withdrawal symptoms?
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"Pops_UK" glyn.robertsnos...@ntlworld.com
Hi all this is my first visit to the group and as you look like a friendly lot I wonder if you can help.
My partner bottomed out on the 21/12/01 and as a result has not taken a drop since, she had drunk at least a bottle of spirit a day for the last ten years.
My Question is what withdrawal symptoms can we expect.
Regards Pops
Blue Moon mf...@clara.net
On Sat, 2 Feb 2002 09:13:48 -0000, "Pops_UK" Most physical withdrawal is felt within the first few days. I have occasional bouts of depression and sleep problems. Some sometimes experience panic attacks, I've had one or two. People's experiences differ.
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Blue Moon Email welcome. mailto:mf...@hotmail.com
"jennerisms" jenneri...@hotmail.com
What I see a lot of-in myself and many others- is difficulty handling emotions-both positive and negative. "Oh that's great-let's have a drink and celebrate!" Oh, that's awful-come, let's drown our sorrows." She will need to learn to deal with life on life's terms. jen
"Don" don_edward...@yahoo.com
Acute alcohol withdrawal Acute alcohol withdrawal can produce some of the more serious morbidity related to alcohol consumption. Clinical features of alcohol withdrawal follow the cessation of regular high-dose alcohol ingestion as soon as the blood alcohol level decreases significantly.21 Within 6 to 24 hours after stopping drinking, tremors, nausea and vomiting, anxiety, mild agitation, tachycardia, hypertension, insomnia and diaphoresis may occur. These symptoms usually peak between 24 and 36 hours and may dissipate after 48 hours. Hallucinations occur in 3%?10% of patients and are usually visual; their onset and duration are variable but typically begin after several days of abstinence.
Convulsions, which are usually 1 or 2 grand mal seizures, occur in 5%?15% of patients during acute alcohol withdrawal and typically occur within 6 to 48 hours after alcohol cessation.21,22 The risk of seizures increases with the duration of alcohol abuse.21,22 Alcohol consumption is more strongly ***ociated with seizures than is alcohol withdrawal.23,24 Delirium tremens (disorientation and global confusion) occur in less than 5% of patients, usually 3 to 5 days after withdrawal, and last for 2 to 3 days.22 The overall rate of death from delirium tremens is estimated at 2%?10%, with death usually due to cardiovascular, metabolic or infectious complications.21,22,25 Diagnosis and monitoring of withdrawal If a clinician suspects that regular high-dose alcohol intake has been recently discontinued, she or he can diagnose and monitor alcohol withdrawal using the Clinical Institute Withdrawal ***essment for Alcohol (CIWA-Ar) scale,26 a reliable and validated 10-item scale. The CIWA-Ar has high interrater reliability (r > 0.8)26 and construct validity.27 The clinician gives a score for each response or observation using a Likert-type scale (0?7 in most cases), with a maximum possible total score of 67. Mild withdrawal is considered if the patient has a CIWA-Ar score of 15 or less, moderate withdrawal if the score is between 16 and 20 and severe withdrawal if the score is above 20.28?32 Each rise in score group is ***ociated with a higher relative risk of complications such as confusion, seizures and hallucinations in those untreated.28 A randomized controlled trial comparing fixed-dose sedation with sedation guided by the CIWA-Ar score showed a shorter duration of sedation and hospital stay in the latter group.29 Although virtually all of the studies of alcohol withdrawal ***essed using the CIWA-Ar scale have been based in specialized alcohol treatment centres, a report of a case series from a general hospital in Australia showed that the CIWA-Ar scale was useful in ***essing hospitalized medical patients and identifying those who needed further treatment.28 Management Standard treatment for acute alcohol withdrawal, regardless of severity, includes supportive care (general nursing care in a quiet environment, re***urance, hydration, nutrition, reality orientation and the monitoring of signs and symptoms of withdrawal) and the administration of thiamine.27,32 Since thiamine deficiency has been reported in 30%?80% of people with alcohol dependence, 25?50 mg of thiamine given intravenously is recommended to prevent Wernicke's encephalopathy.22,25 This vitamin should be administered before intravenous glucose because it is a cofactor necessary for glucose metabolism. Severe and irreversible cerebellar and brain-stem damage has been reported when glucose was administered to patients