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1、AlcoholWithdrawalSyndromesBy:DavidBridgers,M.D.CasePresentation:43y/oAAMwithahx,HTN,andlongtermETOHabuse,whopresentedtotheUrologyserviceafterbeingseenintheEDforHematuria,andbeingdiagnosedwitharenalmass.Hewas1days/pnephrectomy.Hewasonepiduralpainmedicationsperpai
2、ncontrol.Hewasreportedtobeagitatedwhenthenursingstaffevaluatedhim.TheCasePresentation:TheUrologyteamevaluatedthepatientandafterrealizingthathehadnothadadrinkin36hourstheycalledforaMedicineconsultformanagementofDTs.DefinitionsAlcoholism:chronicalcoholabuse,depend
3、ence,oraddiction;chronicexcessivedrinkingofalcoholicbeveragesresultinginimpairmentofhealthand/orsocialoroccupationalfunctioning,andincreasingadaptationtotheeffectsofalcoholrequiringincreasingdosestoachieveandsustainadesiredeffect;specificsignsorsymptomsofwithdra
4、walareusuallyshownonsuddencessationofsuchdrinking.Alcoholic:Onewhosuffersfromalcoholism.Onewhoabusesorisdependentonalcohol(Stedman’s26thed.)AlcoholismintheUnitedStatesAlcoholismisacommoncondition,withcomplicationsthatwilleventuallyconfrontallclinicians.Estimated
5、10-18millionAlcoholicsintheU.S.in1990.15-20%ofhospitalizedandprimarycarepatients.Studiesshowthatb/w13and71percentofpatientsdevelopsymptomsofETOHwithdrawalVariousPresentationsofAcuteETOHWithdrawalMinorWithdrawalSymptoms:-occurw/i6hoursofcessation-insomnia,tremulo
6、usness,mildanxiety,GIupset,diaphoresis,HA,palpitations,andanorexia.-usuallyresolvew/i24-48hrs.-varyfromepisodetoepisodeVariousPresentationsofAcuteETOHWithdrawalWithdrawalSeizures:-w/i48hoursoflastdrink-generalizedtonic-clonic-3%ofchronicalcoholicsdevelopthis-3%o
7、fthosewhoseizedevelopStatusEpilepticusVariousPresentationsofAcuteETOHWithdrawalAlcoholicHallucinosis:-12-24hr.onsetafterlastdrink-usuallyvisual-Resolvew/i24-48hr.-NOTsynonymouswithDT’s*othersignsmayormaynotbepresent*timecourseisdifferent*notusuallyassociatedwith
8、cloudingofthesensoriumDeliriumTremens:-5%ofpatientswhowithdraw-typicallybeginb/w48and96hours-typicallylast1-5days-longerperiodsrequiringmassivedosesofmedicationshaveb
