Alcohol misuse

2020 ◽  
pp. 6486-6490
Author(s):  
Jonathan Wood
Keyword(s):  
Alcohol Withdrawal ◽  
Delirium Tremens ◽  
Active Management ◽  
Psychological State ◽  
Medical Setting ◽  
Medical Conditions ◽  
Korsakoff Syndrome ◽  
Life Threatening ◽  
Harmful Use ◽  
Excessive Intake

Excessive intake of alcohol is common and increases the risk of developing many medical conditions, as well as leading to psychological and social harm. Medical conditions commonly associated with harmful use include upper gastrointestinal and liver disease, hypertension, and accidents. The psychological state of alcohol dependency makes it more difficult to reduce intake and physical dependency may lead to a withdrawal syndrome after admission to hospital. Withdrawal symptoms range from mild to severe and will commonly require treatment to prevent complications of alcohol withdrawal such as seizures. Delirium tremens is a life-threatening consequence of alcohol withdrawal that requires immediate active management. The role of alcohol in the development of Wernicke–Korsakoff syndrome means patients will also need prophylaxis or treatment for this in the acute medical setting.

scholarly journals Dexmedetomidine infusions and phenobarbital in the treatment of an unusual presentation of benzodiazepine-resistant alcohol withdrawal

2019 ◽  
Author(s):  
Neil Shah
Keyword(s):  
Alcohol Withdrawal ◽  
Critical Role ◽  
Delirium Tremens ◽  
Seizure Threshold ◽  
First Line ◽  
Keywords Alcohol ◽  
Threatening Condition ◽  
Life Threatening ◽  
Hospital Stays ◽  
High Doses

Background: Alcohol withdrawal is a life-threatening condition characterized by a myriad of physiologic changes including tachycardia, hypertension, lowered seizure threshold, hallucinations, and potential for delirium tremens. Benzodiazepines remain the gold standard for treatment of alcohol withdrawal, although few studies have compared barbiturates to benzodiazepines as first-line treatment. Methods: This study is a single patient chart review. Results: Over the course of his hospital stay, in addition to receiving a continuous infusion of dexmedetomidine, the patient received a total of 389 mg lorazepam, 650 mg phenobarbital, 40 mg haloperidol, 25 mg quetiapine, 5 mg midazolam, and 75 mg diphenhydramine. Conclusion: Phenobarbital is an effective first line agent for management of alcohol withdrawal and may be a safer and more effective treatment with lower rates of intubation and shorter hospital stays than benzodiazepines. It is particularly successful in patients who require high doses of benzodiazepines or ICU admission. Furthermore, the role of dexmedetomidine infusions in alcohol withdrawal remains unclear but may play a critical role in mitigating tachycardia and hypertension though it poses a risk of bradycardia and hypotension. Keywords: Alcohol withdrawal, Dexmedetomidine, Precedex, Phenobarbital, Ativan, Lorazepam, CIWA, GABA channel.

scholarly journals A Review of Biophysiological and Biochemical Indicators of Stress for Connected and Preventive Healthcare

Diagnostics ◽  
2021 ◽  
Vol 11 (3) ◽  
pp. 556
Author(s):  
Talha Iqbal ◽  
Adnan Elahi ◽  
Pau Redon ◽  
Patricia Vazquez ◽  
William Wijns ◽  
...  
Keyword(s):  
Cardiovascular Events ◽  
Medical Conditions ◽  
Review Of The Literature ◽  
Stress Monitoring ◽  
Preventive Healthcare ◽  
Connected Health ◽  
Root Cause ◽  
Chemical Indicators ◽  
Life Threatening ◽  
Assessment Of Stress

Stress is a known contributor to several life-threatening medical conditions and a risk factor for triggering acute cardiovascular events, as well as a root cause of several social problems. The burden of stress is increasing globally and, with that, is the interest in developing effective stress-monitoring solutions for preventive and connected health, particularly with the help of wearable sensing technologies. The recent development of miniaturized and flexible biosensors has enabled the development of connected wearable solutions to monitor stress and intervene in time to prevent the progression of stress-induced medical conditions. This paper presents a review of the literature on different physiological and chemical indicators of stress, which are commonly used for quantitative assessment of stress, and the associated sensing technologies.

