Question

J.G., a 69-year-old man, was seen in the emergency department (ED) 2 days ago, diagnosed (Dx) with alcohol intoxication, and released after 8 hours to his brother’s care. He was brought back to the ED 12 hours ago with an active gastrointestinal (GI) bleed and is being admitted to ICU; his diagnosis is upper GI bleed and alcohol intoxication. You are assigned to admit and care for J.G. for the remainder of your shift. According to the ED notes, his admission vital signs (VS) were 84/56, 110, 26, and he was vomiting bright red blood. His labs were remarkable for Hct 23%, alanine transaminase (ALT) 69 IU/ml, aspartate transaminase (AST) 111 IU/ml, and serum alcohol (ETOH) 271 mg/dl. He was given IV fluids and transfused 6 units of packed RBCs (PRBCs) in the ED. On initial assessment, you note that J.G.’s VS are blood pressure (BP) 154/90 mm Hg, pulse 98 beats/min; he has a slight tremor in his hands, and he appears anxious. He complains of a headache and appears flushed. You note that he has not had any emesis and has not had any frank red blood in his stool or “black tarry stools” over the past 5 hours. In response to your questions, J.G. denies that he has an alcohol problem but later admits to drinking approximately a fifth of vodka daily for the past 2 months. He reports having been drinking just before his admission to the ED. He admits to having had seizures while withdrawing from alcohol in the past.

What are the 3 main objectives of treatment of chronic alcoholism?

What other medical problems will you need to be aware of as he provides J.G.’s

treatment for alcohol withdrawal? How could you help assess for these problems?

Answer 1

Answer: The three main objectives of treatment of chronic alcoholism are:

• To reduce the excessive alcohol consumption slowly.
• To get rid of the addiction.
• To cure and eliminate the disease developed or risk of the diseases.

There is no drug which can completely treat the chronic alcoholism but some of the medicines can reduce the cravings such as:

• Disulfiram
• Acamprosate (Campral) can help with cravings.

The medical problems that may occur due to withdrawal as weight gain, anxiety, irritability, increased heart rate, palpitations etc. To control this benzodiazepines are given.