MEDI7111 Lecture Notes - Lecture 8: Tachycardia, Naltrexone, Confabulation
Presentations to be Suspicious of Alcohol Dependence
History Examination Conditions
Insomnia
Inability to
concentrate
Confusion
Hallucinations
Frightening dreams
Hands shake in the
morning
Wake up with
headache
Injured in an assault
Hand tremor
Ataxic gait
Spider naevi
Gynaecomastia
Palmar/facial
erythema
Rhinophyma (bumpy
nose)
Bruises
Nicotine stains
Cigarette burns
Nervous system:
Black outs
Withdrawal
symptoms (fits,
tremor etc.)
Head injury
Peripheral
neuropathy
GIT:
Fatty liver
Gastritis/ulcers
Diarrhoea
Malabsorption
Pancreatitis
CVS:
Cardiomyopathy
Unresponsive HTN
Respiratory:
Pneumonia
Fractured ribs
Endocrine:
Hypoglycaemia
T2DM
Reduced fertility
Psychiatric:
Depression
Anxiety
Insomnia
Complications of Alcohol Abuse
Physical Complications Psychiatric Complications
-Liver disease (AFLD, hepatitis, cirrhosis)
-Peptic ulcer
-Gastritis
-Pancreatitis (acute & chronic)
-GI cancer
-Cardiomyopathy
-Hypertension
-Cerebral thrombosis and haemorrhage
-Metabolic disorders
-Nutritional deficiency
-Infections
-Trauma
-Wernicke’s encephalopathy
-Anxiety & Depression (chicken or the egg…?)
-Intoxication
oPotomania
oSudden aggressive behaviour
oAmnesia
-Withdrawal
oSee below
-Alcoholic hallucinosis
oAuditory/visual
oDuring/after heavy drinking
oClear consciousness
-Alcoholic black outs
-Pathological jealousy
oDelusions of infidelity
oCan be very violent to spouse
Wernicke’s Encephalopathy
Wernicke’s encephalopathy is a condition caused by thiamine deficiency resulting in
disordered brain function. There is a classic triad of nystagmus (opthalmoplegia), ataxia &
confusion, however these three signs are only seen in 10% of patients with Wernicke’s
encephalopathy. In patients who are alcoholic, it should be assumed they will have
Wernicke’s encephalopathy if they are not receiving an adequate diet or have one of the
symptoms above.
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Document Summary
Alcoholic hallucinosis: auditory/visual, during/after heavy drinking, clear consciousness. Pathological jealousy: delusions of infidelity, can be very violent to spouse. Wernicke"s encephalopathy is a condition caused by thiamine deficiency resulting in disordered brain function. There is a classic triad of nystagmus (opthalmoplegia), ataxia & confusion, however these three signs are only seen in 10% of patients with wernicke"s encephalopathy. In patients who are alcoholic, it should be assumed they will have. Wernicke"s encephalopathy if they are not receiving an adequate diet or have one of the symptoms above. As thiamine has not upper limit on dosing, thiamine should be given 100mg iv tds for three days, then oral 100mg tds for one month (at least). There is a 20% mortality rate for this condition and if untreated, 85% will develop korsakoff syndrome. Korsakoff"s syndrome is the sequel to untreated (or inadequately treated) wernicke"s encephalopathy which causes impairment in short term memory.
