alcohol withdrawal syndrome
Introduction
Introduction to alcohol withdrawal syndrome Acute alcoholism syndrome (acutealcoholwithdrawalsyndrome) occurs in the long-term (2 to 3 weeks) heavy drinking, and suddenly stop drinking or significant reduction, the patient will immediately produce a series of symptoms and signs, known as alcohol withdrawal syndrome or withdrawal Syndrome. The pathogenesis is caused by excessive inhibition of the cerebral cortex or -adrenergic nerves due to the inhibition of alcohol loss in the central nervous system. It occurs mostly in alcoholics who have physical dependence. The syndrome manifests as tremors, paralysis, convulsions, confusion, mental activity, and excessive autonomic stimulation. Each of the major symptoms of withdrawal syndrome can occur more or less in a simple form, but often in different combinations. basic knowledge The proportion of illness: 0.0035% Susceptible people: long-term heavy drinkers Mode of infection: non-infectious Complications: muscle spasm, acute gastritis, nausea and vomiting, epilepsy, pancreatitis, cirrhosis
Cause
Causes of alcohol withdrawal syndrome
(1) Causes of the disease
Alcoholics with physical dependence, in the process of abstinence, the central nervous system loses the inhibition of alcohol, resulting in excessive excitation of the cerebral cortex and/or -adrenergic nerves.
(two) pathogenesis
Alcoholic tremulousness
The pathogenesis is thought to be caused by excessive excitation of the -adrenergic receptors in the central and peripheral nerves after alcohol withdrawal. That is, due to sympathetic excitation, the increase of catecholamines in the blood increases the rate of skeletal muscle contraction, thus interfering with neuro-muscular conduction. Or muscle spindle activity, resulting in increased tremor intensity in these patients.
2. Alcoholic withdrawal seizure
The pathogenesis is unclear. It has been suggested that various pathogenesis, including hypomagnesemia, carbonemia and various other metabolic disorders, can occur during epileptic activity, but these mechanisms have not been confirmed, supplementing magnesium ions, etc. Measures can not prevent its onset.
3. Deterium tremens (DT)
It is an acute encephalopathy syndrome that is based on chronic alcoholism and can be triggered by factors such as trauma, infection and other factors that weaken the body's resistance.
Prevention
Alcohol withdrawal syndrome prevention
A small amount of reasonable drinking may have certain benefits for the human body. Avoiding long-term heavy drinking is the main measure to prevent alcoholic neurological diseases. The prevention of alcoholism syndrome is mainly early diagnosis and treatment to prevent complications.
Complication
Syndrome of alcohol withdrawal syndrome Complications, muscle spasm, acute gastritis, nausea and vomiting, epilepsy, pancreatitis, cirrhosis
Patients with delirium tremens (DT) are prone to many diseases, such as acute alcoholic myopathy can cause severe muscle spasm; can also be combined with a wide range of multiple peripheral neuropathy, causing systemic sensory disturbances and muscle weakness; with acute gastritis Can cause nausea and vomiting; accompanied by alcoholism epilepsy, can cause trauma, in addition, can also be combined with urinary tract infections, pancreatitis, cirrhosis, gastrointestinal bleeding.
Symptom
Alcohol syndrome syndrome Common symptoms Alcoholic alcoholic tremor Alcoholic hallucinations Mental disorder Anxiety Fatigue Heart failure Alcohol dependence
Alcoholic tremulousness
Or called withdrawal tremulousness is the most common and lightest alcohol withdrawal syndrome.
(1) Tremor is the most common symptom of alcohol withdrawal syndrome, accompanied by irritability and gastrointestinal symptoms, especially nausea and vomiting. These symptoms often start after a few days of alcoholism, and the next morning of sudden alcohol ban, Restoring alcohol can quickly relieve symptoms. Symptoms relapse and aggravate after stopping drinking again. The duration of symptoms can vary greatly, usually lasting 2 weeks, and the condition peaks 24 to 36 hours after stopping drinking completely.
