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

Alcohol Withdrawal Syndromes By: David Bridgers, M.D. Case Presentation: 43 y/o AAM with a hx, HTN, and long term ETOH abuse, who presented to the Urology service after being seen in the ED for Hematuria, and being diagnosed with a renal mass. He was 1 day s/p nephrectomy. He was on epidural pain medications per pain control. He was reported to be agitated when the nursing staff evaluated him.The Case Presentation: The Urology team evaluated the patient and after realizing that he had not had a drink in 36 hours they called for a Medicine consult for management of DTs. Definitions Alcoholism: chronic alcohol abuse, dependence, or addiction; chronic excessive drinking of alcoholic beverages resulting in impairment of health and/or social or occupational functioning, and increasing adaptation to the effects of alcohol requiring increasing doses to achieve and sustain a desired effect; specific signs or symptoms of withdrawal are usually shown on sudden cessation of such drinking. Alcoholic: One who suffers from alcoholism. One who abuses or is dependent on alcohol (Stedman’s 26th ed.) Alcoholism in the United States Alcoholism is a common condition, with complications that will eventually confront all clinicians. Estimated 10-18 million Alcoholics in the U.S. in 1990. 15-20% of hospitalized and primary care patients. Studies show that b/w 13 and 71 percent of patients develop symptoms of ETOH withdrawal Various Presentations of Acute ETOH Withdrawal Minor Withdrawal Symptoms: -occur w/i 6 hours of cessation -insomnia, tremulousness, mild anxiety, GI upset, diaphoresis, HA, palpitations, and anorexia. -usually resolve w/i 24-48 hrs. -vary from episode to episode Various Presentations of Acute ETOH Withdrawal Withdrawal Seizures: -w/i 48 hours of last drink -generalized tonic-clonic -3% of chronic alcoholics develop this -3% of those who seize develop Status Epilepticus Various Presentations of Acute ETOH Withdrawal Alcoholic Hallucinosis: - 12- 24 hr. onset after