Alcohol withdrawal syndrome is a potentially life-threatening condition that can occur in people who have been drinking heavily for weeks, months, or years and then either stop or significantly reduce their alcohol consumption.
Alcohol withdrawal symptoms can begin as early as two hours after the last drink, persist for weeks, and range from mild anxiety and shakiness to severe complications, such as seizures and delirium tremens (also called DTs). The death rate from DTs -- which are characterized by confusion, rapid heartbeat, and fever -- is estimated to range from 1% to 5%.
Because alcohol withdrawal symptoms can rapidly worsen, it's important to seek medical attention even if symptoms are seemingly mild. Appropriate alcohol withdrawal treatments can reduce the risk of developing withdrawal seizures or DTs.
It's especially important to see a doctor if you've experienced previous alcohol withdrawal episodes or if you have other health conditions such as infections, heart disease, lung disease, or a history of seizures.
Severe alcohol withdrawal symptoms are a medical emergency. If seizures, fever, severe confusion, hallucinations, or irregular heartbeats occur, either take the patient to an emergency room or call 911.
Heavy, prolonged drinking -- especially excessive daily drinking -- disrupts the brain's neurotransmitters, the brain chemicals that transmit messages.
For example, alcohol initially enhances the effect of GABA, the neurotransmitter which produces feelings of relaxation and calm. But chronic alcohol consumption eventually suppresses GABA activity so that more and more alcohol is required to produce the desired effects, a phenomenon known as tolerance.
Chronic alcohol consumption also suppresses the activity of glutamate, the neurotransmitter which produces feelings of excitability. To maintain equilibrium, the glutamate system responds by functioning at a far higher level than it does in moderate drinkers and nondrinkers.
When heavy drinkers suddenly stop or significantly reduce their alcohol consumption, the neurotransmitters previously suppressed by alcohol are no longer suppressed. They rebound, resulting in a phenomenon known as brain hyperexcitability. So, the effects associated with alcohol withdrawal -- anxiety, irritability, agitation, tremors, seizures, and DTs -- are the opposite of those associated with alcohol consumption.
In general, how severe alcohol withdrawal symptoms become depends on how much and for how long a person has been drinking.
Minor alcohol withdrawal symptoms often appear 6 to 12 hours after a person stops drinking. Sometimes a person will still have a measurable blood alcohol level when symptoms start. These symptoms include:
Between 12 and 24 hours after they stop drinking, some patients may experience visual, auditory, or tactile hallucinations. These usually end within 48 hours. Although this condition is called alcoholic hallucinosis, it's not the same as the hallucinations associated with DTs. Most patients are aware that the unusual sensations aren't real.
Withdrawal seizures usually first strike between 24 and 48 hours after someone stops drinking, although they can appear as early as 2 hours after drinking stops.. The risk of seizures is especially high in patients who previously have undergone multiple detoxifications.
DTs usually begin between 48 and 72 hours after drinking has stopped, Risk factors for DTs include a history of withdrawal seizures or DTs, acute medical illness, abnormal liver function, and older age.
Symptoms of DTs, which usually peak at 5 days, include:
Disorientation, confusion, and severe anxiety
Hallucinations (primarily visual) which cannot be distinguished from reality
If alcohol withdrawal syndrome is suspected, your doctor will take a complete medical history and ask how much you drink, how long you've been drinking, and how much time has elapsed since your last drink. He or she also will want to know if you have a history of alcohol withdrawal, if you abuse any other substances, and if you have any medical or psychiatric conditions.
If you have mild to moderate withdrawal symptoms, your doctor may prefer to treat you in an outpatient setting, especially if you have supportive family and friends. Outpatient detoxification is safe, effective, and less costly than inpatient detoxification at a hospital or other facility.
However, you may require inpatient treatment if you don't have a reliable social network, are pregnant, or have a history of any of the following:
Severe withdrawal symptoms
Withdrawal seizures or DTs
Multiple previous detoxifications
Certain medical or psychiatric illnesses
The goals of treatment are threefold: reducing immediate withdrawal symptoms, preventing complications, and beginning long-term therapy to promote alcohol abstinence.
Prescription drugs of choice include benzodiazepines, such as diazepam (Valium), chlordiazepoxide (Librium), lorazepam (Ativan), and oxazepam (Serax). Such medications can help control the shakiness, anxiety, and confusion associated with alcohol withdrawal and reduce the risk of withdrawal seizures and DTs. In patients with mild to moderate symptoms, the anticonvulsant drug carbamazepine (Tegretol) may be an effective alternative to benzodiazepines, because it is not sedating and has low potential for abuse.
To help manage withdrawal complications, your doctor may consider adding other drugs to a benzodiazepine regimen. These may include:
An antipsychotic drug, which can help relieve agitation and hallucinations
A beta-blocker, which may help curb a fast heart rate and elevated blood pressure related to withdrawal and reduce the strain of alcohol withdrawal in people with coronary artery disease
Because successful treatment of alcohol withdrawal syndrome doesn't address the underlying disease of addiction, it should be followed by treatment for alcohol abuse or alcohol dependence.