Systemic tremor is the most obvious feature of this disease. It is a rapid (6-8 Hz), light and heavy, relieved in a quiet environment and aggravated tremors during exercise and emotional stress. The tremor can be so intense that the patient cannot Standing, unclear pronunciation, or even unable to eat on their own, sometimes tremor has no obvious objective performance, only the patient complained of "in vivo tremor", a few days later, flushing, anorexia, tachycardia and tremor can be significantly relieved, but excessive alertness, vulnerable to fright Exercise tremor can last for a week or longer, and the feeling of restlessness lasts for 10 to 14 days. The levels of norepinephrine and its metabolites in blood and CSF are elevated.
(2) The patient is accompanied by characteristic clinical manifestations: facial dark red, conjunctival hyperemia, tachycardia, anorexia, nausea, retching, patients are completely awake, vulnerable to intimidation, insomnia, inattention, and unwilling to answer questions. There may be reactions to rude or threatening methods. Patients may also have mild time-disordered dysfunction, no memory for events in the next few days of drinking, but no obvious confusion, good for the surrounding environment and their condition. understanding.
2. Alcoholic hallucinosis
It refers to the state of hallucination caused by long-term heavy drinking. It is a rare syndrome of alcohol withdrawal. Patients often have a large number of distinct hallucinations within 24 hours after sudden stop drinking or reducing the dose. Clinically, they are mainly visual and auditory hallucinations.
(1) Alcoholic tremor patients can often be accompanied by various hallucinations. Patients complain of nightmares, accompanied by sleep disorders. Sometimes patients cannot distinguish between dreaming or real situations. Illusions and reality are confused. Familiar objects are distorted or What is considered to be non-authentic (illusion), according to the frequency of occurrence, in order of pure visual illusion, audio-visual hybrid, tactile or visual, there is no evidence to support certain visual hallucinations (such as insects, red elephants) that are specific to alcoholism. In fact, the hallucinations of alcoholism are widespread, life is more inanimate, humans or animals can be single or in groups; they can be reduced or enlarged; they can be natural, pleasant, or deformed. Scary and horrible.
(2) Alcoholic mental disorders consisting of more or less simple auditory hallucinations are a special type that Kraepelin calls alcoholic hallucinations or alcoholic mental mania, whose core manifestations are: despite patients Feeling normal, such as patient orientation, normal response, good memory, but there are auditory hallucinations, the nature of auditory hallucinations can be unstructured sounds, such as bee barking, ringing, gunshot or knocking, or music-like , low-key humming or chatting, but the most common voice is the human voice, the voice can talk directly to the patient, but more common in talking to a third party patient, in most cases, the voice is malicious, accused or intimidating The patient's normal life is seriously disturbed. For the patient, the sound is extremely real. Another feature of the auditory hallucination (and visual hallucination) is that the patient responds to the illusory content. The patient may alarm or counter the invasion. Behavior, may even attempt to commit suicide to evade the intimidation of the voice, its duration may vary, may be temporary, or intermittently recurring within a few days, in individual cases For several weeks or months.
(3) In the hallucinations, most people do not realize the unreality of hallucinations. As the condition improves, patients begin to doubt the authenticity of their hallucinations, are willing to tell others about the hallucinations and doubt whether they are conscious and can recognize what they hear. The voice is imaginary. If you can recall the abnormal content of the mental disorder, it is a complete recovery.
3. withdrawal of seizure (alcoholic withdrawal seizure)
Also known as "rumfits" (rumfits), is a common symptom during alcohol withdrawal (relative or absolute alcohol ban after long-term chronic alcoholism), more than 90% of withdrawal episodes occur after stopping drinking 7 ~48h, and 13~14h is the peak time of occurrence. During the convulsion activity period, the EEG is abnormal, but it can be recovered after several days.
Can be manifested as a one-time episode, but most cases are sudden 2 to 6 episodes, sometimes more, 2% of patients develop into epilepticus, mostly for large episodes, focal episodes suggest that in addition to alcohol, there are Local lesions (mostly traumatic), about 30% of patients with systemic withdrawal convulsions, developed into a state of tremors (some reported low percentage), seizures are prodromal symptoms of sputum.
