Alcohol Abuse and Withdrawal Syndrome in the Elderly: Signs, Symptoms, and Treatment, Slides of Geriatrics

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ALCOHOL ABUSE AND

WITHDRAWAL SYNDROME IN

THE ELDERLY

Case

 90 year old Female

 Lives with son – on vacation

 Admitted for FTT

 Consult -? GARP

 Develops increasing confusion during hospital stay

 Tremulous, tachycardic, anxious

Questions

 How does alcohol abuse affect the Elderly?

 How is alcohol withdrawal syndrome different in the Elderly?

 How is alcohol withdrawal treated in the Elderly? Special considerations?

Patterns of Alcohol Consumption in the

Elderly

Early onset

 lifelong pattern of drinking and are now elderly

 2/3 of elderly alcoholics

 More likely to have chronic health problems due to alcohol – liver disease, organic brain syndrome, co- morbid psychiatric disorders

Special Considerations in the Elderly

 Decreased body water – reach higher blood alcohol concentration quicker, with lower doses

 Slower metabolism of ETOH in gut and liver

 Polypharmacy and drug interactions

 More prone to alcoholic gastritis

 Increased risk of delirium, falls

 Self medication

Acute ETOH Intoxication

 Inhibits neuro-excitatory NMDA receptors and reduces release of their NT Glutamate

 Activates neuro-inhibitory GABA receptors

 Leads to anxiolysis, sedation, motor incoordination

ETOH Withdrawal

 NMDA function increases

 GABA function decreases

 Increased excitation and decreased inhibition

 Leads to psychomotor agitation and autonomic excitability

*Worse in patients with chronic ETOH neural changes

Diagnosis of ETOH Withdrawal

The 4 clinical states of ETOH withdrawal

Clinical Manifestations

Autonomic Hyperactivity

 Sx typically develop between 6-24 hrs after the last drink

 Due to increased levels of circulating catecholamines

 HTN, tachycardia, palpitations, diaphoresis, GI tract upset, tremors, hyper-reflexia, irritability, agitation, anxiety

 Clear sensorium

Withdrawal Seizures – 10%

 12-48 hrs after last drink

 Generalized tonic-clonic convulsions

 Usually in patients with long history of alcoholism

 Usually singular episode or a brief flurry over a short period

 Prolonged/recurrent/status epilepticus should prompt investigation into other etiology

Delerium Tremens – 5%

 48-96 hrs after last drink

 Lasts 1-5 days

 Delerium combined with autonomic hyperactivity and alcoholic hallucinosis

 Clouded sensorium, hallucinations, disorientation, tachycardia, HTN, fever, diaphoresis, agitation

 Metabolic and electrolyte disturbances due to hypermetabolic state

 Mortality rate of around 5% when treated

Goals of Management

1. Prevent Seizures and DT

2. Decrease severity of withdrawal sx

3. Prevention of concurrent complications

4. Facilitate entry into a treatment program

Supportive Therapy

 Fluids

 Correction of electrolyte and metabolic disturbances

 Prevention of Wernicke’s Encephalopathy with thiamine

 Correction of nutritional deficiencies