Things not to miss - Alcohol withdrawal

A 60 years old male patient admitted with shortness of breath following trauma. He was found to have L/S pneumothorax to which an intercostal tube was inserted. He got symptomatically better.

Next day evening strange commotion in the ward drew attention of the house officer. He rushed to see what's going on and got terrified to see the patient had detached the IC tube from the bottle. He was shouting and asking to be discharged. With the help of some attendants the house officer managed to calm down the patient and reattached the IC tube. Patient remained quite for few hours and during the night he again became agitated and was running around the ward shouting. Finally the house officer had to give a sedative and restrain the patient.

Any thoughts??

Alcohol withdrawal!

Lesson

~ Any patient, particularly a male, behaving odd after admission could be having acute alcohol withdrawal.

~ Before shouting at a patient who's acting weird in the ward pause for a moment and think, could it be because of a disease?

~ Always make a habit of taking the history of alcohol use, but never trust the patient! Most of Sri Lankan patients will say they stopped taking alcohol six months before.

~ Alcohol withdrawal need prompt detection and treatment as delay can lead to establishment of delirium tremens which has a significant mortality.

~ Symptoms can range from anxiety to tremors, diaphoresis, palpitations, hallucinations and seizures.

~ Delirium tremens can lead to life threatening autonomic instability

~ Management is with benzodiazepines. Don't forget they need LARGE doses!

~ Why not read about alcohol withdrawal today?




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