Alcohol Withdrawal

Age: ‍ years old

Gender: ‍malefemale



HISTORY:

Presents with a ‍-‍day history of ‍tremorsymptoms suggestive of alcohol withdrawal

Last drink was ‍ ‍hoursdaysweeks ago

Typical alcohol consumption: ‍ per day, ‍beerwinespirits

Attempts to reduce or stop alcohol consumption: ‍yesno

Severity of withdrawal symptoms is ‍mildmoderatesevere

Alleviating factors: ‍nonemore alcoholbenzodiazepines, ‍effectiveineffective



Associated symptoms: *Try using right-click for negatives*

‍tremors

‍anxiety

‍agitation

‍restlessness

‍irritability

‍insomnia

‍nausea

‍vomiting, ‍ episodes ‍per day, ‍, ‍hematemesis

‍palpitations

‍sweating

‍confusion

‍hallucinations

‍seizures



Contributing factors:

‍heavy drinking

no history of: ‍alcohol use disorder, ‍liver disease, ‍anxiety disorders, ‍depression

no use of: ‍benzodiazepines





EXAM:

General appearance: ‍well-appearing, ‍apparent distress

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

Eyes: conjunctiva/sclera ‍normal, lids/lashes ‍normal

Neck: ‍normal, ‍lymphadenopathy, ‍, c-spine ‍

Heart: ‍RRR, ‍MRG, ‍normal S1 and S2

Lungs: ‍clear bilaterally, ‍abnormal sounds, ‍retractions

Abdomen: ‍soft, ‍non-tender ‍, ‍non-distended, ‍

Extremities: ‍warm, ‍dry, cap refill ‍< 3> 3 sec, pulses ‍intact, ‍edema ‍bilaterally, ‍

Neurologic: cranial nerves ‍intact, strength ‍intact 5/5, sensation ‍intact, reflexes ‍intact 2+, cerebellar function ‍intact, gait ‍steady

Mental status: ‍alert, ‍oriented, speech ‍clear, mood ‍normal, thought ‍organized, ‍suicidal ideation, judgment ‍good





ASSESSMENT:

‍Alcohol withdrawal syndrome ‍likelysuspectedpossible

DDx: acute alcohol withdrawal, alcohol withdrawal seizures, delirium tremens, substance-induced mood disorder, substance-induced anxiety disorder, wernicke-korsakoff syndrome, hepatic encephalopathy, pancreatitis, gastrointestinal bleeding, infections, electrolyte imbalances, dehydration, thiamine deficiency, head trauma, intracranial hemorrhage, sepsis, benzos withdrawal, anxiety disorders





PLAN:

Investigations:

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

- ECG

Treatments:

- Psychoeducation about alcohol withdrawal

- Encourage abstinence from alcohol

- ‍Medications

- ‍Thiamine

- ‍Multivitamin

- ‍Antipsychotics

- ‍Antidepressants

Further care:

- Referral to addiction services

- Referral to social worker

- Referral to psychologist

- Follow-up in ‍ ‍daysweeks

- Return if symptoms worsen or if new symptoms develop

- Referral to ER if seizures, severe tremors, hallucinations, or confusion