Alcohol Withdrawal
Alcoholics that are trying to quit must go through alcohol withdrawal. Alcohol withdrawal should not be gone through with medical attention. If you are an alcoholic trying to quit contact your healthcare provider immediately. There are several treatment options and it can be accomplished effectively with the help of a trained medical professional staff.
Alcoholics can be assessed for risk using the CAGE or AUDIT method.
Found in this article: Hepatology- Study of liver disease
These methods ask how often and how much alcohol the individual consumes. As well as social and behavioral questions.
Questions on the AUDIT questionnaire include:
-How often do you have a drink containing alcohol?
-How many drinks containing alcohol do you have on a typical day when you are drinking?
-How often do you have 5 or more drinks on one occasion?
-How often during the last year have you found that you were not able to stop drinking once you had started?
-How often during the last year have you failed to do what was normally expected of you because of drinking?
-How often during the last year have you needed a first drink in the morning to get yourself going after a heavy drinking session?
-How often during the last year have you had a feeling of guilt or remorse after drinking?
-How often during the last year have you been unable to remember what happened the night before because of your drinking?
-Have you or someone else been injured because of your drinking?
-Has a relative, friend, doctor or other health care worker been concerned about your drinking or suggested you cut down?
These questions are assessed on their frequent and a rating is given to determine the likelihood of alcohol abuse and risk of withdrawal.
The most common approach to determining if a person is currently experiencing alcohol withdrawal is assessing them with a CIWA assessment scale 8 hours after their last alcoholic drink.
The CIWA is a Clinical Institute Withdrawal Assessment. Below is an example of one that would be used in a clinical setting (such as a hospital or treatment facility).
CIWA link to larger image
This assessment is done to give the medical professional an idea of hard the body is taking the withdrawal.
Many different treatment option are available and will be discussed later.
Source: Oxford Journal-Management of Alcohol Withdrawal
With this a patient may be given an appropriate dose of a benzodiazepine to calm them.
The most commonly used is Lorazepam also known as Ativan.
Benzodiazepines calm the body helping to reduce many of the symptoms especially agitation and anxiety.
The most common symptoms of alcohol withdrawal are those assessed in the CIWA assessment tool.
-Nausea and Vomiting
-Paroxysmal Sweats
-Tremors
-Anxiety
-Agitation
-Visual Disturbances
-Auditory Disturbances
-Headaches
-Tactile Disturbances
-Disorientation
These all have a high chance of occurring (no specific numbers could be found).
Those experiencing withdrawal can often become confused and disoriented and have a diminished sense of balance. This put them at an increased risk for falls and harm to themselves.
Most facilities will institute fall precautions and monitor the patient every 4 hours (or more often if it is deemed necessary) for symptoms and adjust care as needed. No two people experience withdrawal symptoms the same way and so care must be altered to fir the need of each individual person throughout the length of their care.
Hydration, nutrition, and safety are the highest concerns for those experiencing withdrawal.
IV fluids may be given alongside supervised feeding to ensure the safety of the individual.
Alcoholic Liver Disease
Alcoholic liver disease is scarring of the liver (cirrhosis) or other damage to the liver tissue. The liver is the organ that eliminates alcohol from the body.
Source: Hepatology- Study of liver disease
Merely assessing outward physical appearance makes it difficult to assess the extent of ALD, but some common symptoms are ascites (swelling of the abdomen), erythema (flushed skin), pain in the right upper abdomen (where the liver is located), and malnutrition.
Often a blood test is done looking for elevated liver enzymes. These can indicate damage to the liver.
Hepatic imaging may also be done. A CT scan or an MRI may be done to look at the liver and determine if there is tissue damage or scarring present. Different features being diminished may indicate different forms of liver damage. Doctors can determine if the damage is more likely to have been caused by alcohol, hepatitis infections or other sources by looking at the imaging tests. Repeat testing can observe a trend in liver function and assess the extent of damage and how the treatment team will proceed.
If a patient is found positive for ALD the biggest step for them to begin treatment is to abstain from alcohol consumption. Some cases where there is risk for abuse to recur are managed with Disulfiram. Disulfiram is a medication that makes it difficult for the individual to attempt to consume alcohol by making the nauseous or sick to their stomach when the drink alcohol alongside the medication. It also makes their body and mind associate drinking alcohol with feeling very ill and they develop an aversion to drinking.
There are many combinations of therapies that may be recommended for the liver to recover. Nutrition focused on liver health as well as steroids and other medications may be prescribed by your health care provider.
The key note is for those recovering from ALD to eat balanced diets with small means and additional snacks in the mornings and evenings to help their body balance important nutrients along with nitrogen and bilirubin levels. Moderate levels of protein should also be consumed.
For advanced ALD where the liver is unlikely to be able to recover due to excessive scarring or damage it is often recommended to get a liver transplant. A live transplant may be easier than other transplants as it does not require the host to make a permanent sacrifice as the liver is able to regenerate if part of it is removed. The biggest issue is finding a match that the body will not reject once it is in place. Most people must go on a wait list for a new liver unless they have a next of kin that is a match. While they are waiting for a new liver treatment is much the same to reduce further damage. Those who do receive a liver transplant should go through counseling before receiving it, as the recurrence rate of those drinking alcohol after receiving a new liver can be quite high (with rates between 11 and 49%).
Of course the best way to deal with ALD is to prevent it from occurring in the first place. Consuming low amounts of alcohol or no alcohol greatly increases your liver's health. Whereas heavy use does not guarantee you will suffer from ALD it does put you at a very high risk for developing it.
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