354alcoholic withdrawal seizures) withdrawal... · 2009-02-12 · 3 hallucination lm0 , , ˘ˇ 0 ,...
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![Page 1: 354Alcoholic Withdrawal Seizures) Withdrawal... · 2009-02-12 · 3 Hallucination lm0 , , ˘ˇ 0 , ˘ˇ h ˆ 12 -24 ˙/ ˘ˇ ˘ˆˆ ˙ ˘20 24 -48 ˙/ ˘ ˇ 0 .' & , , ' # ' +ˆ,](https://reader033.vdocument.in/reader033/viewer/2022041806/5e5477ad93c2362eca643181/html5/thumbnails/1.jpg)
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Alcoholic Withdrawal Seizures Alcoholic Withdrawal Seizures and and
NeurologicNeurologic Complication Complication ����..����..��� !"#$��� !"#$ %&'(�%!)*%&'(�%!)*
�*+*,#-*.�/�*&,#&(*�*+*,#-*.�/�*&,#&(* 0*1,#-*0*1,#-*2*(3�2*(3��*�4�5�*�4�5
16/7�&(�*�4�516/7�&(�*�4�5 �8*,#&(*9 (+2�7!)��8*,#&(*9 (+2�7!)�
EE--mail: mail: [email protected]@kku.ac.th
Alcohol Alcohol ��������������������
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Pharmacokinetic Pharmacokinetic ��Alcohol Alcohol "#��#�$%�&'���(���(�����"#��#�$%�&'���(���(�����//�*�+�,��-��./0�,0�*�+�,��-��./0�,0
�� /���(��1+�,���20/���(��1+�,���20 55 0�&'0�&'
�� �# ���&'��# ���&'� 3030--9090 0�&'0�&'
�� ����0�����0�,, �������0�������0 &*�2�,�#�$%�0,��� &*�2�,�#�$%�0,���
�� ��9�: �#�$%���-/��9�: �#�$%���-/
�� ��;�.�&� �����0,����;�.�&� �����0,��
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Effect on Nervous System Effect on Nervous System �� �����&*� �0�� �(11<�(��&�����&*� �0�� �(11<�(��&�� ��,������1��,������1,, ��������2��������2�� �./ =��(��(��,0��� �./ =��(��(��,0��� �,�/�,�/�,�/�,�/ �#�����#������ �������<�(��&&'���'��/�,� �������<�(��&&'���'��/�,�
1.1. OpioidOpioid2.2. GABAGABA3.3. GlutamateGlutamate4.4. Serotonin Serotonin
�/" C�/" C alcohol alcohol D�%9E2"D�%9E2" ((�!�!././"9"9.).) 2*!*�2*!*�
5050--150150 �1���1��,, ���1��������1�����,, ������P������P150150--250250 �#��,��#��,�,, ��0�$��0�$,, ���$,�0���$,�0
�.��,�0�� ���.��,�0�� ��300300 $%����$%����,, ���'�0���'�0400400 ���.����.�500500 +�.���2+�.���2
���&� �(11<�(��&&'���'��/�,� ��1���&� �(11<�(��&&'���'��/�,� ��1 alcohol alcohol 1.1. Alcohol intoxication Alcohol intoxication 2.2. Withdrawal syndrome Withdrawal syndrome 3.3. Nutritional disease Nutritional disease
WW WernickeWernicke YY KorsakoffKorsakoff syndrome syndrome WW PolyneuropathyPolyneuropathyWW Optic neuropathy Optic neuropathy WW Pellagra Pellagra
4.4. Others Others WW CerebellarCerebellar degeneration degeneration WW Cerebral atrophy Cerebral atrophy WW Dementia Dementia WW Hepatic coma Hepatic coma
Alcohol Withdrawal Syndrome Alcohol Withdrawal Syndrome
1.1. Tremulousness and associated symptoms Tremulousness and associated symptoms
2.2. Hallucination Hallucination
3.3. Withdrawal seizures Withdrawal seizures ddRum FitsRum Fitsgg
4.4. Delirium tremens Delirium tremens
!9I!!*�%!#"!9I!!*�%!#"
����'��/�,� ��1�������<�(��&�,� �,0��'��/�,� ��1�������<�(��&�,� �,0
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���������������� alcohol alcohol &�0&'&*�2�,��������(��,0&�0&'&*�2�,��������(��,0�(11<�(��&�(11<�(��&