4. tremor (delirium tremens, DT)
(1) tremor is the most serious alcoholic disease state that can lead to death. It is an acute encephalopathy syndrome based on chronic alcoholism. It occurs in alcohol-dependent patients who continue to drink a lot of alcohol. It can be infected by trauma. Some factors that weaken the body's resistance are often caused by sudden onset of illness after 3 to 5 days of alcohol withdrawal or reduction. The main manifestations are severe confusion, loss of orientation, vivid delusions and hallucinations, accompanied by tremors and anxiety. Uneasy, insomnia and hypersympathetic activity, such as dilated pupils, fever, increased breathing and heartbeat, increased or decreased blood pressure, and sweating.
(2) Most patients have a self-limited course of disease. After a few days of restlessness and sleepless nights, they often end in sleep state, then wake up, wake up and be conscious, quiet, tired, and have nothing to do with the confrontation stage. Memory, in rare cases, the state of paralysis gradually subsides. If tremor is a single episode, 80% of patients continue to do not exceed 72h. In rare cases, there may be one or more recurrences, and several different episodes of seizures to relatively awake. The period is separated, the whole process lasts for several days, and occasionally lasts for 4 to 5 weeks.
(3) Some cases may not recover completely after tremor, and the course progresses to Wernicke encephalopathy or Coxsack's syndrome (about 15%). Cases without complications have a low mortality rate (about 3). %~4%), in the event of complications, the mortality rate will increase significantly, often dying from high fever, pneumonia or heart failure, etc., or sudden death may not determine the cause.
(4) Atypical -illusion or confusion: It is closely related to typical DT, and the incidence is the same. Patients can only show short-term, quiet confusion, anxiety or abnormal behavior lasting for several days or months, and typical Different tremors, atypical state, often manifested as a single localized event, no longer repeated, occasionally a seizure attack, no death, it can be said that this atypical state, is a partial mild tremor.
Examine
Examination of alcohol withdrawal syndrome
1. Occasionally, blood sugar is significantly reduced under alcohol withdrawal; normal blood sugar ketoacidosis can also occur.
2. The incidence and degree of electrolyte imbalance are not the same. The change of blood sodium is not common. If the change is higher than the decrease, the blood chlorine and blood phosphorus have the same change. About one-fourth of the patients have lower serum calcium and potassium. Most patients have a certain degree of hypomagnesemia, low carbon dioxide partial pressure and elevated arterial pH.
3. Regular lumbar puncture examination is very meaningful for the identification of acute alcohol withdrawal syndrome, especially tremor.
4. EEG examination
The brain wave frequency is reduced during chronic alcoholism, and the EEG can quickly return to normal after stopping drinking. The transient arrhythm (spine wave and paroxysmal discharge) consistent with the convulsion activity also returns to normal soon, except during the withdrawal period. In addition to short-term disability, the abnormal rate of EEG in patients with rum episodes is not higher than that of normal people, and in patients with non-alcoholic seizures, the abnormal rate of EEG is much higher.
5. Brain, chest X-ray and CT scan are useful for differential diagnosis.
Diagnosis
Diagnosis and identification of alcohol withdrawal syndrome
Acute alcohol withdrawal syndrome occurs in the long-term (2~3 weeks) drinking, and when it suddenly stops drinking or significantly reduces the amount, it mainly manifests as tremor, paralysis, convulsions, confusion, mental exercise and autonomic nerves. Excessive excitement, based on medical history and typical clinical manifestations, diagnosis is generally not difficult, EEG, brain, chest X-ray and CT scan, help differential diagnosis.
1. Pay attention to the identification of other toxic encephalopathy.
2. Special attention should be paid to certain primary epilepsy or traumatic epilepsy, which may also be induced by drinking. It should be carefully excluded to make a diagnosis, a systemic episode with focal manifestations, or a focal manifestation. Seizures, such as mental exercise or complex partial epilepsy, focal sports epilepsy, etc., can not be alcoholism epilepsy, EEG examination helps identify.