Dexmedetomidine Infusion as Adjunctive Therapy to Benzodiazepines for Acute Alcohol Withdrawal

2008 ◽  
Vol 42 (11) ◽  
pp. 1703-1705 ◽  
Author(s):  
Jamil Darrouj ◽  
Nitin Puri ◽  
Erin Prince ◽  
Anthony Lomonaco ◽  
Antoinette Spevetz ◽  
...  
Keyword(s):  
Intensive Care Unit ◽  
Intensive Care ◽  
Alcohol Withdrawal ◽  
Delirium Tremens ◽  
Poor Response ◽  
Altered Mental Status ◽  
Primary Treatment ◽  
Respiratory Drive ◽  
Medical Unit ◽  
Pubmed Database

Objective: To report a case of alcohol withdrawal and delirium tremens successfully treated with adjunctive dexmedetomidine. Case Summary: A 30–year-old man with a history of alcohol abuse was admitted to the general medical unit because of altered mental status and agitation. He was initially treated for alcohol withdrawal with benzodiazepines; his condition then deteriorated and he was transferred to the intensive care unit. Because of the patient's poor response to benzodiazepines (oxazepam and lorazepam, with midazolam the last one used), intravenous dexmedetomidine was started at an initial dose of 0.2 µg/kg/h and titrated to 0.7 µg/kg/h to the patient's comfort. Midazolam was subsequently tapered to discontinuation due to excessive sedation. In the intensive care unit, the patient's symptoms remained controlled with use of dexmedetomidine alone. He remained in the intensive care unit for 40 hours; dexmedetomidine was then tapered to discontinuation and the patient was transferred back to the general medical unit on oral oxazepam and thiamine, which had been started in the emergency department. He was discharged after 5 days. Discussion: A review of the PubMed database (1989-2007} failed to identify any other instances of dexmedetomidine having been used as the principal agent to treat alcohol withdrawal. The use of sedative to treat delirium tremens Is well documented, with benzodiazepines being the agents of choice. The clinical utility of benzodiazepines is limited by their stimulation of the γ-aminobutyric acid receptors, an effect not shared by dexmedetomidine, a central α2-receptor agonist that induces a state of cooperative sedation and does not suppress respiratory drive. Conclusions: In patients with delirium tremens, dexmedetomidine should be considered as an option for primary treatment. This case illustrates the need for further studies to investigate other potential uses for dexmedetomidine.

scholarly journals Endoscopic Management of Portal Hypertension

2012 ◽  
Vol 2012 ◽  
pp. 1-12 ◽  
Author(s):  
Said A. Al-Busafi ◽  
Peter Ghali ◽  
Philip Wong ◽  
Marc Deschenes
Keyword(s):  
Portal Hypertension ◽  
Endoscopic Ultrasound ◽  
Capsule Endoscopy ◽  
Interventional Therapy ◽  
Gastric Varices ◽  
Active Management ◽  
Endoscopic Management ◽  
Diagnostic Modality ◽  
Gastroesophageal Varices ◽  
Life Threatening

Cirrhosis is the leading cause of portal hypertension worldwide, with the development of bleeding gastroesophageal varices being one of the most life-threatening consequences. Endoscopy plays an indispensible role in the diagnosis, staging, and prophylactic or active management of varices. With the expected future refinements in endoscopic technology, capsule endoscopy may one day replace traditional gastroscopy as a diagnostic modality, whereas endoscopic ultrasound may more precisely guide interventional therapy for gastric varices.

scholarly journals A view from the acute hospital: managing patients with alcohol problems

2019 ◽  
Vol 80 (9) ◽  
pp. 500-506
Author(s):  
David Pang ◽  
Pete Duffield ◽  
Ed Day
Keyword(s):  
Health Care ◽  
Alcohol Consumption ◽  
Brief Intervention ◽  
Delirium Tremens ◽  
Alcohol Problems ◽  
Acute Hospital ◽  
Korsakoff Syndrome ◽  
Wide Range ◽  
Long Acting ◽  
Abstinence From Alcohol