Relatively brief outpatient interventions can be effective for alcohol abuse, but more intensive therapy may be required for alcohol dependence. If you have alcohol dependence, your doctor may prescribe other medications to help you stop drinking. He or she also may recommend joining a 12-step group -- such as Alcoholics Anonymous and Narcotics Anonymous -- or staying at a comprehensive treatment facility that offers a combination of a 12-step model, cognitive-behavioral therapy, and family therapy.
A seizure is the physical findings or changes in behavior that occur after an episode of abnormal electrical activity in the brain.
The term "seizure" is often used interchangeably with "convulsion." During convulsions a person has uncontrollable shaking that is rapid and rhythmic, with the muscles contract and relax repeatedly. There are many different types of seizures. Some have mild symptoms without shaking.
· Withdrawal from alcohol or certain medicines after using for a long time
Sometimes, no cause can be found. This is called idiopathic seizures. They are usually seen in children and young adults, but can occur at any age. There may be a family history of epilepsy or seizures.
If seizures continue repeatedly after the underlying problem is treated, the condition is called epilepsy.
Most seizures stop by themselves. But during a seizure, the person can be hurt or injured.
When a seizure occurs, the main goal is to protect the person from injury:
· Try to prevent a fall. Lay the person on the ground in a safe area. Clear the area of furniture or other sharp objects.
· Cushion the person's head.
· Loosen tight clothing, especially around the neck.
· Turn the person on their side. If vomiting occurs, this helps make sure that the vomit is not inhaled into the lungs.
· Look for a medical ID bracelet with seizure instructions.
· Stay with the person until he or she recovers, or until professional medical help arrives.
Things friends and family members should NOT do:
· DO NOT restrain (try to hold down) the person.
· DO NOT place anything between the person's teeth during a seizure (including your fingers).
· DO NOT move the person unless they are in danger or near something hazardous.
· DO NOT try to make the person stop convulsing. They have no control over the seizure and are not aware of what is happening at the time.
· DO NOT give the person anything by mouth until the convulsions have stopped and the person is fully awake and alert.
· DO NOT start CPR unless the seizure has clearly stopped and the person is not breathing or has no pulse.
If a baby or child has a seizure during a high fever, cool the child slowly with lukewarm water. DO NOT place the child in a cold bath. Call your child's health care provider and ask what you should do next. Also, ask if it is OK to give the child acetaminophen (Tylenol) once he or she is awake.
A person who has had a new or severe seizure is usually seen in a hospital emergency room. The provider will try to diagnose the type of seizure based on the symptoms.
Синдром отмены – это дискомфортное физическое или психическое изменение, которое происходит, когда организм лишают алкоголя или наркотиков, к которым оно привыкло. Симптомы могут длиться несколько дней и могут включать тошноту, рвоту, потливость, беспокойство, неустойчивость и тревожность.
Симптомы синдрома отмены могут появиться только, если человек потребляет чрезмерное количество алкоголя и наркотиков.
Симптомы синдрома отмены алкоголя начинают проявляться через 4-12 часов после прекращения потребления алкоголя, либо через несколько дней после последнего распития. Чем сильнее алкогольная зависимость, тем сильнее симптомы синдрома отмены (так называемые белая горячка). Симптомами белой горячки могут быть зрительные и слуховые галлюцинации, замешательство и раздражительность, сильная дрожь и припадки. В редких случаях белая горячка, если её не лечить, может привести к смерти.
Симптомами синдрома отмены наркотиков (запрещенные наркотики и лекарства, отпускаемые по рецепту врача) различаются в зависимости от типа наркотика. Общими симптомами являются тошнота, рвота, боль в животе и припадки.
Для лечения при синдроме отмены алкоголя и наркотиков могут потребоваться лекарства и заместительная терапия. Во многих случаях при алкоголизме и приеме наркотиков рекомендуется реабилитация.
Приступы – являются внезапной вспышкой аномальной электрической активности в мозгу, которая может повлиять на управление мышц человека, движения, речь, зрение или сознание. Результат приступа зависит от индивидуальной реакции человека, а также от типа, частоты и степени тяжести.
Некоторые приступы заставляют человека пасть на землю и биться в конвульсиях, при которых мышцы становятся жесткими или начинают судорожно подергиваться. Некоторые могут впасть в состояние транса, при этом у них проявятся лишь несколько мышечных сокращений, либо появится ощущение странного запаха, или зрительных помех, не испытанных никем больше.
Иногда приступ является симптомом другой медицинской проблемы, например, сильной лихорадки (особенно у детей), припадка, заражения, низкого уровня сахара в крови (гипогликемия), очень низкого уровня кровяного давления, либо опухоли мозга.
