Ethanol withdrawal from

The treatment goals for withdrawal from ethanol, cocaine/ amphetamines, and opioids include (1) a determination if pharmacologic treatment of withdrawal symptoms is necessary, (2) management of medical manifestations of withdrawal such as hypertension, seizures, arthralgias, and nausea, and (3) referral to the appropriate program for substance abuse treatment. 

The immediate concern in the treatment of alcoholics is detoxification and management of the ethanol withdrawal syndrome. Once the patient is detoxified, longterm treatment requires complete abstinence, psychiatric treatment, family involvement, and frequently support from lay organizations such as Alcoholics Anonymous. 

Long-acting drugs such as chlordiazepoxide and diazepam and, to a lesser extent, phenobarbital are administered in progressively decreasing doses to patients during withdrawal from physiologic dependence on ethanol or other sedative-hypnotics. Parenteral lorazepam is used to suppress the symptoms of delirium tremens. 

Clomethiazole has sedative, muscle relaxant, and anticonvulsant properties. It is used outside the U. S. for hypnosis in elderly and institutionalized patients, for preanesthetic sedation, and especially in the management of withdrawal from ethanol. Given alone, its effects on respiration are slight, and the therapeutic index is high. However, deaths from adverse interactions with ethanol are relatively frequent. 

Alcohol inhibits the release of vasopressin (antidiuretic hormone see Chapter 29) from the posterior pituitary gland, resulting in enhanced diuresis. The volume loading that accompanies imbibing complements the diuresis that occurs as a result of reduced vasopressin secretion. Alcoholics have less urine output than do control subjects in response to a challenge dose with ethanol, suggesting that tolerance develops to the diuretic effects of ethanol. Alcoholics withdrawing from alcohol exhibit increased vasopressin release and a consequent retention of water, as well as dilutional hyponatremia. 

Describe the major signs and symptoms of overdose with, and withdrawal from, CNS stimulants, opioid analgesics, and sedative-hypnotics, including ethanol. 

In addition to the symptoms described above, abrupt withdrawal from sedative-hypnotic dependence may include hyperreflexia progressing to seizures, with ensuing coma and possibly death. The risk of a convulsion is increased if the patient abruptly withdraws from ethanol use at the same time. The answer is (D),... 

Withdrawal from ethanol or sedative-hypnotic drugs... 

B. Management of withdrawal from ethanol and other sedative-hypnotic drugs. 

Schwarz et al. (183) measured the number of ATP-deficient preneo-plastic foci in rats which received ethanol (10% w/v in the drinking water) either during or after withdrawal from a dose of diethylnitrosamine (3 mg/kg). They found a significant increase in the size and number of enzyme-deficient foci at 16 wk when ethanol was consumed during the time of administration of the carcinogen. No effect was observed when the ethanol was consumed after withdrawal of the carcinogen. The level of ethanol given in this study was, however, quite low. 

Once dependence is entrenched, abstinence from it leads to the symptoms of ethanol withdrawal. In mild form this is characterised by agitation, anxiety, wakefiil-ness and a lowering of seizure threshold about 6-8 hours after withdrawal. In more severe cases, tremor (known as delirium tremens) and hallucinations can also be manifested and will continue for the first 24-48 hours. This stage is followed by a period of confusion and a ession along with a continued higher risk of convulsions and arrhythmias. 

---