Regular heavy consumption of alcohol is associated with a wide range of physical, psychological and social problems. All health-care clinicians should be able to screen for and detect problematic levels of alcohol consumption in their patients, and deliver an effective brief intervention. When patients with alcohol dependence are admitted to hospital there must be an assessment of whether medication is required to prevent withdrawal symptoms and potential delirium tremens and withdrawal seizures. Medically assisted alcohol withdrawal using a long-acting benzodiazepine such as chlordiazepoxide should be carefully monitored and titrated to effect, and the clinician should be aware of the risk of Wernicke–Korsakoff syndrome and other complications. Abstinence from alcohol is usually only the first step in treatment, and effective linkage to community alcohol services is an important step.

scholarly journals Scalp Micro-Pigmentation via Transcutaneous Implantation of Flexible Tissue Interlocking Biodegradable Microneedles

Pharmaceutics ◽  
2019 ◽  
Vol 11 (11) ◽  
pp. 549 ◽  
Author(s):  
Lahiji ◽  
Um ◽  
Kim ◽  
Jang ◽  
Yang ◽  
...  
Keyword(s):  
Hair Loss ◽  
Psychological State ◽  
Insertion Depth ◽  
Normal Cycle ◽  
Visual Contrast ◽  
Considerable Research ◽  
Threatening Condition ◽  
Cadaver Skin ◽  
Life Threatening ◽  
Post Implantation

Alopecia, characterized by hair follicle blockage and hair loss, disrupts the normal cycle of hair growth. Although not a life-threatening condition, a growing body of evidence suggests that the psychological state of individuals experiencing alopecia can be highly influenced. Despite considerable research on hair loss treatment, interest in micro-pigmentation has increased in recent decades. Micropigmentation is an effective method to camouflage the visual contrast between the scalp and hair strands. However, the localization, intensity and dimension of microdots depend highly upon the physician performing the implantation. Incorrectly localized microdots within the skin may lead to patchy or faded micropigmentation. To overcome the limitations of conventional micro-pigmentation, we aimed to develop micro-pigment-encapsulated biodegradable microneedles (PBMs), capable of accurately implanting pigments below the epithelial-dermal junction of the scalp in a minimally invasive manner. A tissue interlocking microneedle technique was utilized to fabricate double-layered PBMs over a biodegradable flexible sheet, which could be washed off post-implantation. We confirmed that the intensity, dimension and insertion depth of 1,000 μm-long PBMs was maintained on pig cadaver skin over time. This study suggested that the developed PBMs would serve as an attractive platform for scalp micro-pigmentation in the future.

Alcohol withdrawal and treatment

2000 ◽  
Vol 57 (4) ◽  
pp. 257-260 ◽  
Author(s):  
Croissant ◽  
Mann
Keyword(s):  
Alcohol Withdrawal ◽  
Delirium Tremens ◽  
Medikamentöse Behandlung

Wenn Alkoholabhängige die Alkoholzufuhr abrupt vermindern oder unterbrechen, kommt es in der Regel zur Ausbildung eines Alkoholentzugssyndroms. In den meisten Fällen entwickelt sich ein vegetatives Syndrom mit Störungen des Magen-Darm-Traktes, des Kreislaufes, der Atmung und des ZNS. In der Regel klingen die Hauptsymptome des Entzugssyndroms nach vier bis sieben Tagen ab, längere Verläufe sind selten. Eine medikamentöse Behandlung ist bei rund einem Drittel der Patienten erforderlich. Hierfür wurde eine Fülle von Pharmaka vorgeschlagen. In den ersten Stunden nach dem Alkoholentzug ist die Sensibilität der Noradrenalinrezeptoren erniedrigt, steigt dann aber erheblich an. Die Zahl der NMDA-Rezeptoren nimmt durch chronische Intoxikation mit Ethanol zu. Der Standard der Therapie basiert vorwiegend auf der oralen Monotherapie mit Clomethiazol und alternativ mit Benzodiazepinen. Die Höhe der Dosis orientiert sich an der Ausprägung der Symptomatik. Bei schwerer Entzugssymptomatik kann die Behandlung auf einer Intensivstation mit Infusionstherapie notwendig werden, z.B. im Rahmen eines Delirium tremens, welches einen lebensbedrohlichen Zustand darstellt. Hier haben sich neben Clomethiazol auch Benzodiazepine bewährt.

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