INTRODUCTION:
Alcohol is a part of New Zealand culture and is considered as an inevitable factor for celebrations and for relieving stress (“Alcohol misuse”, 2016). Long-term high rate of alcohol consumption can lead to alcohol misuse and make people dependent on alcohol. It has now become a very common thing to see an alcoholic patient presenting to the hospital frequently to treat the withdrawal symptoms.
Most of the patients admitted with Alcohol Withdrawal Syndrome (AWS) have multiple management problems such as withdrawal symptoms, anxiety, liver disorders, electrolyte imbalances, seizures, poly substance abuse and depression (McKeon, Frye & Delanty, 2008). I have taken care of alcoholic patients who present with AWS because they had to stop drinking due to lack of money to buy alcohol. These patients are discharged from the hospital after treatment, but it is unfortunate to see that most of them are readmitted with the same complaints. It is high time to tackle alcohol misuse problem as it has a detrimental effect on our society.
This assignment will discuss the use of Diazepam to treat Alcohol Withdrawal Syndrome (AWS). The patient will be referred as Mrs G in the following discussion. A summary of the case study is provided comprising of patient’s history, medication list, laboratory investigations and plan of treatment. The medication profile of Diazepam is discussed along with its pharmacodynamics and pharmacokinetic properties. The potential interactions of diazepam with Mrs G‘s current medications and diseases are also outlined. This case study also highlights the clinical effectiveness of Diazepam in treating alcohol withdrawal. SUMMARY OF PATIENT G’S INITIAL ASSESSMENT: History of presenting complaints: 70-year-old female patient was brought in to hospital by ambulance with alcohol withdrawal symptoms. Patient has a history of alcoholism; drinks two bottles of wine per day. Last drink was the day before hospital admission, when she ran out of money and stopped drinking. Later on, in the night she started shaking and vomiting. No history of malena or coffee ground vomitus. No cough or abdominal pain and never had withdrawal seizures. Past medical history: • Alcoholism • Cirrhosis -Ascites -Low albumin -Varices • Anxiety • Chronic anaemia • Dementia/ cognitive impairment Medications: Regular medications • Thiamine 50 mg PO BD ;for preventing Wernicke - Korsakoff syndrome • Fluoxetine 20 mg PO OD for anxiety/ depression • Furosemide 80 mg PO OD for ascites • Omeprazole 40 mg PO OD for preventing GI bleed • Nozinan 12.5 mg PO nocte for anxiety Extra medications while in hospital • Multivitamin 2 tablets OD • Thiamine 100 mg IV stat followed by 100 mg PO BD , increased from 50 mg BD • Diazepam 10-20 mg, PO/IV ,2- 4 hourly as per CIWA scale ; maximum dose 80 mg/ day (Prn) Mrs G does not have any known drug allergies. Social history: Rest home resident Alcoholic – 2* wine bottles / day Independent with ADLS Non-smoker On examination: Appears alert and oriented RR- 20, HR- 110, BP- 156/78, O2 saturations- 94% on RA, temp- 37.7 degree Celsius JVP – normal CIWA score - 17 Marked tremors, not distressed but wants to get some rest Spider nevi on chest area HS dual, lungs clear Abdomen- dull, flanks slightly distended but soft and non-tender PR examination – no malena; smear of soft brown stool Investigations Na 127; ALT -14; alkaline phosphatase – 101; Albumin- 24; bilirubin 43; amylase 16 Creatinine- 68 HB 91, platelets 87, WCC 3.3; ECG shows sinus tachycardia with HR of 110 bpm. Impression Alcohol withdrawal Alcohol induced anaemia, thrombocytopenia Plan CIWA scale monitoring and Diazepam Advice to cut down alcohol Admission under general medicine DIAGNOSIS AND RATIONALE FOR THE CHOICE OF MEDICATION: Alcohol withdrawal syndrome (AWS) is diagnosed when there is clear evidence of cessation or rapid reduction of alcohol after prolonged periods of excessive alcohol consumption and simultaneous presence of alcohol withdrawal symptoms post cessation (Kattimani & Bharadwaj, 2013). …show more content…
The main signs and symptoms of AWS as listed by CCDHB guidelines are hyper-reflexia, tremors, anxiety, restlessness, depression, insomnia, nausea, confusion, sweating, tachycardia and hypertension (Robinson & Cameron, 2015). Mrs G was admitted to the hospital two days post stopping alcohol due to anxiety, tremors, nausea and vomiting that are classic symptoms of AWS. Even though Mrs G‘s
Alcohol is a part of New Zealand culture and is considered as an inevitable factor for celebrations and for relieving stress (“Alcohol misuse”, 2016). Long-term high rate of alcohol consumption can lead to alcohol misuse and make people dependent on alcohol. It has now become a very common thing to see an alcoholic patient presenting to the hospital frequently to treat the withdrawal symptoms.
