HEPATOLOGY

ACUTE ALCOHOL WITHDRAWAL

Introduction

5 min

Introduce yourself and the group

Provide rationale for the session and relevance to clinical practice

Outline learning objectives:

Take a focused alcohol history from a patient
Identify signs and symptoms of acute alcohol withdrawal
Understand the management of acute alcohol withdrawal
Identify complications of acute alcohol withdrawal

Explain structure of session

Total time:

45 min

Number of students:

1-5

Grade of students:

3rd to 5th year medical students

Created by:

Dr Rachel Cooke

Uploaded:

20th September 2019

Last updated:

20th September 2019

Resources needed for this session:

Resources linked to this session:

Activity 1: Taking an Alcohol History

10 min

Prepare the student(s) before this task by discussing approaches to taking an alcohol history. Consider the questions used, how may patients may respond and react to these.

For example, compare 'do you drink a lot of alcohol?' with 'how much alcohol do you drink?'. Similarly compare 'how often do you drink alcohol?' with 'what would you drink in an average week?'.

Discuss strategies to obtain accurate responses from patients when considering their alcohol intake and questions to screen for dependency.

Ask the student(s) to take a focused social and alcohol history from a patient. Use more than one patient if necessary, they not need to drink an excessive amount of alcohol. Allow 5 minutes. The QR code opposite links to the mdcalc CAGE questionnaire for reference - students can scan this to view on their phone if required.

Activity 2: Assessment of Alcohol Intake

10 min

Ask the student(s) to calculate how many units per day/per week the patient is consuming. Discuss the recommended guidelines and how the patient compares.

Discuss the difference between hazardous and harmful drinking. Refer to CAGE questions above.

Consider:

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?

Ask the student(s) to find the local inpatient alcohol assessment and alcohol withdrawal risk assessment form. Allow students to reflect on differences between their own history and the assessment form.

Activity 3: Understanding CIWA-Ar

5 min

Ask the student(s) to find local alcohol withdrawal assessment protocol e.g. CIWA-Ar score and ask them to complete the scoring system for the patient they have seen.

Activity 6: Prescribing

5 min

Ask the student(s) to 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.

Discuss pharmacological treatment options for inpatient acute alcohol withdrawal including fixed rate vs. symptom triggered approaches.

Activity 7: Further Management

10 min

Discuss with the student(s):

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?

Ask the student(s) about any prevention or community services they are aware of surrounding alcohol dependency and consider any specialist team members in the hospital for management of inpatients with acute alcohol withdrawal and prevention?