Alcohol withdrawal 

Pathophysiology

Alcohol results in the following:

  • Increased GABA mediated inhibition of the CNS (considered a depressant)
  • Inhibition of NMDA-type glutamate receptors

Therefore alcohol withdrawal results in

  • Reduced GABA levels leading to CNS overstimulation (disinhibition)
  • Increased NMDA-glutamate receptor activation

Clinical features

  • Symptoms often begin 6-12 hours following last drink and peak at approximately 36 hours
    • Tremor
    • Tachycardia
    • Confusion and agitation
    • Sweating
  • Delirium tremens can occur at 48-72 hrs and is characterised by
    • Coarse tremor
    • Confusion and delusions
    • Hallucinations

Management of alcohol withdrawal

CIWA scoring with a benzodiazepine, either

  • Diazepam
  • Chlordiazepoxide 

Some trusts are now using alcohol

  

Korsakoff Dementia

Pathophysiology

  • Thiamine deficiency results in haemorrhage within the mamillary bodies of the thalamus and hypothalamus

Clinical Features

  • Anterograde amnesia - inability to form new memories 
  • Retrograde amnesia with confabulation