Withdrawal syndrome ethanol

Fadda F, Columbo G, Mosca E, et al Suppression by gamma-hydroxybutyric acid of ethanol withdrawal syndrome in rats. Alcohol Alcohol 24 447-451, 1989 Fine J, Finestone SC. Sensory disturbances following ketamine anesthesia recurrent hallucinations. Anesth Analg 52 428 30, 1973 Freese TE, Miotto K, Reback CJ The effects and consequences of selected club drugs. J Subst Abuse Treat 23 151—156, 2002... 

The withdrawal syndrome from ethanol includes anxiety, insomnia, possibly convulsions and visual hallucinations (delirium tremens - the Dts). It is treated or better still prevented by a calm environment, adequate (but not excessive) hydration, and careful monitoring, with the added use of anticon-vulsive/sedative agents, mainly benzodiazepines to prevent or treat convulsions. The preventive effects of benzodiazepines on withdrawal morbidity has been clearly demonstrated. There do not seem to be major differences between benzodiazepines, such as chlordiazepoxide or diazepam or others. Because of the abuse potential in these highly susceptible patients, these should be rapidly weaned, and proper prevention of relapse instituted. Other drugs such as meprobamate and clomethiazole (Hemineurin) are commonly used in some countries. The effectiveness... 

Alcoholism is among the major health problems in most countries. Dependence on ethanol, as with other addictive drugs, is expressed as drug-seeking behavior and is associated with a withdrawal syndrome that occurs after abrupt cessation of drinking. The ethanol withdrawal syndrome is characterized by tremors, seizures, hyperthermia, hallucinations, and autonomic hyperactivity. 

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. 

Diazepam BDZ receptor agonist that facilitates GABA-mediated activation of GABA A receptors Prevention and treatment of acute ethanol withdrawal syndrome ... 

Diana M, Pistis M, Carboni S, Gessa GL, Rossetti ZL (1993) Profound decrement of mesolimbic dopaminergic neuronal activity during ethanol withdrawal syndrome in rats elctrophysiological and biochemical evidence. Proc Natl Acad Sci USA, 90 7966-7969. 

Fadda, F., G. Colombo, E. Mosca, and G. L. Gessa. Suppression by Gamma-hydroxybutyric Acid of Ethanol Withdrawal Syndrome in Rats. Alcohol... 

Treatment of cough associated with use of ACE inhibitors Suppression of the ethanol withdrawal syndrome... 

The patient is experiencing symptoms of the withdrawal syndrome from physical dependency on ethanol. Since seizures are possible, it would not be appropriate to attempt sedation with a phenothiazine such as chlorpromazine. Thiamine is usually administered to counteract the symptoms of Wernicke-Korsakoff syndrome but will not alleviate withdrawal symptoms. Neither buspirone nor naltrexone has value in the immediate management of alcohol withdrawal states. The patient is indeed suffering from delirium tremens. The answer is (B). 

Opioids (especially methadone and heroin) are the most common cause of serious neonatal drug withdrawal symptoms. Other dmgs for which a withdrawal syndrome has been reported include phencyclidine (POP), cocaine, amphetamines, tricyclic antidepressants, phenothiazines, benzodiazepines, barbiturates, ethanol, clonidine, diphenhydramine, lithium, meprobamate, and theophylline. A careful dmg history from the mother should include illicit drugs, alcohol, and prescription and over-the-counter medications, and whether she is breast-feeding. 

Oimedo R, Hoffman RS Withdrawal syndromes. Emerg Med Clin North Am 2000 18(2) 273-288. [PMID 10767884] (Ovenriew of different withdrawal syndromes with emphasis on ethanol.)... 

Ethanol also reduces the activity of the noradrenergic system in the locus coeruleus, and alterations in norepinephrine activity may account for some aspects of intoxication and the abstinence syndrome. The 0.2 antagonist clon-idine and the P-receptor antagonist propranolol reduce some symptoms of alcohol withdrawal (Bailly et al. 1992 Carlsson and Fasth 1976 Dobrydnjov et al. 2004 Kahkonen 2003 Petty et al. 1997 Wong et al. 2003). 

Tiapride appears to be useful in alcohol withdrawal as an alternative to the benzodiazepines (2). It facilitates the management of ethanol withdrawal, but its use in patients at risk of severe reactions in acute withdrawal should be accompanied by adjunctive therapy for hallucinosis and seizures. Since it may prove difficult to identify such patients and since there is also a small risk of the neuroleptic malignant syndrome (particularly with parenteral administration), the usefulness of tiapride in this setting is likely to be limited. The potential risk of tardive dyskinesia at the dosage used in alcoholic patients following detoxification (300 mg/day) requires evaluation and necessitates medical supervision. It is unlikely to produce problems of dependence or abuse. 

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