Alcohol Withdrawal Syndromes：酒精戒断综合征.pptVIP

* * * * * * * * * * * * * * Alcohol Withdrawal Syndromes Hasan Shabbir, MD January 10th, 2008 Background 8 million Alcoholics in US1,2 4 million hospitalizations for AWS/yr4 12-30% of inpatients have ongoing excess alcohol intake3 Pathophysiology Not well understood Alcohol causes CNS depression Inhibits dopaminergic and adrenergic receptors GABA like effects Cessation results in brain hyperexcitability Definition-DSM IV ?A.??? Cessation of (or reduction in) alcohol use that has been heavy and prolonged.??B.??? Two (or more) of the following, developing within several hours to a few days after Criterion A: ??1)??? autonomic hyperactivity (e.g., sweating or pulse rate greater than 100)??2)??? increased hand tremor??3)??? insomnia??4)??? nausea or vomiting??5)??? transient visual, tactile, or auditory hallucinations or illusions??6)??? psychomotor agitation??7)??? anxiety??8)??? grand mal seizures??C.??? The symptoms in Criterion B cause clinically significant distress or impairment in social, occupational, or other important areas of functioning.??D.??? The symptoms are not due to a general medical condition and are not better accounted for by another mental disorder. TIMELINE Alcoholic Hallucinosis 10-25% of patients with AWS hallucinate Usually in first 24-48hrs of cessation7,10 Does not predict DT’s Usually auditory or visual Formication (bugs crawling on skin) “Minor” Withdrawal May occur within 6-12hrs of cessation Need to treat promptly May take up to 2 weeks to resolve Autonomic hyperactivity anxiety, tremulousness, insomnia hypertension, tachyarrythmias nausea, vomiting, or diarrhea Myalgias Alcohol Withdrawal Seizures Usually Generalized Tonic Clonic Seizures Usually self-limited 90% occur within 8-48hrs of cessation Usually 12-24hrs post-cessation May occur without any warning Most recurrent seizures within 6hrs of first seizure Alcohol Withdrawal Seizures (cont.) Further work-up if Fever Trauma 1st seizure Focal seizure No clear history of al