A chronic alcoholic patient is brought to the emergency department by his wife. The person has not consumed alcohol for the past two days due to religious reasons. The person complained of nausea, vomiting and dizziness. On the second day. he developed seizures, that progressed to generalized tonic clonic seizures (GTCS). Which of the following would be best medication to manage the seizure of the patient?
Ans. c. Diazepam (Ref: Niraj Ahuja 6/e p39-40; Kaplan and Sadock's 9/e p1278, 1284-1285)The seizures in this patient, is due to alcohol withdrawal. Diazepam would be best medication to manage the seizure of the patient.Symptoms of Alcohol withdrawal:Hang over (MC)QHallucinationsQ (usually auditory) and illusionsQInsomniaQSeizures (Alcoholic seizures/Rum fits)QDelirium tremens;Occurs within 5 daysQ of complete or significant abstinenceQ from from heavy alcohol drinking Recovery occurs within 7 daysCharacteristic features are clouding of consciousnessQ, disorientationQ, hallucinations (mostly visual and auditory)Q, illusionQ, autonomic disturbancesQ, agitationQ and insomniaQ.Long acting benzodiazepines such as chlordiazepoxide and diazepam or short acting such as Iorazepam can he used to treat mild-moderate uncomplicated alcohol withdrawal.''Chlordiazepoxide is preferred over diazepam for treatment of alcohol withdrawal syndrome.'Management ofAlcohol IntoxicationAlcohol WithdrawalDelirium TremensDrugs used are:* Lorazepam (can worsen the vitals due to CNS depression)* Haloperidol (can lower seizure threshold) Other drugs which may be used:* Ziprasidone* Olanzapine* All patients should be given multiple oral vitamin B1 including 50-100 mg of thiamine daily for a week.* Replace alcohol (CNS depressant) with any other CNS depressant.* Benzodiazepines are commonly used.* Chlordiazepoxide is drug of choice because of its long half- life.* High dose benzodiazepines or antipsychotics arerecommended.* Anticonvulsants are not given to control seizures seen in delirium tremens. Withdrawal SyndromesSubstanceFeaturesOpioid* YawningQ, Insomnia. Dysphoric mood* Water loss from different orificesQ (LacrimationQ, sweatingQ, diarrheaQ, vomiting, rhinorrheaQ)* Increased vitalsQ (BP, Pulse, RR, Temperature)Q* Pupilary dilation, piloerectionQAlcohol(Hls delirium)* Hang over (MC)Q* HallucinationsQ (usually auditory) and illusionsQ* InsomniaQ* Seizures (Alcoholic seizures/Rum fits)Q* Delirium tremens:- Occurs within 5 daysQ of complete or significant abstinenceQ from from heavy alcohol drinking- Recovery occurs within 7 days- Characteristic features are clouding of consciousnessQ, disorientationQ, hallucinations (mostly visual and auditory)Q, illusionQ, autonomic disturbancesQ, agitationQ and insomniaQ.Cocaine* Increased or decreased- Sleep (hypersomniaQ or insomnia)- Psychomotor activity* Vivid unpleasant dreamsQ* Increased apetite and fatigueRemember:Drug of choice in withdrawal syndromeOpium* Methadone (1st choice)* Clonidine (2nd choice)Alcohol* Chlordiazepoxide (1st choice)* Diazepam (2nd) choice)Treatment of Alcohol DependenceAversion therapy: ApomorphineQ, sub-threshold electric shockPsychotherapyGroup therapyDeterrent agents: (Alcohol sensitizing drugs)QDisulfiramQCitrated calcium carbimide (CCC)MetronidazoleQ, NitrafezoleQMethyltetrazolethiolSulfonylureas (specially ChlorpropamideQ)Cephalosporins (cefoperazoneQ, moxalactamQ, cefamandoleQ)Anticraving agents: (FAN)FluoxetineQAcamprosateQNaltrexoneQ
Sodium valproate
Phenytoin
Diazepam
Carbamazepine
Alcohol-Related Disorders