Baseline tests- All patients should have FBC, U&E, LFT, Magnesium, phosphate, Blood glucose, clotting, B12 and folate.0.5 mg of lorazepam is roughly equivalent to 5 mg of diazepam.Oxazepam and lorazepam are benzodiazepines with shorter half life that are not significantly metabolised by the liver so are preferred for patients with liver failure as there is a lower risk of accumulation.Chlordiazepoxide 5mg is approximately equivalent to diazepam 2mg.Oral chlordiazepoxide is the drug of choice as it has a lower potential for abuse than diazepam.The oral long-acting benzodiazepines, chlordiazepoxide and diazepam, are preferred as they have both a long half-life and a smoother more protracted effect.Benzodiazepines are used to control psychomotor agitation and prevent progression to more severe withdrawal.Concomitant use of other psychotropic drugsĭiscuss the role of benzodiazepine in the treatment of AWS?.Previous history of severe withdrawal, seizures and/or DTs.Patients should also be considered for treatment, if they do not have symptoms of AWS but are at risk of developing severe AWS.Patients having symptoms of AWS as listed above.Untreated, DT is fatal in 15-20% cases, mostly from arrhythmias or cardiovascular or respiratory failure. Recurrent or prolonged seizures are unusual and should prompt investigations (CT scan/LP) It may resolve within 72 hours or go on to progressive stages of withdrawalĭT and Alcoholic hallucinosis are not synonymous Symptoms that occur within a few hours, even if severe, are not manifestations of DT. Profound symptoms of autonomic over activity (as in uncomplicated alcohol withdrawal).Untreated can progress to DT in 1/3 rd of cases Grand mal seizures usually single or as a brief flurry over a short period. Visual, auditory or tactile hallucinations with intact sensorium (Unlike DT where sensorium is impaired) The AWS can therefore be grouped into four sets of symptoms: The alcohol withdrawal syndrome may be a continuum from simple tremulousness through hallucinosis in a clear sensorium to seizures and most severe delirium tremens.
What are the symptoms of alcohol withdrawal? Alcohol withdrawal reverses the excitatory pathway inhibition while the GABA inhibition persist leading to the symptoms of alcohol withdrawal. Establishment of Gastrointestinal Endoscopy Areasĭiscuss the pathogenesis of alcohol withdrawal?Ĭhronic alcohol intake down regulates the inhibitory GABA pathway as well as the excitatory pathways (glutamate neurotransmission).Iron Replacement (parenteral dosing) for Iron Deficiency.
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