suffering acute alcohol withdrawal who were not given concomitant thiamine therapy.22,25 The value of multivitamin or other B vitamin prophylactic therapy for patients in alcohol withdrawal remains unproven.25,33 For patients with a total CIWA-Ar score of less than 10 and no hallucinations or disorientation, supportive care is sufficient.25,26,28,29,32 The trials we reviewed varied in their threshold for starting benzodiazepine therapy. Supportive care may be sufficient for patients with mild withdrawal whose CIWA-Ar scores are higher (10 to 15) if the patient is in a well-staffed detoxification unit rather than a busy, noisy emergency department. Providing supportive care might take 10 minutes of every hour at first, then less time as the patient stabilizes.25,32 Such care does not, however, necessarily prevent the occurrence of seizures or hallucinations. For patients who have a CIWA-Ar score of more than 10 or who are experiencing hallucinations or disorientation, pharmacotherapy should be considered.25,26,32 Phenytoin has not been demonstrated to be superior to placebo in the prevention of simple withdrawal-induced seizures34?36 but may be required for multiple recurrent seizures or focal seizures or in patients with a history of epilepsy or head trauma.25 Neuroleptics are not recommended for routine use or prophylaxis because of a lack of evidence of efficacy and because of their adverse effects, particularly the lowering of the seizure threshold.22,37,38 Nonetheless, patients experiencing severe agitation, thought disorders and hallucinations may require haloperidol (0.5?5 mg orally, intravenously or intramuscularly every 2?4 hours as needed) in addition to a benzodiazepine.25 Many sedatives, including benzodiazepines, have been tried to relieve symptoms of acute alcohol withdrawal.22,30,39?41 Benzodiazepines have been advocated as the keystone therapy for alcohol withdrawal because they have both sedating and anticonvulsant effects. Observations of a wide variation in clinical practice in benzodiazepine regimens, in the use of additional medications and in the duration of inpatient treatment for alcohol withdrawal has led to a call for a review of regimen efficacy with a view toward practice guidelines.41 In an accompanying article in this issue we report on a meta-analysis we conducted of the evidence for the use of benzodiazepines in the treatment of acute alcohol withdrawal.42 Our findings from the meta-analysis support the view that benzodiazepines are effective in reducing signs and symptoms of withdrawal and preventing complications. All of the benzodiazepines studied appear to have similar efficacy. Two key points emerge as the most relevant for prescribers. First, clinicians should start treatment with benzodiazepines early, as indicated by the CIWA-Ar score, rather than waiting for withdrawal to advance. Second, adequate doses of benzodiazepine should be used (20 mg of diazepam or 4 mg of lorazepam). These high doses are required to counteract the tolerance that most people with alcohol dependence have to benzodiazepines. Higher doses given early, along with close monitoring using the CIWA-Ar scale, are considered safe and may avoid the late sedation that occurs with ongoing administration of lower doses.
People suffering alcohol withdrawal are often admitted to busy acute care wards of hospitals, settings where staff cannot devote their attention solely to this type of patient. After reviewing our local situation and the medical literature, we instituted a care path approach to the treatment of alcohol withdrawal to facilitate consistent, high-quality ***essment and treatment. The package includes a structured order form for physicians to initiate the care path and an ***essment form for nurses to chart the CIWA-Ar score and medications given. Physicians and nurses can call on a trained nurse educator for help in using the care path with patients when necessary.
"Pops_UK" glyn.robertsnos...@ntlworld.com
time you spent Regards Pops
"Pops_UK" glyn.robertsnos...@ntlworld.com
partner I have been guilty of the above and will take on board what you have said as it is very true and I'll watch myself in the future.
Regards Pop.
BTW Blue Moon I did reply with a thanks to your post but as it not showing in the newsgroup I'll thank you again Pops.
"Don" don_edward...@yahoo.com
Well, actually, it was just a copy and paste job ;) A couple of years ago I was very afraid of Alcohol Withdrawal Syndrome and spent many many hours on the net studying it.
Don
"Pops_UK" glyn.robertsnos...@ntlworld.com
Don you have saved me many many hours, thanks again Pops
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