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ALCOHOL WITHDRAWAL
SYNDROME – A CASE STUDY
PRESENTED BY
MARTIN SHAJI
PHARM D
DEMOGRAPHIC DATA
NAME OF THE PATIENT: Mr. Hari
AGE / GENDER:32 years/male
AD.NO:5544. WARD: Psychiatric ward
DOA:1/9/2017 DOD.:9/9/2017
Provisional diagnosis: alcohol with
DRAWAL syndrome
CHIEF COMPLIENTS
C/O of tremor, palpitation ,headache,fever,
PERSONAL HISTORY:
weight:54 kgs.
Bowel and bladder: normal
Diet: mixed
Appetite: decreased
Sleep: disturbed
Alcohol: since 10 years
FAMILY HISTORY:
NOTHING SIGNIFICANT
Past medication history: nothing significant
ALERGIES: nill
GENERAL EXAMINATION
On general examination the patient is counscious and
coherent
PHYSICAL EXAMINATION
TEMP:102' F
PR:16 beats/ minutes
Rs:22cycles/ min
Bp: 120/80 mmhg
SYSTEMIC EXAMINATION
CVS: S1S2 +
RS: Clear
Abdomen: abnormal
CONFORMATORY
DIAGNOSIS
Based on the lab investigations.the doctor confirmed as
alcoholic withdrawal syndrome
LAB
INVESTIGATIONS
4.2MGS/DL UP TO 1.0 MGS/ DL
DIRECT BILIRUBIN 1.7 MGS/ DL U P TO 0.2 MGS/ DO
INDIRECT BILIRUBIN 2.5 MGS/DL 0.2TO 0.8 MGS/DL
ALBUMIN PHOSPHATE 92 I U/L 92 TO 128 IU/ L
BILIRUBIN.
LAB
INVESTIGATIONS
SGPT 81IU/L 0 TO 95 IU/ L
SGOT 84 IU/L 0 TO 95 IU/ L
SOAP NOTES
SUBJECTIVE
A male patient of 32 yrs old was
admitted in Psychiatric ward with c/o of
fever.tremor, palpitation and head ache. His
past medical history and family history was
nothing significant. Allergies also nothing
significant.in his personal history bowel and
bladder is normal .He is not using alcohol
since 2 years His appetite and sleep is normal
OBJECTIVE EVALUATION
On lab examination his bilirubin range is
increased ..it is 4.3mgd/dl. On his physical
examination vitals are normal. His indirect
bilirubin is 2.5 mgs/ dl. SGOT AND SGPT is
normal. Albumin phosphate is in normal
range.
ASSESMENT
Based on the subjective and
objective evaluation the patient was
found to be diagnosed as
Alcohol Withdrawal Syndrome
PLAN
ON THE DAY OF ADMISSION 1
and 2
Vitals
Tp.102 ' f.
PS.:80 beats/ mint. Rs: 16 cycles/ mint.
Treatment
T Ativan - 2mg- p/o -BD
T.valpicate- 200mg-p/o BD
T.hepato protectant - 250 mg -p/o- BD
T.rantac - 150 mg-p/o - BD
T Ativan - 2mg- p/o -BD
T.valpicate- 200mg-p/o_ BD
T.hepato protectant - 250 mg -p/o- BD
T.rantac - 150 mg-p/o - BD
T.BC._ 66.7 mg_ p/o- BD
T.Rheoheptin- 250 mg-p/o-bd
On the day of 4,5,6,7,8, days
DRUG CHART
S.no Brand
name
Generi
c
name
Indicat
ion s
Dose ROS Freque
ncy
Durati
on
1 T.ativa
n
Loraze
pam
Anti
anxiet
y
2mg P/o BD 5 days
2 T.valpi
cate
Sodiu
m
valpica
te
Anti
convul
sant
200
mg
p/o BD 5days
3 T.reph
eptin
- Hepato
protect
ant
250
mg
P/o BD 3days
4 Inj.MV
T
Multivi
tamin
Vitami
n
supple
355
mg
IV BD 2 days
DRUG CHART
5 Rantac Ranitid
ine
Antaci
d,and
lb
recept
or
antagi
nist
150
mg
P/o BD 4 days
6 T.BC B
combl
ex
Vitami
n
supple
ment
664
mg
P/o BD 4 days
PHARMACEUTICAL
INTERVENTION
The given prescription was
rational...
