Alcohol use disorder
(Redirected from Chronic alcoholics)
- Chronic mental illness characterized by inability to limit alcohol ingestion, compulsive drinking, and a negative emotional state when not drinking.
- Previously separated into alcohol abuse and alcohol dependence, but as of DSM-5, the diagnoses were combined into alcohol use disorder, and subdivided into mild, moderate, or severe.
- It is estimated that about 6% of adults in the US suffer from alcohol use disorder.
- Drinking more or for a longer period of time than intended.
- Feeling incapable of cutting back on the amount of alcohol consumed.
- Becoming sick for an extended period of time as a result of drinking too much.
- Inability to concentrate due to alcohol cravings.
- Inability to care for a family, hold down a job, or perform in school.
- Continuing to drink despite problems caused with friends or family.
- Decreased participation in activities which were once important.
- Finding oneself in dangerous or harmful situations as a direct result of drinking.
- Continuing to drink despite adding to another health problem, feeling depressed or anxious or blacking out.
- Drinking more as a result of a tolerance to alcohol.
- Experiencing withdrawal symptoms.
- Mild = 2-3 features
- Moderate = 4-5 features
- Severe = 6 or more features
- Ethanol toxicity
- Alcohol use disorder
- Alcohol withdrawal
- Electrolyte/acid-base disorder
- A history alone is sufficient to make the diagnosis of alcohol use disorder, however, if a patient presents to the ER, it is important to evaluate for the presence of acute alcohol intoxication, alcohol withdrawal, and co-ingestion with other drugs or toxic alcohols.
- If the patient is not acutely intoxicated or at risk for alcohol withdrawal, they should be referred to a social worker or their PCP for resources to quit drinking and can usually be discharged safely.
- Disulfiram can be prescribed as alcohol avoidance therapy, but this should be done by a PCP or psychiatrist treating the patient's addiction.
Vitamin Prophylaxis for Chronic alcoholics
- At risk for thiamine deficiency, but no symptoms: thiamine 100mg PO q day
- Give multivitamin PO; patient at risk for other vitamin deficiencies
- Thiamine 100mg IV
- Folate 1mg IV (cheaper PO)
- Multivitamin 1 tab IV (cheaper PO)
- Magnesium sulfate 2mg IV
- Normal saline as needed for hydration
- Krishel, S, et al. Intravenous Vitamins for Alcoholics in the Emergency Department: A Review. The Journal of Emergency Medicine. 1998; 16(3):419–424.
- Li, SF, et al. Vitamin deficiencies in acutely intoxicated patients in the ED. The American Journal of Emergency Medicine. 2008; 26(7):792–795.