354alcoholic withdrawal seizures) withdrawal... · 2009-02-12 · 3 hallucination lm0 , , ˘ˇ 0 ,...

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1 Alcoholic Withdrawal Seizures Alcoholic Withdrawal Seizures and and Neurologic Neurologic Complication Complication . . E- mail: mail: [email protected] [email protected] Alcohol Alcohol Pharmacokinetic Pharmacokinetic Alcohol Alcohol / 5 30 30- 90 90 ,

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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,

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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 ��������������������

����������������

���� ���� ��

������������������ ����������������

����������� ����������������������� ��������������

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,���

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�� ��;�.�&� �����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

���������� alcohol alcohol &�0&'20h#,&'�������0�0&�0&'20h#,&'�������0�0

���������������� alcohol alcohol &�0&'&*�2�,��������(��,0&�0&'&*�2�,��������(��,0�(11<�(��&�(11<�(��&

����(��,0�(11<�(��&����0�����(��,0�(11<�(��&����0���

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��������

����2 .����2 .�� 0�0+�.���10�0+�.���1 ���P��� ���P���

��������'�%�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

Page 5: 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,

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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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