Most of the patients admitted with Alcohol Withdrawal Syndrome (AWS) have multiple management problems such as withdrawal symptoms, anxiety, liver disorders, electrolyte imbalances, seizures, poly substance abuse and depression (McKeon, Frye & Delanty, 2008). I have taken care of alcoholic patients who present with AWS because they had to stop drinking due to lack of money to buy alcohol. These patients are discharged from the hospital after treatment, but it is unfortunate to see that most of them are readmitted with the same complaints. It is high time to tackle alcohol misuse problem as it has a detrimental effect on our society.
This assignment will discuss the use of Diazepam to treat Alcohol Withdrawal Syndrome (AWS). The patient will be referred as Mrs G in the following discussion. A summary of the case study is provided comprising of patient’s history, medication list, laboratory investigations and plan of treatment. The medication profile of Diazepam is discussed along with its pharmacodynamics and pharmacokinetic properties. The potential interactions of diazepam with Mrs G‘s current medications and diseases are also outlined. This case study also highlights the clinical effectiveness of Diazepam in treating alcohol withdrawal. SUMMARY OF PATIENT G’S INITIAL ASSESSMENT: History of presenting complaints: 70-year-old female patient was brought in to hospital by ambulance with alcohol withdrawal symptoms. Patient has a history of alcoholism; drinks two bottles of wine per day. Last drink was the day before hospital admission, when she ran out of money and stopped drinking. Later on, in the night she started shaking and vomiting. No history of malena or coffee ground vomitus. No cough or abdominal pain and never had withdrawal seizures. Past medical history: • Alcoholism • Cirrhosis -Ascites -Low albumin -Varices • Anxiety • Chronic anaemia • Dementia/ cognitive impairment Medications: Regular medications • Thiamine 50 mg PO BD ;for preventing Wernicke - Korsakoff syndrome • Fluoxetine 20 mg PO OD for anxiety/ depression • Furosemide 80 mg PO OD for ascites • Omeprazole 40 mg PO OD for preventing GI bleed • Nozinan 12.5 mg PO nocte for anxiety Extra medications while in hospital • Multivitamin 2 tablets OD • Thiamine 100 mg IV stat followed by 100 mg PO BD , increased from 50 mg BD • Diazepam 10-20 mg, PO/IV ,2- 4 hourly as per CIWA scale ; maximum dose 80 mg/ day (Prn) Mrs G does not have any known drug allergies. Social history: Rest home resident Alcoholic – 2* wine bottles / day Independent with ADLS Non-smoker On examination: Appears alert and oriented RR- 20, HR- 110, BP- 156/78, O2 saturations- 94% on RA, temp- 37.7 degree Celsius JVP – normal CIWA score - 17 Marked tremors, not distressed but wants to get some rest Spider nevi on chest area HS dual, lungs clear Abdomen- dull, flanks slightly distended but soft and non-tender PR examination – no malena; smear of soft brown stool Investigations Na 127; ALT -14; alkaline phosphatase – 101; Albumin- 24; bilirubin 43; amylase 16 Creatinine- 68 HB 91, platelets 87, WCC 3.3; ECG shows sinus tachycardia with HR of 110 bpm. Impression Alcohol withdrawal Alcohol induced anaemia, thrombocytopenia Plan CIWA scale monitoring and Diazepam Advice to cut down alcohol Admission under general medicine DIAGNOSIS AND RATIONALE FOR THE CHOICE OF MEDICATION: Alcohol withdrawal syndrome (AWS) is diagnosed when there is clear evidence of cessation or rapid reduction of alcohol after prolonged periods of excessive alcohol consumption and simultaneous presence of alcohol withdrawal symptoms post cessation (Kattimani & Bharadwaj, 2013). …show more content…
The main signs and symptoms of AWS as listed by CCDHB guidelines are hyper-reflexia, tremors, anxiety, restlessness, depression, insomnia, nausea, confusion, sweating, tachycardia and hypertension (Robinson & Cameron, 2015). Mrs G was admitted to the hospital two days post stopping alcohol due to anxiety, tremors, nausea and vomiting that are classic symptoms of AWS. Even though Mrs G‘s