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Tremulousness Tremulousness ����������0��������0,, ����0+�,����0+�,,, ���'�0���'�0
�� ��,�/�0=���� �������������,�/�0=���� �����������
�������������<i0����<i0����%�0�������%�0������ ���20���20 2424--3636 ���/�� ���/��
���0,�=� �0,�=� ��=� ��=� ��/2��,0��-/��/2��,0��-/ �1���������1��������
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��������'�%�0���20������'�%�0���20 22--33 /�0/�0 ����0&20����0&20 22 ��<���k��<���k
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Hallucination Hallucination ��lm0�,��lm0�,��,, ������0������0,, �� h��� h�
��1212--2424 ���/�� ��� �����������/�� ��� ��������
��������20������20 2424--4848 ���/�� ���/��
��������0��.��'&� ������0��.��'&� ,, �,� �'���#�,� �'���#
�������� ��'� ��'� ���+�,�0���+�,�0 �����0�����0
Withdrawal SeizureWithdrawal Seizure��Rum fits Rum fits
�� �,���(�,���( 9090 ������20������20 77--4848 ���/�� ���/�� ��� �������,���� �������,�
�� ���<�(��;���<�(��; 22--66 ���� ����
�� �,���(�,���( 22 �<i0�<i0 status status epilepticusepilepticus
�� ����<i0=11����<i0=11 generalized tonic generalized tonic--clonicclonic seizures seizures
�� ",��<i0=11",��<i0=11 focal focal �,� �����������0�,� �����������0 ��.0��.0 head injury head injury
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Delirium tremens (DT)Delirium tremens (DT)���,���(�,���( 55 �� h#,<q/��������������� h#,<q/�������������
���������1�0�������1�0 �� h��� h� <�(��&���0<�(��&���0
�����0���0 +�. ./ +�. ./ �.�0�������.�0������ +�,+�, ��/2��,0��-/��/2��,0��-/
���� ����������� ���������
��4848--9696 ���/�� ���/�� ��� ����������� ��������
.MNN (%�'O(P!*�%!#".MNN (%�'O(P!*�%!#" DT DT
1.1. �������,���0�0����<r�������,���0�0����<r ���*��������*�����
2.2. ����<i0����<i0 DTDT ���.�0���.�0
3.3. ��������/.���������/.� 3030 <r<r
4.4. �'������0s�'������0s �./��,/��./��,/�
5.5. �'������'����� alcoholic withdrawal alcoholic withdrawal 0�0"% 0�0"% 22 /�0��� �����/�0��� �����
2*!*�2EO�Q2*!*�2EO�Q �����2��-/���2��-/
����/(�.� ������0�*���/(�.� ������0�*�
����/(��/( hypokalemiahypokalemia
����/(��/( hypo hypo--Mg, POMg, PO44
����/2��,0h�� �/(��/2��,0h�� �/(
��Pneumonia Pneumonia
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!*�� !R*!*�� !R*���������/(�������/( delirium delirium
���������/(&'����1�./���.0�������/(&'����1�./���.0 head injury head injury ��1��1�.�0�����1�.�0�����1,, pneumoniapneumonia
��=�,+���/(���0�*�=�,+���/(���0�*�
��=�,+���/(�����=�.h�<��=�,+���/(�����=�.h�<��
!*�4�,N&*P8S2P.T#C 4#!*�!*�4�,N&*P8S2P.T#C 4#!*�
��Skull film Skull film
��Chest xChest x--ray ray
��LPLP
��Electrolyte, LFT, BUN, CrElectrolyte, LFT, BUN, Cr
!*�� !R*2*!*�- !!*�� !R*2*!*�- !�� ������0��0+�.�'��0����������0��0+�.�'��0����
�� +�.�'��������2�s+�.�'��������2�s (�<�'��0=<� ����*��00���+�,(�<�'��0=<� ����*��00���+�,
�� +�.*��<i0�,� 2�,��2�s+�.*��<i0�,� 2�,��2�s
�� ���/,0���/,0
YY ���0�0����/.����0�0����/.� 55 0�&'0�&'
