Synonyms and related conditions:
Alcohol withdrawal seizures & delirium tremens DT
Diagnosis:
This is a clinical diagnosis
Clinical features
Within 6-36 hours of cessation of/decrease in alcohol consumption,
Autonomic symptoms: diaphoresis, tachycardia, and hypertension
Neurological symptoms: tremor, anxiety, hallucinations (tactile, visual or auditory), agitation, seizures, headache, insomnia.
Delirium tremens DTs:
- Alcohol withdrawal
- +disorientation, confusion, agitation or hallucination
Alcohol hallucinosis:
- Alcohol withdrawal
- +Auditory hallucinations, without consciousness disturbance,
Scales & questionnaires:
CAGE questionnaire
Clinical Institute Withdrawal Assessment for Alcohol-Revised CIWA-Ar score:
- Mild <10
- Moderate 10-20
- Severe >20
Investigations to consider:
FBC (megalobastic anemia),
U&E, Mg++: hypokalemia, hypomagnesemia,
Liver enzymes:
- In hepatitis: AST:ALT ratio > 2:1, AST rarely >300 U/L
B1 Thiamine: by functional transketolase assay, thiamine chromatography or urinary thiamine
Glucose: hypoglycemia
Monitor:
- Vitals in acute setting
- Signs of withdrawal
Treatment:
Symptom triggered dosing of Benzodiazepines: diazepam P.O. or chlorediazepoxide P.O., or lorazepam I.V.
Consider Carbamazepine CBZ P.O. if recurrent.
Thiamine repletion, Adequate nutrition & correct electrolyte abnormalities:
- If liver disease: High calorie & High protein
- Multivitamin, thiamine B, folate,
- Correct electrolyte abnormalities & hypoglycemia: routine magnesium sulfate is not indicated.
- NB. Never give dextrose or glucose before correcting thiamine deficiency in these patients.
Addiction/depedence counselling