Medical Emergencies: Alcohol Withdrawal Syndrome

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Alcohol Withdrawal SyndromeAlcohol withdrawal syndrome is an acute toxic state which occurs as a result of a sudden cessation of alcohol intake of a known alcoholic following a session of heavy drinking. Upon the body’s dependence on the substance, an abrupt intake of alcohol can lead to various health complications which is highly dependent on how much alcohol was ingested and for how long.

Alcohol withdrawal syndrome or otherwise known as delirium tremens may be precipitated by infection or acute injury (such as hepatitis, pancreatitis and pneumonia) and is considered the most severe form of withdrawal syndrome.

Initial signs and clinical manifestations of alcohol withdrawal syndrome

Individuals with alcohol withdrawal syndrome will typically show signs of anxiety, uncontrollable fear, irritability, agitation, incontinence and insomnia. Moreover, such individuals show signs of decreased inhibition by being very talkative and preoccupied in their visual, tactile, olfactory and auditory experience which are very terrifying as these forms of hallucinations can lead to injury to the individual’s self as well as the health care providers rendering care.

Autonomic excitability occurs and is evidenced by tachycardia, dilated pupils and profuse sweating or perspiration. Normally, all vital signs are elevated in the individual’s alcoholic state. This form of withdrawal syndrome is very life-threatening and carries with it a high mortality rate if not treated properly.      

Treatment objectives for individuals with alcohol withdrawal syndrome

The ultimate goals in the management of alcohol withdrawal syndrome are  to give adequate sedation and support to allow the victim ample enough rest and recovery without endangering the individual’s peripheral vascular integrity. An in depth physical examination is normally performed in order to identify any preexisting illnesses that might contribute or aggravate injuries (e.g.: pneumonia, head injury). A drug history is also obtained to further elicit additional information that may help facilitate adjustment of any sedative procedure. Baseline blood pressure is determined because the individual’s subsequent treatment/procedures may depend on changes in the individual’s blood pressure.

Ideally, the patient is sedated as directed with a sufficient dosage of sedative medications such as benzodiazepines to help establish and maintain continuity of sedation which significantly reduces agitation, prevents exhaustion, prevents seizures and help promote sleep and comfort. The individual is expected to be calmer, able to respond and maintain an airway on their own without added support. Normally, assessment data will be the guide ED physicians and nurses will follow when adjusting dosages according to the individual’s symptoms and blood pressure response.

Clinical management of alcohol withdrawal syndrome

An Individual who is in the acute phase of alcohol withdrawal syndrome is to be placed in a calm and non-stressful environment (usually in a private room and so that they can be monitored closely. The room should be adequately lighted so help minimize illusions (visual interpretations) as well as hallucinations. Homicidal or suicidal responses are closely associated with such stimulus.

Fluid loss is monitored and intake of fluids via orally or intravenously is prescribed to curb additional fluid imbalance. Temperature, pulse, respiration and blood pressure are recorded every 30 minutes for severe forms of delirium. The aforementioned assessment guide should be recorded and relayed to members of the health care team in the ED to avoid hypothermia and peripheral circulatory collapse which are the tow most common complications of alcohol withdrawal syndrome.

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