YY ����������� 20����������� 20 11 ���/�� ���/��
YY �'��1���������������'��1��������������
(*&'OD-S� !R*(*&'OD-S� !R*��Valium 10 mg IM, IVValium 10 mg IM, IV
��+�.�/�2�,����/.�+�.�/�2�,����/.� 22 ���� ����
��",��'��������$�*���� +�,",��'��������$�*���� +�, valium valium �/�2�,���/�2�,����0�����0��� ��.0��.0 phenytoinphenytoin, , phenobarbitalphenobarbital
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!*�� !R*!*�� !R* DT DT1.1. Benzodiazepine Benzodiazepine
WW Valium, Librium, Valium, Librium, AtivanAtivan
2.2. Barbiturate Barbiturate
3.3. Alcohol Alcohol
4.4. CarbamazepineCarbamazepine
5.5. NeurolepticNeuroleptic
6.6. Thiamine, MgThiamine, Mg
,#U'!*�� !R*"S,((*,#U'!*�� !R*"S,((*1.1. FixedFixed--schedule therapy schedule therapy
WW CholordiazepoxideCholordiazepoxide 5050--100 100 ����.. &��&�� 66 ���/�� ���/�� 11 /�0/�0WW CholordiazepoxideCholordiazepoxide 2525--50 50 ����.. &��&�� 66 ���/�� ���/�� 22 /�0/�0WW �.��s�.��s ���0��� ���0���
2.2. FrontFront--loading loading WW Diazepam 20Diazepam 20 ����..&��&�� 22 ���/�� ���/�� 0�/.�0�/.�(����������(����������
3.3. SymptomSymptom--triggered therapy triggered therapy WW 2�,�{��(�/���'�����2�,�{��(�/���'�����
�����0s�����0s
��BetaBeta--blockerblocker
��ClonidineClonidine
��CarbamazepineCarbamazepine
��NeurolepticNeuroleptic
WernickeWernicke--KorsakoffKorsakoff syndrome syndrome 1.1. �����&� �������&� ��
YY NystagmusNystagmus, , ophthalmoplegiaophthalmoplegia
2.2. Ataxia Ataxia
3.3. ConfusionConfusion
4.4. KorsakoffKorsakoff psychosis psychosis
1,2,3 1,2,3 WernickeWernicke encephalopathy encephalopathy
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1,*�W#".!4#+2P�/" C1,*��XS�Y!4 ,1,*�W#".!4#+2P�/" C1,*��XS�Y!4 ,
1.1. Global Global confusionalconfusional state state
YY +�.�02�� =/��,��+�.�02�� =/��,�� �#�����#���� +�.��1�*�"��+�.��1�*�"��
2.2. ������� ������� alcoholic withdrawal alcoholic withdrawal
YY <�(��&���0<�(��&���0 ��1�0��1�0 ��(��1��(�.����(��1��(�.��
3.3. Stupor, coma Stupor, coma
4.4. Alert Alert
Amnesic stateAmnesic state :: 9E�9E�
��ShortShort--term, retrograde memory term, retrograde memory
��Confabulation Confabulation
��AnterogradeAnterograde amnesia amnesia
2*!*�2EO�Q2*!*�2EO�Q
��Peripheral neuropathyPeripheral neuropathy
��Postural hypotension Postural hypotension
!*�� !R*!*�� !R*1.1. Thiamine 100 mg IV, IM stat Thiamine 100 mg IV, IM stat
2.2. Thiamine 50 mg IV, IMThiamine 50 mg IV, IM 0�/.������(�'�%�00�/.������(�'�%�0
3.3. =�,��/(���0�*�=�,��/(���0�*�,, �����=�.�����=�.,, ��� �0��� �0
4.4. �(/� ��/(=&��$,�0���0s�(/� ��/(=&��$,�0���0s ��.0��.0 rhabdomyolysisrhabdomyolysis
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1,*�W#".!4#2EO�Q1,*�W#".!4#2EO�Q1.1. Alcoholic dementiaAlcoholic dementia
YY Frontal lobe atrophyFrontal lobe atrophy
YY Cognitive impairment Cognitive impairment
2.2. CerebellarCerebellar degeneration degeneration
YY Ataxia Ataxia
YY Wide base gait Wide base gait
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