Alcohol Intoxication and Withdrawal

Symptoms of Alcohol Intoxication

Disinhibition (Sexual/Aggressive)

Labile Mood (shifts)

Slurred Speech

Incoordination

Flushed face

Nystagmus (eye movement)

Impaired

• Judgment

• Functioning

When is intoxication usually evident (blood level)

100-200 mg/dl

When does alcohol withdrawal occur after cessation/reduction

within 4-12 hours

Early signs of Alcohol Withdrawal

TREMORS (coarse hands, tongue, eyelid)

Agitation/Anxiety/depression

Insomnia

Nausea

Sweating

Hallucination

HA

INCREASED BP&HR

What is are medical emergency of severe alcohol withdrawal

Seizures & Delirium Tremens

Signs of Delirium Tremens

Confusion Hallucination
Autonomic Hyperactivity ( INCREASE: HR BP TEMP)

What is a major risk of Delirium Tremens?

SEIZURE risk → Initiate seizure precautions

What assessment tool can be used to screen for alcohol misuse?

CAGE

CAGE Screening tool for alcohol use disorder → C

C: Have you ever felt you should cut down on your drinking?

CAGE Screening tool for alcohol use disorder → A

A: Have people annoyed you by criticizing your drinking?

CAGE Screening tool for alcohol use disorder → G

G: Have you ever felt guilty about your drinking?

CAGE Screening tool for alcohol use disorder → E

E: Have you ever had a drink FIRST THING in the morning (eye-opener) to steady your nerves or relieve a hangover?

Seizure precautions for Alcohol Withdrawal

Padded side rails, suction at bedside

Screening tool used to assess for Alcohol withdrawal

CIWA

What CIWA score requires medication?

>20

What is used to treat Alcohol Withdrawal? (Pharm)

Long-acting Benzodiazepines

Long-acting Benzodiazepines used to tx Alcohol Withdrawal

Chlordiazepoxide (Librium)
Diazepam (Valium)

Lorazepam (Ativan)

Nursing interventions to restore fluid and nutrition

• Give thiamine (Vit B1) to correct deficiencies and prevent Wernicke-Korsakoff syndrome

• Provide hydration + Electrolytes (potassium & mag) to prevent imbalances

What med can be given to prevent relapse?

Disulfiram (Antabuse)

Disulfiram (Antabuse) purpose and effects

Deterrent medication → causes alcohol flush reaction (due to acetaldehyde)

• HA, Flushing, Vomiting

When can you administer Disulfiram (Antabuse)?

12 hours after last drink

Important teaching with Disulfiram (Antabuse)

Avoid alcohol in all forms → cough syrups & mouthwash

Why might anticonvulsants be given in alcohol withdrawal?

to prevent seizures

Why may Naltrexone (revia) be given?

Tx for ADDICTION

Why may Acamprocate (Campral) be given?

Maintain abstinence

Why may SSRIs be given?

Recude cravings