detoksifikasi alcohol

7/29/2019 DETOKSIFIKASI ALCOHOL

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RAWATAN DETOKSIFIKASI

ALKOHOL


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? ALCOHOL PROBLEM

When, the desire to drink alcohol starts controlling people thebody, the thoughts and the feelings strive for alcohol.

The first step in recovering from alcoholism after acknowledging theproblem and resolving to get help

alcohol abuse,

which is not the same as alcoholism,

the patient has not yet become physically addicting

can detox with fewer side effects.

Alcoholics, on the other hand, have developed dependence and maysuffer severe withdrawal symptoms.


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Alcohol withdrawal syndrome is a potentially

life-threatening condition

that can occur in people who have been drinking

heavily for weeks, months, or years

and then either stop or significantly reduce their

alcohol consumption


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Alcohol withdrawal symptoms can begin as early as two hours after the last drink, persist for weeks,

and range from mild anxiety and shakiness

to severe complications, such as seizures and delirium

tremens (also called DTs).

The death rate from DTs -- which are characterized byconfusion, rapid heartbeat, and fever -- is estimated torange from 1% to 5%.

Severe alcohol withdrawal symptoms are a medicalemergency
http://www.webmd.com/anxiety-panic/default.htmhttp://www.webmd.com/anxiety-panic/default.htm


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Causes of Alcohol Withdrawal Syndrome

Heavy, prolonged drinking -- especially excessive daily drinking -- disrupts thebrain's

neurotransmitters, the brain chemicals that transmit messages.

For example, alcohol initially enhances the effect of GABA, the neurotransmitter which

produces feelings of relaxation and calm. But chronic alcohol consumption eventually

suppresses GABA activity so that more and more alcohol is required to produce the desired

effects, a phenomenon known as tolerance.

Chronic alcohol consumption also suppresses the activity of glutamate, the neurotransmitter

which produces feelings of excitability. To maintain equilibrium, the glutamate system

responds by functioning at a far higher level than it does in moderate drinkers and

nondrinkers.

When heavy drinkers suddenly stop or significantly reduce their alcohol consumption, the

neurotransmitters previously suppressed by alcohol are no longer suppressed. They rebound,resulting in a phenomenon known as brain hyperexcitability.

So, the effects associated with alcohol withdrawal -- anxiety, irritability, agitation, tremors,

seizures, and DTs -- are the opposite of those associated with alcohol consumption.
http://www.webmd.com/brain/picture-of-the-brainhttp://www.webmd.com/brain/picture-of-the-brain


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Withdrawal Symptoms

Mild to moderate psychological symptoms:

Feeling of jumpiness or nervousness

Feeling of shakiness

Anxiety

Irritability or easily excited

Emotional volatility, rapid emotional changes

Depression

Fatigue

Difficulty with thinking clearly

Bad dreams
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Mild to moderate physical symptoms

Headache - general, pulsating

Sweating, especially the palms of the hands or the face

Nausea and Vomiting

Loss of appetite

Insomnia, sleeping difficulty Paleness

Rapid heart rate (palpitations)

Eyes, pupils different size (enlarged, dilated pupils)

Skin, clammy

Abnormal movements

Tremor of the hands

Involuntary, abnormal movements of the eyelids
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Severe symptoms:

A state of confusion and hallucinations (visual) --

known as delirium tremens (DT)

Agitation

Fever

Convulsions

"Black outs" -- when the person forgets what

happened during the drinking episode
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DT (delirium tremens )

- 48 and 72 hours after alcohol cessation, although they can appearas early as two hours after cessation.

Risk factors for DTs include a history of withdrawal seizures or DTs, acute medical illness,

abnormal liver function,

and older age.

usually peak at five days, include: Disorientation, confusion, and severe anxiety

Hallucinations (primarily visual) which cannot be distinguished from reality

Profuse sweating

Seizures High blood pressure

Racing and irregular heartbeat

Severe tremors

Low-grade fever
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Alcohol Detoxification

The immediate goal of treatment is to calm the patient asquickly as possible.

About 95 percent of people have mild to moderate

withdrawal symptoms, including agitation, trembling,disturbed sleep, and lack of appetite.

In 15 percent to 20 percent of people with moderatesymptoms, brief seizures and hallucinations may occur, but

they do not progress to full-blown delirium tremens.

Such patients can nearly always be treated as outpatients.
http://alcoholism.about.com/od/withdraw/g/delirium_tremens.htmhttp://alcoholism.about.com/od/withdraw/g/delirium_tremens.htmhttp://alcoholism.about.com/od/withdraw/g/delirium_tremens.htm


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Alcohol DetoxificationOutpatient treatment

Mild to moderate Withdrawal

After being examined and observed,

the patient is usually sent home with a four-day supply of

anti-anxiety medication,

scheduled for follow-up and rehabilitation,

and advised to return to the emergency room if

withdrawal symptoms become severe.

If possible, a family member or friend should support the

patient through the next few days of withdrawal.


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Benzodiazepines.

