1

18

(alcohol withdrawal syndrome)

4 5 autonomic
dysfunction 3-6
( 1)
1. Simple withdrawal state



2. Complex withdrawal state 3
single tonic-clonic (grand mal) focal features 95
48 complex withdrawal
acute delirium delirium tremens (DTs) hyperactivity, severe
tremor, severe agitation, , , disorientation,
distractibility visual, tactile auditory hallucinations, paranoid delusions
5 complex withdrawal
DTs
hyperactive dehydration, cardiac
arrhythmia delirium tremens
2-5
embolism, infection, meningitis, pancreatitis severe fluid-electrolyte disturbance

blackouts (
)

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Alcohol Withdrawal Scale (AWS) ()
-
-
4 3
- AWS 5 2
- AWS 10 1

complicated withdrawal
AWS clinical judgement

1. Sedation
(oversedating)
sedatives intoxication
sedatives

benzodiazepine diazepam, chlordiazepoxide
lorazepam cross-tolerance
diazepam chlordiazepoxide
diazepam chlordiazepoxide,
metabolism lorazepam diazepam
lorazepam , diazepam lorazepam
blood-brain barrier chlordiazepaxide
euphoria

1) chronic liver disease hepatic
encephalopathy diazepam cirrhosis
severe alcoholic hepatitis lorazepam
2
4-6
2) chronic airflow limitation chronic airways disease
respiratory failure diazepam
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respiratory failure (pO2 < 60 mmHg) CO2 retention

(pCO2 > 44 mmHg) sedate
2. sedation


2-3

3.
Thiamine (Vitamine B1) B1
Wernicke's encephalopathy thiamine
alcohol dependent thiamine
100 . 3

3



4.




1-2 interpersonal contact

1. American Psychiatric Association. Practice guideline for the treatment of patients with substance use
disorders: alcohol, cocaine, opioids. Am J Psychiatry 1995; 152(Suppl11):1-59.
2. Brower K, Severin J. Alcohol and other drug-related problems. In: Knesper D, Riba M, Schwenk T, eds.
Primary care psychiatry. Philadelphia: WB Saunders Company, 1997:309-42.

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4
3. Mayo-Smith MF. Pharmacological management of alcohol withdrawal. A meta-analysis and evidencebased practice guideline. American Society of Addiction Medicine Working Group on Pharmacological
Management of Alcohol Withdrawal. JAMA 1997; 278:144-51.
4. Sullivan JT, Swift RM, Lewis DC. Benzodiazepine requirements during alcohol withdrawal syndrome:
clinical implications of using a standardized withdrawal scale. J Clin Psychopharmacol 1991; 11:291-5.

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1 alcohol withdrawal syndromes

onset

peak

Uncomplicated
alcohol Withdrawal

4-12

1-2

Alcohol hallucinosis

Delirium tremens
(DTs)

3-4

3-4

Alcohol withdrawal
seizures (rumfits)

12-48

1-2

5-7
, vital signs ( >
100 /), ,
, ,
, , ,
reflex
7

,

,

6-9
,
, vital signs
, ,

psychomotor agitation

1-2
Few generalized tonic-clonic
seizures
grandmal

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Alcohol Withdrawal Scale

alcohol withdrawal syndrome
Alcohol Withdrawal Scale (AWS)
4 AWS 3 AWS
5 8

: Diazepam
: advanced liver disease (encephalopathy, jaundice or ascites) lorazepam
(equivalent dose: lorazepam 1 mg = diazepam 5 mg) thiamine 100 mg
3-5 Wernicke/Korsakoff syndrome

diazepam

diazepam 5-10 . 6-8 48

( AWS = 1-4)




loading dose regimen diazepam 10 .
( AWS = 5-14)
2 4
diazepam 120 . 12
diazepam
5-10 . 6
3-5

( AWS = 15+)
diazepam 10-20 . 30
10-20 . 6
apnoea 2-3 diazepam
24 diazepam 5-10 .
6 3-5

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HN

AWS
(mmHg)
(/)
(/)

(.)
sedative

0 1 2 , 3

0 1 (Positional hand tremor) 2

3
0 1 (uneasy)
2 (apprehensive and
easily startled)
3 4 panic attacks

0 1 (Unsettled, Fidgety) 2
(Restlessness) ,
3
4

0 37.0 C 1 37.1 C - 37.5 C 2 37.6 C -38.0 C 3

38.1 C -38.5 C 4 38.5 C

0 1
2
reasonable contact with reality 3 2

4

0 (fully orientated) 1

2 3 4

, (disorientated)
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