How do I deal with an alcoholic patient?

alcoholicAlcohol abuse is so incredibly common that you may not even realize you have an alcoholic patient on your hands until she starts exhibiting symptoms of alcohol withdrawal. So ask all patients about alcohol use on admission; in particular, ask when they had their last drink. Alcohol withdrawal symptoms—including anxiety, hand tremors and heart palpitations—may occur within 12 hours of her last drink.
About 36 hours after her last drink, your patient may develop full-blown alcohol withdrawal syndrome (AWS). The severity of AWS depends on the alcohol abuse; the patient who drinks a pack a day (and has for the last five years) will experience more intense symptoms than a patient who drinks less.

Symptoms of alcohol withdrawal include hand tremors, sweating, nausea, vomiting, seizures, anxiety, agitation and hallucinations. Notify the patient’s physician as soon as you suspect alcohol abuse or withdrawal; the physician may prescribe an anti-anxiety or anti-psychotic med to control withdrawal symptoms and prevent seizures. Keep the patient safe and comfortable. The room should be calm, quiet, uncluttered and dimly lit. Monitor the patient’s vital signs and orientation frequently, reorienting as necessary. Avoid the TV, as it may increase agitation and hallucinations and institute seizure precautions.

Encourage oral intake, if your patient is up to it, and carefully monitor I & O. Call for a nutritional consult, since many alcoholic patients are nutritionally depleted.

Watch for progression to delirium tremens (DTs), a medical emergency with a two to ten percent mortality rate. Symptoms include auditory and visual hallucinations, confusion, disorientation, hypertension, tachycardia, increased respiratory rate and tremors, and usually occur two to three days after the last drink.

Upon discharge, relate the patient’s medical condition (admission with a GI bleed, for instance) to her alcohol abuse, if appropriate. Provide information about community treatment options and support. Your patient may not take you up on your offer of continued treatment, but you owe it to her to try.

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