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Alcoholism Etiology - Genetic predisposition o Children of alcoholics 4x risk of developing alcohol dependence- Refers to all types of harmful drinking - Males o Alcohol dependence - Occupation o Alcohol related complications o Sailors, bartenders, military - Ethnic – Chinese have protective aldehyde dehydrogenase deficiciency- Suspect if >14 units/wk males, >7 units/wk females - Personality o 1 unit = 9g alcohol = 1 shot , 1 glass of wine, ½ pint of beer - Mental IllnessDSM-IV Criteria- A destructive pattern of alcohol use, leading to significant social, occupational, Complications or medical impairment. - Liver o Fatty liverMust have three (or more) of the following, occurring when the alcohol use was at o CLDits worst: o HCC1. Alcohol tolerance: Either need for markedly increased amounts of alcohol to achieve intoxication, or markedly diminished effect with continued use of the - Neurological same amount of alcohol. o Memory lapses, amnesia2. Alcohol withdrawal symptoms: Either (a) or (b). o Dementia (a) Two (or more) of the following, developing within several hours to a o Peripheral Neuropathy few days of reduction in heavy or prolonged alcohol use: o Wernicke’s encephalopathy (NOA) - sweating or rapid pulse Nystagmus - increased hand tremor Ophthalmoplegia - insomnia Ataxia - nausea or vomiting +/- confusion - physical agitation mx: oral/IM thiamine - anxiety o Korsakoff’s psychosis (irreversible) - transient visual, tactile, or auditory hallucinations or illusions Progression from Wernicke’s - grand mal seizures Confubalutions (b) Alcohol is taken to relieve or avoid withdrawal symptoms. o Marchiafava-Bignami3. Alcohol was often taken in larger amounts than was intended Degeneration of corpus callosum4. Persistent desire to cut down alcohol use Unilateral dysgraphia/arthria5. Great deal of time spent in using alcohol, or recovering from hangovers Dementia/ mutism6. Important social, occupational, or recreational dysfunction7. Alcohol use is continued despite knowledge of it causing harm - Cardiovascular o CardiomyopathyCAGE screening (2 out of 4) o Arrythmia- Cut down- Annoyed at others’ comments - GIT- Guilty o Peptic ulcers, erosions- Eye-Opener o Pancreatitis
- Blood - Primary Rehab o Anemia o Group support Either macrocytic secondary to folate deficiency o Counseling Or microcytic secondary to GI bleed o Continuing care e.g 12-step Alcoholics Anonymous - Medication (if indicated, can reduce relapse rates)- Teratogenic o Disulfiram o Fetal Alcohol Syndrome Alcohol-flushing: flushing, tachycardia, tachypnea Low IQ Severe SE: stroke, malignant HTN, death Absent philtrum o Naltrexone Short palpebral fissure Hepatitis Small eyes N+V+D dizziness- Psychiatric/ Social o Acamprosate o Delirium Tremens NVD 3 days after alcohol stoppage C/I: pregnancy Tachycardia Sweating Organisations Anxiety - Alcohol Clinics: IMH, NUH Visual/ Tactile hallucinations - Alcoholics Anonymous o Depression - Halfway Houses o Anxiety o Christian Outreach Center o Family neglect/ Abuse o Teen Challenge o Work performance decline o AccidentsInvestigations- LFT – gamma GT esp- FBC – anemia, plt dysfunction- Other investigations as indicated to look for complicationsManagement- Outpatient- Inpatient if o Severe med/psy cx o Elderly Digitally signed by DR WANA HLA SHWE o Poor support DN: cn=DR WANA HLA SHWE, c=MY, o Failed inpatient tx o=UCSI University, School of Medicine, KT-Campus, Terengganu, ou=Internal- After 1 year: 30% relapse into heavy drinking Medicine Group, email=wunna. email@example.com Reason: This document is for UCSI year 4- Detox students. Date: 2009.02.22 15:23:20 +0800 o Diazepam/ lorazepam tapered dose o + Vitamin B1 supplementation