Adult Medical Emergency Handbook - Scottish Intensive Care Society

i
Chapter 12
PSYCHOLOGICAL MEDICINE
ALCOHOL
PRESENTATION
• Acute intoxication.
• Withdrawal “DT’s” see below.
• Seizures: withdrawal or intoxication, or hypoglycaemia.
• Associated problem e.g. pneumonia, rhabdomyolysis.
• Incidental e.g. admission for unrelated problem.
MANAGEMENT
• Check plasma alcohol level, FBC, U&E’s, glucose, LFT’s, clotting,
and other tests indicated e.g. amylase if abdominal pain.
• Start thiamine 300mg od oral.
• Pabrinex may be required if NBM, actual or incipient Wernicke’s
encephalopathy or Korsakoff’s psychosis (see below).
• Indications for Pabrinex or those at risk of Wernicke-Korsakov
syndrome ie those with alcohol dependence and diarrhoea,
vomiting, other physical illness, weight loss, poor diet.
Signs of possible Wernicke-Korsakov syndrome:
- Acute confusion
- Reduced conscious level
- Memory problems
- Ataxia
- Ophthalmoplegia
- Hypoglycaemia
• Pabrinex IVHP (No1 and No2 mixed) by IV infusion in 100ml 5%
dextrose over 30mins then 8 hourly for 48 hours.
N.B. Risk of anaphylaxis - facilities for treating this must be readily
available.
• Alcohol withdrawal management guidelines are detailed below
and updates are available on the Intranet.
• Never prescribe hypnotics as discharge drugs.
High dependency or intensive care and nursing observation is
required with IV sedatives.
• Treat any associated problems. Screen for infection including CXR.
adult medical emergencies handbook | NHS LOTHIAN: UNIVERSITY HOSPITALS DIVISION | 2009/11
273