Alcohol withdrawal from

Delirium tremens (the D.T.s ) resulting from alcohol withdrawal is slightly different in that it is usually preceded by the shakes, convulsions and occasionally by alcoholic hallucinosis - characterized by accusatory auditory hallucinations. As observed 60 years ago by Maurice Victor, an expert on alcohol problems, delirium tremens usually does not appear until day 3 or 4 following abrupt withdrawal from alcohol. The patient is generally malnourished and grossly deficient in vitamin Bj (thiamine) as the result of a diet consisting of little but alcohol. This deficiency ftirther compromises mental function. 

Similarly, BZDs are used for insomnia but are best reserved for short-term use. They are also used to assist withdrawal from alcohol, where a long elimination half-life drug is best. In acute psychotic states short-term use of a high-potency drug, such as lorazepam, can be helpful in managing acute agitation or aggression. 

The main drugs in this section are the barbiturates which can be considered as dry drink , and the withdrawal effects are very similar to the withdrawal from alcohol. Full-blown delirium tremens and epileptic fits can be observed and will need, usually, in-patient management and close supervision and sedation. 

RBD is characterized by a relative absence of the atonia characteristic of REM sleep. This lack of atonia permits the physical acting out of dream mentation, particularly dreams involving confrontation, aggression and violence. RBD is seen most frequently in older men. RBD occurs in both acute and chronic forms. Acute RBD can occur during withdrawal from alcohol or sedative-hypnotics. RBD has also been induced by the tricyclics, SSRIs and venlafaxine. The chronic form of RBD may occur as part of an identifiable underlying neurological disorder, but typically is idiopathic. RBD may also be an initial manifestation of parkinsonism. RBD is very responsive to clonazepam, although this use has not been FDA approved. 

Disturbance in the sleep pattern commonly occurs in the alcoholic. The sleep pattern in this type of patient is characterized by frequent awakenings and decreased REM and slow-wave sleep. Concomitantly, stages 1 and 2 are increased but shallower than usual. After withdrawal from alcohol, the... 

TABLE 7.2. Signs and Symptoms of Physical Withdrawal from Alcohol... 

Alcohol also shows cross-dependence with CNS depressant drugs. This means that taking one drug can suppress withdrawal symptoms of the other. For example, alcohol and the benzodiazepine drugs such as Valium and Librium show cross-dependence. This phenomenon has proved valuable in managing withdrawal from alcohol in individuals who arc physically dependent on it. 

ANTICONVULSANT, HYPNOTIC and SEDATIVE properties. It is used in some countries as a hypnotic in the elderly, for preoperative medication and in the managment of withdrawal from alcohol. 

I Persistent depressive symptoms following withdrawal from alcohol should be treated... 

During acute withdrawal from alcohol, the intravenous administration of diazepam is recommended, usually followed by chlordiazepoxide given orally. 

P Blockers may be of some value in the treatment of patients undergoing withdrawal from alcohol or those with akathisia. Propranolol and nadolol are efficacious in the primary prevention of variceal bleeding in patients with portal hypertension caused by hepatic cirrhosis. 

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. 

Anxiety is a feeling of apprehension, worry, or uneasiness that may or may not be based on reality. Anxiety may be seen in many types of situations, ranging from the anxiety that may accompany one s employment to tiie acute anxiety that may be seen during withdrawal from alcohol. Although a certain amount of anxiety is normal, excess anxiety interferes with day-to-day functioning and can cause undue stress in the lives of certain individuals. Dru used to treat anxiety are called anti anxiety drugs. Anotiier term tiiat refers to the antianxiety dru is anxiolytics. 

Alcohol lowers levels of serotonin in the brain, and many alcoholics have dreamless sleep, devoid of rapid eye movement activity. When alcoholics withdraw from alcohol, many experience delirium tremens (DTs), manifest by shaking, sweating profusely, anxiety, and hallucinations. Alcohol depletes the brain of serotonin, the levels of which may rise to higher than normal levels with the withdrawal of alcohol. Excessive production of serotonin is thought to cause the hallucinations, which characterize DTs. 

Librium is useful in preventing delirium tremens in clients withdrawing from alcohol. The majority of clients diagnosed with chronic pancreatitis (75%) are middle-aged males who also have chronic alcoholism. 

Withdrawal from alcohol or a sedative-hypnotic drug. 

Clomethiazole is commonly used to treat withdrawal from alcohol because of its hypnotic, anxiolytic and anticonvulsant effects. It is very effective if a rapidly reducing dosage regimen is followed over six days, but if it is used long-term and drinking continues it carries several serious risks. 

Disulflram reduces the clearance of caffeine, which might complicate the withdrawal from alcohol. 

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