Published: Tue, March 21, 2017
World | By Tasha Manning

Medicine Today - The world of medicine at your fingertips

Medicine Today - The world of medicine at your fingertips

Abandoning alcohol is dangerous too.

Alcoholics suffer from a variety of life-threatening medical conditions: cancer, pancreatitis, accidents, cirrhosis. The truth is that serious complications can occur both when drinking and when they stop drinking. Today we are going to focus on the process of abandoning alcohol consumption and some of the considerations necessary for wise management of these cases.

Alcohol withdrawal syndrome
Symptoms of alcohol withdrawal Alcohol depend on how much alcohol you usually consume, how long you have consumed it and how much time has passed since the patient took his last drink:

6 to 12 hours: Anxiety, shaky hands, sweating, Nausea, vomiting, insomnia, diarrhea
12 to 24 hours: Visual, auditory and tactile hallucinations (the patient is aware that they are not real)
From 24 to 48 hours: Convulsions
48 to 72 hours: Delirium Tremens: disorientation, confusion, hypertension, tachycardia, visual hallucinations that can not be distinguished from reality, profuse sweating, seizures, palpitations, severe tremors, low fever. Hallucinations in particular can be very vivid and frightening, for example spiders on the wall, or even walking on your body .

Patients with confusion, hallucinations, convulsions or abnormalities of signs Vital signs should always be admitted to the hospital until they have passed the 4-day mark as they are very high risk.

The main medical interventions are:

Place the patient in a quiet room with Low lights.

Day 1 Chlordiazepide 50 mg orally every 6 hours (4 times a day)
Day 2 Chlordiazepide 50 mg orally every 8 hours (3 times a day)
Day 3 Chlordiazepide 50 mg Oral solution every 12 hours (2 times a day)
Day 4 Chlordiazepide 50 mg orally once daily

The initial dose should be adjusted to the number of mg needed to control symptoms. It is important to gradually reduce the dose to zero within 5 to 6 days to avoid creating an addiction.

(You Never Can Tell) C'est La Vie Lyrics - Emmylou Harris - Cowboy Lyrics
It was a teenage wedding And the old folks wished them well You could see that Pierre Did you really love the mademoiselle And now the young monsieur and madame Have rung the chapel bell "C'est la vie", say the old folks It You can not tell, you can not tell.

If there is no chlordiazepoxide other benzodiazepines can be considered: Day 1: Diazepam 10 mg IV every 6 hours

Day 2 Diazepam 10 mg IV every 8 hours,
Day 3 Diazepam 10 mg orally every 12 hours,
Day 4 Diazepam 5 mg every 12 hours Or Clonazepam 1 mg orally by Day 5 Clonazepam 0.5 mg orally

Lighter Outpatient Cases:
Day 1 Clonazepam 0.5 mg orally three times a day
Day 2 Clonazepam 0.5 mg orally, twice daily
Day 3 Clonazepam 0.5 mg once daily on the third day,
Day 4 Clonazepam 0.25 mg once daily

Doses Should be adjusted to the patient's usual alcohol consumption. Alcoholics generally tolerate higher doses of benzodiazepines that would cause respiratory arrest for nonalcoholics. Similar to the case of organophosphate poisoning and treatment with atropine, it is impossible to specify an exact dose because it must be adjusted to provide adequate symptomatic relief of agitation, and the total amount may be surprising. The goal is to have a patient who is fully awake but with a little sleep. If your patient is asleep you are giving too much.

What do we do if there are no benzodiazepines?
If there is no benzodiazepines the detoxification process is very dangerous. The best thing would be to do a detoxification with beer (see below)

More serious cases:
If an alcoholic is in poor condition or manifests neurological symptoms, then it would be better to administer thiamine 500 mg IV daily for three days.

Lighter cases: If you are going to In addition to benzodiazepines, daily oral doses of thiamine 100 mg, folic acid 1 mg, vitamin D 400 IU or a multivitamin containing the same may be given daily. It is reasonable to administer Gatorade or other electrolyte-containing fluids.

Beta blocker : only if there is tachycardia or hypertension. Usually tachycardia and hypertension respond best to benzodiazepines.

Gabapentin 400 mg three times a day or baclofen 10 mg three times a day can help reduce The total dose of benzodiazepines that are required during detoxification and may decrease the craving for alcohol after detoxification. The dose should be gradually lowered over a week once the withdrawal symptoms are over.

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