No DDI & ADR was found
PATIENT COUNSELLING
Regarding disease.
Alcoholic withdrawal syndrome is the
discontinuation or reduction of prolonged
heavy alcohol use that result in minor or
major withdrawal symptoms.
It is characterized by central nervous system
hyperactivity that occur where an alcohol is
dependent in withdrawal abruptly stops
REGARDING
MEDICATION
T.Ativan.
It is an anti anxiety drug take 2 mg twice daily orally for 4
days
T.VALPICATE
it is an anti convulsant drug take 200 mg twice in a day
trough orally/ parentally for 5 days
T REOHEPTIN
it a hepato protectant take 200 mgt twice in a day trough
orally/ parentally route for 3 days
T MVT
It is a vitamin supplement. Take 300 mg twice in a day trough iv
route
T HEPALIAL
it is a hepatic protectant.take200 mg twice in a day trough orally
,/parentally
T RANTAC
it an antacid take 150 mg through the oral route/ parenteral route
DISCUSSION
Alcoholic withdrawal syndrome is the discontinuation
or reduction of prolonged heavy alcohol use. That
results in minor and major withdrawal syndrome.
SIGHNS AND SYMPTOMS
Tachycardia
Loss of appetite
Shaking
Sweating
Convulsions
Hypertension
PATHOPHYSIOLOG
Y
Not well understand
Alcohol causes CNS
depression
Inhibit dopaminergic and
adrenergic receptor
GABA Like effects
Cessation results in brain
hyper excitability
NON PHARMACOLOGICAL
TREATMENT
Encourage healthy life style
Reduction of weight
Diatary sodium reduction
Moderate alcohol consumption
Strict adhere to medication
Take exercises
Drink plenty of water
Avoid OTC medication
Healthy diet
THANK YOU ...https://www.slideshare.net/martinshaji/a-case-study-on-
alcohol-withdrawal-syndrome

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Alcohol withdrawal syndrome - a case study

  • 1. ALCOHOL WITHDRAWAL SYNDROME – A CASE STUDY PRESENTED BY MARTIN SHAJI PHARM D
  • 2. DEMOGRAPHIC DATA NAME OF THE PATIENT: Mr. Hari AGE / GENDER:32 years/male AD.NO:5544. WARD: Psychiatric ward DOA:1/9/2017 DOD.:9/9/2017 Provisional diagnosis: alcohol with DRAWAL syndrome
  • 3. CHIEF COMPLIENTS C/O of tremor, palpitation ,headache,fever, PERSONAL HISTORY: weight:54 kgs. Bowel and bladder: normal Diet: mixed Appetite: decreased Sleep: disturbed Alcohol: since 10 years
  • 4. FAMILY HISTORY: NOTHING SIGNIFICANT Past medication history: nothing significant ALERGIES: nill
  • 5. GENERAL EXAMINATION On general examination the patient is counscious and coherent PHYSICAL EXAMINATION TEMP:102' F PR:16 beats/ minutes Rs:22cycles/ min Bp: 120/80 mmhg
  • 6. SYSTEMIC EXAMINATION CVS: S1S2 + RS: Clear Abdomen: abnormal
  • 7. CONFORMATORY DIAGNOSIS Based on the lab investigations.the doctor confirmed as alcoholic withdrawal syndrome
  • 8. LAB INVESTIGATIONS 4.2MGS/DL UP TO 1.0 MGS/ DL DIRECT BILIRUBIN 1.7 MGS/ DL U P TO 0.2 MGS/ DO INDIRECT BILIRUBIN 2.5 MGS/DL 0.2TO 0.8 MGS/DL ALBUMIN PHOSPHATE 92 I U/L 92 TO 128 IU/ L BILIRUBIN.
