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| Alcohol Withdraw Syndromes |
 | Minor withdraw
 | Symptoms: tremor, irritability, anorexia, nausea, Tachycardia |
| Usually starts few hours after reduction of intake |
| Treatment: well lighted room, presence of relatives, Maintain fluid and
electrolyte balance |
|
| Seizures
| Usually occur 12 to 48 hours after last drink |
| Single generalized tonic clonic seizure |
| Long term anticonvulsant not indicated |
| Acute treatment: Benzodiazepine, barbiturate |
| Watch out for other causes of seizures: intracranial bleed, infection |
|
| Delirium Tremens
| Usually begins 48 to 96 hours after last drink |
| Symptoms: Delirium, Hallucinations, fever, agitated behavior |
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| Wenicke's encephalopathy
| Symptoms: Dementia, lethargy, Apathy, Amnesia, Ophthalmoparesis, Ataxia,
Autonomic signs |
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| Korsakoff's Psychosis
| Dementia, confabulation, Amnesia |
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| Treatment of Minor withdraw |
| Chlordiazepoxide (Librium)
| 25-100 mg po q6h. |
| Long half life, metabolized by liver. |
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| Diazepam (Valium)
| 5 to 20 mg q6h. |
| Long half life, difficult to titrate, metabolized by liver. |
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| Lorazepam (Ativan)
| 2 mg q6h, shorter half life, easier to titrate. |
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| Thiamine: 100 mg IM x 1, then 50 mg qd po x 5 days. |
| Multivitamin: 1 po qd |
| Folate 1 mg po q a day |
|
| Treatment of Delirium Tremens |
| Lorazepam 2-4 mg IV q 1 hour prn, then use above. |
| Haldol: 2-4 mg IV q 1 hour prn until calm. |
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| Other medications |
| Clonidine
| 0.1 po qid. |
| May decrease withdraw symptoms, watch for hypotension |
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| Atenolol: 50-100 mg qd |
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| Further reading |
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| Chronic complications of alcohol |
| Cerebellar degeneration
| Truncal ataxia without dysarthria |
| Cerebellar vermis atrophy |
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| Polyneuropathy
| 20% of alcoholics |
| paresthesia, loss of reflexes, postural hypotension |
| Axonal degeneration & demyelination |
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| Marchiafava-Bignami disease
| Insidious onset: dementia, depression, apathy, delusions |
| Necrosis of central zone of corpus callosum and symmetric demyelination |
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