupils are dilated, breathing is stertorous, and pulse is full and bounding.
Death occurs uncommonly from respiratory or circulatory failure.
A scale relating blood alcohol levels to sign and symptoms of acute alcoholic intoxication in a non habituated person are given below...
If the blood level of alcohol is...
- 30 mg%- Then the patient feels mild euphoria
- 50 mg%- Dizziness, mild incoordination
- 100 mg%- Ataxia, slurred speech
- 200 mg%- Confusion, drowsiness, blurred vision
- 300 mg%- Stupor and later progressively increasing coma.
Occasionally, acute alcoholic intoxication manifests in an atypical pattern. These include:
(i) “acute excitation,” which takes the form of a sudden and unprovoked outburst of anger with even assaultive and destructive behavior; and
(ii) “blackouts” in the form of episodes of transient amnesia that accompany heavy intoxication.
Clinical features of acute alcohol withdrawal syndrome...
Sudden withdrawal of alcohol in a chronic alcoholic patient sometimes produces acute and frightening symptoms in the form of...
- Confusion
- Irritability
- Tremulousness
- Nausea
- Vomiting
- Insomnia
- Hallucinations
- Psychosis and convulsive seizures are also called rum fits.
The most severe form of alcohol withdrawal syndrome results in “delirium tremens,” characterized by marked...
- Confusion
- Hallucinations
- Delusions
- Coarse tremors
- Agitation and Sleeplessness.
The patient presents a flushed appearance and has features of marked autonomic activity such as Dilated pupils, Tachycardia, Raised temperature, Excessive sweating, etc.
Any associated infection or injury aggravates the symptoms. In severe cases, death may occur from hyperpyrexia or peripheral circulatory failure.
Management of acute alcohol withdrawal syndrome...
In patients with mild to moderate withdrawal symptoms, treatment aims to ensure rest and sleep of the patient. This can be achieved easily by sedatives like Diazepam given in doses of 10 mg every 4-6 hours.
When delirium tremens have developed, it constitutes a medical emergency. The patient should, therefore, be immediately hospitalized.
(1) Control of Agitation...
Control of agitation
Agitation and Restlessness are best controlled by benzodiazepines. To avoid rapid changes in blood levels, long-acting benzodiazepines are ordinarily used, such as Diazepam or Chlordiazepoxide.
On the first day, an average patient requires 40-60 mg diazepam or 200-300 mg chlordiazepoxide, administered in four divided doses.
This should alleviate most of the symptoms of alcohol withdrawal. The dose is then reduced slowly by 20 percent on successive days over 3-5 days.
It is important to remember that in cases with evidence of associated liver disease or pre-existing encephalopathy(brain involvement), long-acting benzodiazepines may prove hazardous. In such patients, drugs with a short half-life should only be used like Oxazepam, etc.
2) Other Measures...
Intravenous fluids
An adequate amount of fluids, including intravenous D5W, should be administered, and laboratory values of important electrolytes kept within the normal range.
Large doses of vitamins are recommended, especially Vitamin B1, since glucose infusions may utilize the last available stores of Thiamine (chronic alcoholics may have a meager reserve of B vitamins) and thus precipitate acute Wernicke's encephalopathy.
Conclusion...
In case of acute withdrawal of alcohol in any person, create an emergency medical situation, so to handle it properly, the person should get admitted to the best hospital under the supervision of a psychiatrist.
Everybody must know the severity of this situation and know about the medicines used in controlling the symptoms of acute alcohol withdrawal.
Disclaimer...
This article is intended only for information purposes, so please consult with a doctor before treating an alcoholic patient.
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