Alcohol Withdrawal

HISTORY:

‍TremorSymptoms suggestive of alcohol withdrawal for ‍ ‍hoursdays

Last drink: ‍ ‍hoursdaysweeks ago

Typical consumption: ‍ per day, ‍beerwinespirits

Attempts to reduce or stop: ‍yesno

Severity of symptoms: ‍mildmoderatesevere

Treatments tried: ‍nonemore alcoholbenzodiazepines, ‍effectiveineffective

‍tremors

‍anxiety

‍agitation

‍restlessness

‍irritability

‍insomnia

‍nausea

‍vomiting

‍palpitations

‍sweating

‍confusion

‍hallucinations

‍seizures



EXAM:

General appearance: ‍well-appearing

Vital signs: ‍normal, BP ‍, HR ‍, RR ‍, SpO2 ‍ %, Temp ‍°

Eyes: -R: ‍normal, -L: ‍normal, ‍

Neck: ‍normallymphadenopathy

Heart: ‍RRR, ‍normal S1 and S2

Lungs: ‍clearabnormal sounds, ‍retractions

Abdomen: ‍softsemi-softtense, ‍non-tender ‍, ‍non-distended, ‍

Extremities: ‍edema, ‍warm, cap refill ‍< 3 sec> 3 sec, pulses ‍normal, ‍

Neurologic: cranial nerves ‍normal, strength ‍5/5 throughout, sensation ‍normal, reflexes ‍2+ throughout, cerebellar function ‍normal, gait ‍stable

Mental status: ‍alert, ‍oriented, speech ‍clear, mood ‍normal, thought process ‍organized, ‍no suicidal ideation, judgment ‍good



ASSESSMENT:

‍Alcohol withdrawal syndrome ‍likelysuspectedpossible

DDx: ‍



PLAN:

- Blood work: ‍CBC, ‍electrolytes, ‍creatinine, ‍glucose, ‍LFTs, ‍albumin, ‍vitamin B12, ‍folate

- ECG

- Psychoeducation about alcohol withdrawal

- Encourage abstinence from alcohol

- ‍Medications

- ‍Thiamine

- ‍Multivitamin

- ‍Antipsychotics

- ‍Antidepressants

- Referral to addiction services

- Referral to social worker

- Referral to psychologist

- Follow-up in ‍ ‍daysweeks

- Return if symptoms worsen or if new symptoms develop

- Go to ER if seizures, severe tremors, hallucinations, or confusio