Citation

Cross GM, Hirsch KA. Consultant 1997; 37(5): 1390-1402.

Copyright

(Copyright © 1997)

DOI

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PMID

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Abstract

In the assessment of an intoxicated patient, rule out subdural hematoma or other head injury, hypoglycemia, diabetic ketoacidosis, hepatic encephalopathy, post-ictal status, and abuse of sedatives. Alcoholic hallucinosis usually starts within 48 hours of cessation on reduction of alcohol intake and is usually characterized by visual and/or tactile hallucinations. The patient's awareness that the hallucinations are not real distinguishes alcoholic hallucinosis from other psychiatric conditions, although this awareness may be absent in chronic alcoholism. Hospitalize persons with alcoholic withdrawal delirium and immediately start a detoxification regimen. Cross-tolerant sedative-hypnotic medications are indicated in this setting; haloperidol, thiamine, and magnesium sulfate may also be beneficial. A cross-tolerant sedative-hypnotic, supplemented by thiamine and close observation, is appropriate for a patient with withdrawal seizures. Keep a high index of suspicion for depression and be sure to assess suicide risk, which tends to increase considerably 1 or 2 weeks after alcohol withdrawal.

Language: en