A 38year old male with alcohol withdrawal

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 This is an online E log book to discuss our patient's de-identified health data shared after taking his/her/guardian's signed informed consent. 


Here we discuss our individual patient's problems through series of inputs from available global online community of experts with an aim to solve those patient's clinical problems with collective current best evidence based inputs. 


This E log book also reflects my patient-centered online learning portfolio and your valuable inputs on the comment

 

A 38 year old male patient, who used to work in pharma company as a lab assistant, came to OPD with chief complaints of alcohol dependence since 15 years. (referred case from psychiatry) 

HISTORY OF PRESENTING ILLNESS: 

Patient was apparently asymptomatic 15 years back and then he started drinking with friends, partied everyday for almost three years. Since the last five years, he skipped going to work and had change of jobs since then due to irregularity.

He started working as teaching assistant in engineering colleges then as a network engineer, and recently as a lab technician in a pharma company in Hyderabad until 3 months back. 

He usually drinks alone since then. He drank almost everyday since 15years except for five days in a month or so.. he usually drinks in the night, starts with 90ml and can go up to 270ml depending on the company. 

He had 4 previous DAC admissions before the present one. Patient also smokes cigarettes, bidi from 15 years. He smokes around 1/2 a pack everyday since then.

He used to work in a pharma company in Hyderabad 3 months back but lost his job again due to irregularity. 

His mother passed away 12 years ago. He used to quarrel or put up fights with people more, especially if there was binge of alcohol.  1 month back, he had many disputes with his brother about some land, property and started consuming more alcohol since then.

On last Friday (09.12.22), patient took 5 tablets of Loraz on his own as he unable to sleep. On 11.12.22 night, patient himself decided to come to hospital for DAC admission and got admitted. Last binge of alcohol= 11.12.22 evening 5pm.

Patient was apparently alright till yesterday 12am (13.12.22) and then he was having irritability, sleeplessness. He also had a fall in the hospital and does not remember anything after..

Patient complains of headache, sleeplessness and irritability. 

Not associated with any upward rolling of  upper eyelids and lower eyelids. Not associated with any tremors. No upwards rolling of eyeballs. No frothing. 

 

DAILY ROUTINE:

Patient wakes up at around 9am, has breakfast and watches TV later. He would try to go to work when he was working but mostly skipped it. He takes his lunch at 1pm and gets some rest until evening. He then starts drinking at around 7:30pm - 8:00pm, continues till 1am-2am and tries to get some sleep.

 

PAST HISTORY:

Patient had similar complaints in the past with four DAC admissions.

1st DAC- year 2018         2nd DAC- year 2021   3rd DAC- Jan 2022 (3months)                  4th DAC- Oct 2022 (4days)

Patient is not a known case of TB, Diabetes, Asthma, hypertension, CVD, CAD, epilepsy, thyroid disorders. 

 

FAMILY HISTORY:

No similar complaints seen in the family.

 

PERSONAL HISTORY: 

Diet is mixed, appetite decreased (due to acidity), sleep is not adequate, bowel movements are regular, bladder movements are irregular (forced micturition; no burning micturition). No known allergies. Addicted to alcohol and smoking from 15 years. (Alcohol- 90ml to 270ml, everyday since 15 years) (Smoking- cigarettes or bidi, half a pack everyday since 15 years)


GENERAL EXAMINATION:

Patient is conscious, confused and cooperative. Not oriented to time. Moderately built and nourished. 

No pallor, icterus, cyanosis, clubbing, lymphadenopathy and edema.

Vitals:   Temp: afebrile    BP: 130/90mmHg   PR: 82/min   RR: 16/min                                GRBS: 115mg/dl


SYSTEMIC EXAMINATION:

CVS- S1, S2 heard. No murmurs.

RS- NVBS +  BAE +  No added breath sounds

Per abdomen- Soft, non tender

CNS- E4V4M6  (GCS); eye opening response spontaneously, verbal response is confused, motor response- obeys commands.

 

PROVISIONAL DIAGNOSIS: 

Alcohol withdrawal..?  Wernicke korsakoff syndrome..? 

 

INVESTIGATIONS: 

 







 

TREATMENT: 

 supplementation on Thiamine

 Tab. Lorazepam 4mg H/S IM Lorazepam 1mg (sos) 

as advised by the psychiatry department. 


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