  • 9. LAB INVESTIGATIONS SGPT 81IU/L 0 TO 95 IU/ L SGOT 84 IU/L 0 TO 95 IU/ L
  • 10. SOAP NOTES SUBJECTIVE A male patient of 32 yrs old was admitted in Psychiatric ward with c/o of fever.tremor, palpitation and head ache. His past medical history and family history was nothing significant. Allergies also nothing significant.in his personal history bowel and bladder is normal .He is not using alcohol since 2 years His appetite and sleep is normal
  • 11. OBJECTIVE EVALUATION On lab examination his bilirubin range is increased ..it is 4.3mgd/dl. On his physical examination vitals are normal. His indirect bilirubin is 2.5 mgs/ dl. SGOT AND SGPT is normal. Albumin phosphate is in normal range.
  • 12. ASSESMENT Based on the subjective and objective evaluation the patient was found to be diagnosed as Alcohol Withdrawal Syndrome
  • 13. PLAN ON THE DAY OF ADMISSION 1 and 2 Vitals Tp.102 ' f. PS.:80 beats/ mint. Rs: 16 cycles/ mint. Treatment T Ativan - 2mg- p/o -BD T.valpicate- 200mg-p/o BD T.hepato protectant - 250 mg -p/o- BD T.rantac - 150 mg-p/o - BD
  • 14. T Ativan - 2mg- p/o -BD T.valpicate- 200mg-p/o_ BD T.hepato protectant - 250 mg -p/o- BD T.rantac - 150 mg-p/o - BD T.BC._ 66.7 mg_ p/o- BD T.Rheoheptin- 250 mg-p/o-bd On the day of 4,5,6,7,8, days
  • 15. DRUG CHART S.no Brand name Generi c name Indicat ion s Dose ROS Freque ncy Durati on 1 T.ativa n Loraze pam Anti anxiet y 2mg P/o BD 5 days 2 T.valpi cate Sodiu m valpica te Anti convul sant 200 mg p/o BD 5days 3 T.reph eptin - Hepato protect ant 250 mg P/o BD 3days 4 Inj.MV T Multivi tamin Vitami n supple 355 mg IV BD 2 days
  • 16. DRUG CHART 5 Rantac Ranitid ine Antaci d,and lb recept or antagi nist 150 mg P/o BD 4 days 6 T.BC B combl ex Vitami n supple ment 664 mg P/o BD 4 days
  • 17. PHARMACEUTICAL INTERVENTION The given prescription was rational... No DDI & ADR was found
  • 18. PATIENT COUNSELLING Regarding disease. Alcoholic withdrawal syndrome is the discontinuation or reduction of prolonged heavy alcohol use that result in minor or major withdrawal symptoms. It is characterized by central nervous system hyperactivity that occur where an alcohol is dependent in withdrawal abruptly stops
  • 19. REGARDING MEDICATION T.Ativan. It is an anti anxiety drug take 2 mg twice daily orally for 4 days T.VALPICATE it is an anti convulsant drug take 200 mg twice in a day trough orally/ parentally for 5 days T REOHEPTIN it a hepato protectant take 200 mgt twice in a day trough orally/ parentally route for 3 days
  • 20. T MVT It is a vitamin supplement. Take 300 mg twice in a day trough iv route T HEPALIAL it is a hepatic protectant.take200 mg twice in a day trough orally ,/parentally T RANTAC it an antacid take 150 mg through the oral route/ parenteral route
  • 21. DISCUSSION Alcoholic withdrawal syndrome is the discontinuation or reduction of prolonged heavy alcohol use. That results in minor and major withdrawal syndrome. SIGHNS AND SYMPTOMS Tachycardia Loss of appetite Shaking Sweating Convulsions Hypertension
  • 22. PATHOPHYSIOLOG Y Not well understand Alcohol causes CNS depression Inhibit dopaminergic and adrenergic receptor GABA Like effects Cessation results in brain hyper excitability
  • 23. NON PHARMACOLOGICAL TREATMENT Encourage healthy life style Reduction of weight Diatary sodium reduction Moderate alcohol consumption Strict adhere to medication Take exercises Drink plenty of water Avoid OTC medication Healthy diet