AlcoholWithdrawlSyndromes：酒精戒断综合征

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1、AlcoholWithdrawalSyndromesBy:DavidBridgers,M.D.CasePresentation:43y/oAAMwithahx,HTN,andlongtermETOHabuse,whopresentedtotheUrologyserviceafterbeingseenintheEDforHematuria,andbeingdiagnosedwitharenalmass.Hewas1days/pnephrectomy.Hewasonepiduralpainmedicationsperpaincontrol.Hewasreportedtobea

2、gitatedwhenthenursingstaffevaluatedhim.TheCasePresentation:TheUrologyteamevaluatedthepatientandafterrealizingthathehadnothadadrinkin36hourstheycalledforaMedicineconsultformanagementofDTs.DefinitionsAlcoholism:chronicalcoholabuse,dependence,oraddiction;chronicexcessivedrinkingofalcoholicbe

3、veragesresultinginimpairmentofhealthand/orsocialoroccupationalfunctioning,andincreasingadaptationtotheeffectsofalcoholrequiringincreasingdosestoachieveandsustainadesiredeffect;specificsignsorsymptomsofwithdrawalareusuallyshownonsuddencessationofsuchdrinking.Alcoholic:Onewhosuffersfromalco

4、holism.Onewhoabusesorisdependentonalcohol(Stedman’s26thed.)AlcoholismintheUnitedStatesAlcoholismisacommoncondition,withcomplicationsthatwilleventuallyconfrontallclinicians.Estimated10-18millionAlcoholicsintheU.S.in1990.15-20%ofhospitalizedandprimarycarepatients.Studiesshowthatb/w13and71pe

5、rcentofpatientsdevelopsymptomsofETOHwithdrawalVariousPresentationsofAcuteETOHWithdrawalMinorWithdrawalSymptoms:-occurw/i6hoursofcessation-insomnia,tremulousness,mildanxiety,GIupset,diaphoresis,HA,palpitations,andanorexia.-usuallyresolvew/i24-48hrs.-varyfromepisodetoepisodeVariousPresentat

6、ionsofAcuteETOHWithdrawalWithdrawalSeizures:-w/i48hoursoflastdrink-generalizedtonic-clonic-3%ofchronicalcoholicsdevelopthis-3%ofthosewhoseizedevelopStatusEpilepticusVariousPresentationsofAcuteETOHWithdrawalAlcoholicHallucinosis:-12-24hr.onsetafterlastdrink-usuallyvisual-Resolvew/i24-48hr.

7、-NOTsynonymouswithDT’s*othersignsmayormaynotbepresent*timecourseisdifferent*notusuallyassociatedwithcloudingofthesensoriumDeliriumTremens:-5%ofpatientswhowithdraw-typicallybeginb/w48and96hours-typicallylast1-5days-longerperiodsrequiringmassivedosesofmedicationshaveb