Patients are usually given one of the anti-anxiety

drugs known as benzodiazepines (tranquilizers

such as Valium), which inhibit nerve-cellexcitability in the brain. They are used to relieve

withdrawal symptoms, help prevent progression

to delirium tremens, and reduce the risk for

seizures.
http://alcoholism.about.com/od/prescription/g/benzodiazepines.htmhttp://alcoholism.about.com/od/prescription/g/benzodiazepines.htm


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Inpatientmoderate to severe dependence is demonstrated

so that medical management is likely

previous complicated withdrawal (eg. seizures or DTs)

may have signs of withdrawal as judged clinically and/or supportedby a rating scale

concomitant physical or psychiatric illness, injury or recent surgery

no reliable carer is available and has no stable home environment*

alcohol or drug use in pregnancy or in mothers with babies whohave no supportive environment

may have had repeated unsuccessful attempts to detoxify at home*particularly relevant for admission to a specialist

detoxification unit, less so for a general hospital


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Inpatient Diazepam has a longer duration of action thanlorazepam or midazolam.

Typically, the physician may give the patient an initial (or loading) intravenous dose of diazepam withadditional doses given every one to two hours thereafter over the period of withdrawal.

This regimen can cause very heavy sedation.

Symptomatic Relief when the patient can take oral medication:

Metoclopramide

an antacid

Paracetamol

Supplements: Thiamine,

(Magnesium, Phosphate, Folate, Zinc, Vitamins A, D, E, C & B group)

Thiamine (Vitamin B1) deficiency is especially common, and may lead to acute Wernickesencephalopathy if not corrected. Thiamine is given routinely to all patients undergoing alcoholdetoxification, indeed all alcohol dependent inpatients.

Supportive Environment: Nurse in a well-lit single room or in a quiet area of the ward;reassurances and explanations of procedures by the focal nurse;

restrict visitors to a minimum
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Other medications

Beta-blockers. Beta blockers, such as propranolol(Inderal)and atenolol (Tenormin), slow heart rate and reduce tremor. They are

sometimes used in combination with benzodiazepines.

Anti-Seizure Medications. Anti-seizure agents, suchas carbamazepine (Tegretol) or divalproex sodium (Depakote) may beuseful for reducing the requirements of a benzodiazepine. When used bythemselves, however, they do not appear to be effective in reducing

seizures or delirium.

Psychosis. For hallucinations or extremely aggressive behavior,antipsychotic drugs, particularly haloperidol (Haldol), may beadministered. Korsakoff's psychosis (Wernicke-Korsakoff-Syndrome) is very difficult to treat.

It is caused by severe vitamin B1 (thiamine) deficiencies, which cannot bereplaced orally. Rapid and immediate injection of the B vitamin thiamin isnecessary.
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Other medications

Specific Treatment for Severe Symptoms

Treating Delirium Tremens. People with symptoms of delirium tremens must betreated immediately. Untreated delirium tremens has a fatality rate that can be ashigh as 20 percent.

Restraints may be necessary to prevent injury to themselves or others.

Treating Seizures. Seizures are usually self-limited and treated with a

benzodiazepine. Intravenous phenytoin (Dilantin) along with a benzodiazepinemay be used in patients who have a history of seizures, who have epilepsy, or inthose whose seizures cannot be controlled.

Psychosis. For hallucinations or extremely aggressive behavior, antipsychoticdrugs, particularly haloperidol (Haldol), may be administered. Korsakoff's psychosis(Wernicke-Korsakoff-Syndrome) is very difficult to treat. It is caused by severe

vitamin B1 (thiamine) deficiencies, which cannot be replaced orally. Rapid andimmediate injection of the B vitamin thiamin is necessary.
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Preventing Future Alcohol Withdrawal Episodes

Because successful treatment of alcohol withdrawalsyndrome doesn't address the underlying diseaseofaddiction, it should be followed by treatment for alcoholabuse or alcohol dependence.

Relatively brief outpatient interventions can be effective foralcohol abuse, but more intensive therapy may be requiredfor alcohol dependence.

joining a 12-step group -- such as Alcoholics Anonymous and

Narcotics Anonymous

staying at a comprehensive treatment facility that offers a

combination of a 12-step model, cognitive-behavioral therapy,and family therapy
http://www.webmd.com/mental-health/alcohol-abuse/tc/alcohol-and-drug-problems-topic-overviewhttp://www.webmd.com/mental-health/alcohol-abuse/default.htmhttp://www.webmd.com/mental-health/alcohol-abuse/default.htmhttp://www.webmd.com/mental-health/alcohol-abuse/tc/alcohol-and-drug-problems-topic-overviewhttp://www.webmd.com/mental-health/alcohol-abuse/default.htmhttp://www.webmd.com/mental-health/alcohol-abuse/default.htmhttp://www.webmd.com/mental-health/alcohol-abuse/default.htmhttp://www.webmd.com/mental-health/alcohol-abuse/default.htmhttp://www.webmd.com/mental-health/alcohol-abuse/tc/alcohol-and-drug-problems-topic-overview

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