Adult Medical Emergency Handbook - Scottish Intensive Care Society

N.B. Remember spontaneous bacterial peritonitis and tap any ascites
and send for culture (in blood culture bottles), and urgent Gram stain
and cell count, WCC (>250 per microlitre suggestive of SBP). Check
cytology on ascitic tap.
• Consider a referral to the liaison psychiatrist/alcohol dependence
team/social worker.
NOTE
• Myelo-suppression, with a reduced platelet count is not
uncommon, as is folate deficiency.
• In chronic pancreatitis the amylase may be normal. A raised CRP
is the best guide.
• TB is more common in alcoholics. Request AFB’s on sputum
sample x3 (preferably early morning).
• Don’t assume alcohol is responsible for a fit. Could the patient
have meningitis, or intra-cerebral pathology following a fall?
• Check for hypoglycaemia.
• Encephalopathic patients may have flap, LOC, signs of chronic
liver disease. Distinguish from DT’s (tremor, restlessness).
• Common precipitating causes of encephalopathy are infection, GI
bleed, electrolyte disturbance, constipation.
• Withdrawal may occur two to three days after hospitalization.
MANAGEMENT OF ALCOHOL WITHDRAWAL
Alcohol dependence and withdrawal are associated with significant
morbidity and mortality. People who admit to drinking more than 10
units a day are likely to have withdrawal symptoms. Delirium tremens
is rare at a consumption of less than 15 units per day. Hypoglycaemia,
hypokalemia, hypocalcaemia and fever may predispose patients to
seizures or delirium tremens.
INITIAL ASSESSMENT
History
Ask the patient ‘Do you take a drink sometimes?’ or ‘What have you
had to drink in the last week?’ Make a note of alcohol consumption
in units wherever possible. If you suspect alcohol dependence ask
‘have you experienced tremor or shakiness in the morning - and taken
a drink to relieve this?’ Ask when they last had a drink. Try to take a
history from an informant if the patient is unable to co-operate.
274 adult medical emergencies handbook | NHS LOTHIAN: UNIVERSITY HOSPITALS DIVISION | 2009/11