HEPATOLOGY

Before going to see a patient, begin by considering approaches to taking an alcohol history:

• What questions might you use? How may patients may respond and react to these?
• How might you quantify alcohol units consumption?
• What questions might be useful to screen for dependency?

After answering these questions, review the CAGE questions - available online here.

Using the questions above, take a focused alcohol history from a patient. This should take no more than 10 minutes.

Using the information gained above, calculate how many units per day/per week the patient is consuming.

Find the Public Health England guidance online and see how the patient you have seen compares.

Consider:

• What is the difference between hazardous and harmful drinking?
• What are the risk factors of acute alcohol withdrawal?
• What signs and symptoms would you expect if a patient is acutely withdrawing from alcohol?
• What investigations would be useful acutely and what would you expect them to show?

Find the local inpatient alcohol assessment and alcohol withdrawal risk assessment form e.g. symptom triggered alcohol withdrawal protocol. Compare your answers to the withdrawal criteria summarised on the proforma.

Using this proforma, complete a withdrawal assessment for the patient you have seen,

Find the local guidelines on prescribing guidance for patients with acute alcohol withdrawal and prescribe appropriate treatment if a patient is scoring >8 after CIWA-Ar assessment.

What different pharmacological treatment options for inpatient acute alcohol withdrawal are you aware of? Research fixed rate vs. symptom triggered approaches.

Consider:

• What are the complications of acute alcohol withdrawal?
• How does delirium tremens and Wernicke’s encephalopathy present?
• How would you manage an alcohol withdrawal seizure?
• What are the long term complications of alcohol dependency?
• What specialist team members in the hospital for management of inpatients with acute alcohol withdrawal and prevention?

Highlight three key things you have learned today. Summarise them on a post-it note and keep it somewhere you will find in a week or two.

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1. https://www.mdcalc.com/cage-questions-alcohol-use