Alcohol use disorder: Difference between revisions
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==Clinical Features== | ==Clinical Features== | ||
* | *Drinking more or for a longer period of time than intended. | ||
*Feeling incapable of cutting back on the amount of alcohol consumed. | |||
*Becoming sick for an extended period of time as a result of drinking too much. | |||
*Inability to concentrate due to alcohol cravings. | |||
*Inability to care for a family, hold down a job, or perform in school. | |||
*Continuing to drink despite problems caused with friends or family. | |||
*Decreased participation in activities which were once important. | |||
*Finding oneself in dangerous or harmful situations as a direct result of drinking. | |||
*Continuing to drink despite adding to another health problem, feeling depressed or anxious or blacking out. | |||
*Drinking more as a result of a tolerance to alcohol. | |||
*Experiencing withdrawal symptoms. | |||
;Mild = 2-3 features | |||
;Moderate = 4-5 features | |||
;Severe = 6 or more features | |||
==Differential Diagnosis== | |||
{{Ethanol DDX}} | |||
==Evaluation== | ==Evaluation== | ||
* A history alone is sufficient to make the diagnosis of alcohol use disorder, however, if a patient presents to the ER, it is important to evaluate for the presence of acute alcohol intoxication, [ | * A history alone is sufficient to make the diagnosis of alcohol use disorder, however, if a patient presents to the ER, it is important to evaluate for the presence of acute alcohol intoxication, [[alcohol withdrawal]], and co-ingestion with other drugs or [[toxic alcohols]]. | ||
==Management== | ==Management== | ||
* If the patient is not acutely intoxicated or at risk for alcohol withdrawal, they should be referred to a social worker or their PCP for resources to quit drinking and can usually be discharged safely. | * If the patient is not acutely [[Ethanol toxicity|intoxicated]] or at risk for [[alcohol withdrawal]], they should be referred to a social worker or their PCP for resources to quit drinking and can usually be discharged safely. | ||
* Disulfiram can be prescribed as alcohol avoidance therapy, but this should be done by a PCP or psychiatrist treating the patient's addiction. | * Disulfiram can be prescribed as alcohol avoidance therapy, but this should be done by a PCP or psychiatrist treating the patient's addiction. | ||
{{Vitamin prophylaxis for ETOH}} | |||
==Disposition== | |||
*Outpatient | |||
==See Also== | |||
==External Links== | |||
==References== | |||
<references/> | |||
[[Category:Psychiatry]] |
Revision as of 23:09, 7 November 2017
Background
- Chronic mental illness characterized by inability to limit alcohol ingestion, compulsive drinking, and a negative emotional state when not drinking.
- Previously separated into alcohol abuse and alcohol dependence, but as of DSM-5, the diagnoses were combined into alcohol use disorder, and subdivided into mild, moderate, or severe.
- It is estimated that about 6% of adults in the US suffer from alcohol use disorder.
Clinical Features
- Drinking more or for a longer period of time than intended.
- Feeling incapable of cutting back on the amount of alcohol consumed.
- Becoming sick for an extended period of time as a result of drinking too much.
- Inability to concentrate due to alcohol cravings.
- Inability to care for a family, hold down a job, or perform in school.
- Continuing to drink despite problems caused with friends or family.
- Decreased participation in activities which were once important.
- Finding oneself in dangerous or harmful situations as a direct result of drinking.
- Continuing to drink despite adding to another health problem, feeling depressed or anxious or blacking out.
- Drinking more as a result of a tolerance to alcohol.
- Experiencing withdrawal symptoms.
- Mild = 2-3 features
- Moderate = 4-5 features
- Severe = 6 or more features
Differential Diagnosis
- Ethanol toxicity
- Alcohol use disorder
- Alcohol withdrawal
- Electrolyte/acid-base disorder
Evaluation
- A history alone is sufficient to make the diagnosis of alcohol use disorder, however, if a patient presents to the ER, it is important to evaluate for the presence of acute alcohol intoxication, alcohol withdrawal, and co-ingestion with other drugs or toxic alcohols.
Management
- If the patient is not acutely intoxicated or at risk for alcohol withdrawal, they should be referred to a social worker or their PCP for resources to quit drinking and can usually be discharged safely.
- Disulfiram can be prescribed as alcohol avoidance therapy, but this should be done by a PCP or psychiatrist treating the patient's addiction.
Vitamin Prophylaxis for Chronic alcoholics
- At risk for thiamine deficiency, but no symptoms: thiamine 100mg PO q day
- Give multivitamin PO; patient at risk for other vitamin deficiencies
Banana bag
The majority of chronic alcoholics do NOT require a banana bag[1][2]
- Thiamine 100mg IV
- Folate 1mg IV (cheaper PO)
- Multivitamin 1 tab IV (cheaper PO)
- Magnesium sulfate 2mg IV
- Normal saline as needed for hydration
Disposition
- Outpatient