case presentation on alcohol withdrawal syndrome

1. CLERKSHIP CASE
PRESENTATION
ON
ALCOHOL
WITHDRAWAL
SYNDROME SALMA TASNEEM
170310820020
PharmD-5thyear
MESCO COLLEGE OF
PHARMACY

2. SUBJECTIVE
 Name of patient: XYZ
 Age: 55yrs
 Sex: Male
 DOA:19/4/15
 Complaints: Altered sensorium, loss of consciousness
since morning.
 History of disease: Shrunken eye on left side since 3
months
 CNS: Left eye enopthalus.
 GI: Not coherent
 Personal Habits: Chronic alcoholic +

3. OBJECTIVE
 BP:130/90mmhg
 PR:84/min
 RR:18/min
 Temp:afebrile
 Random Blood Sugar: 134 mg/dl.
 Serum Urea: 22 mg/dl
 Serum Creatinine: 0.9 mg/dl
 Sodium:139 mEq/ L
 Potassium: 4.6 mEq/
 CT Scan of Brain: Diffuse cerebral atrophy; pthysis bulby of left
eye.

4. ASSESMENT
 Alcohol withdrawal syndrome with pthysis bulbi of left eye.

5. PLAN
Drug
brand
name
Generic
name
Indicatio
n
Dose Route of
administr
ation
Fre
que
ncy
T.optineur
on
Thiamine Vitamin
suppleme
nt
1amp IV OD
T.librium chlordiaze
poxide
antianxie
ty
25mg PO OD
T.benalgis benfortam
ine
vitaminb1
suppleme
nt
100mg PO OD
I.monocef ceftriaxon
e
antibiotic 1gm IV BD
I.rantac ranitidine H2recept
or
antagonis
t
150mg IV BD

6. Drug brand
name
Generic
name
Indication Dose Route of
administratio
n
Fr
eq
ue
nc
y
I.levoflox levofloxacin antibiotic 750mg IV OD
I.pantop pantaprazole Proton pump
inhibitor
40mg IV OD
I.metrogyl metriondazol
e
antibiotic 100ml IV TI
D
25%dextrose
IVF
dextrose Glucose
supplement
I.mannitol mannitol Osmotic
diuretic
100ml IV TI
D
I.piptaz pipperacillin antibiotic 4.5mg IV TI
D
I.neurogard multivitamin vitaminsupple
ment
IM OD

7. Patient counselling regarding disease state
 Alcohol withdrawal syndrome: is a set of symptoms that can
occur when an individual reduces or stops alcoholic consumption
after long periods of use. Prolonged and excessive use of alcohol
leads to tolerance and physical dependence. The withdrawal
syndrome is largely a hyper-excitable response of the central
nervous system to lack of alcohol.
 Symptoms typical of withdrawal include agitation, seizures, and
delirium tremens.

8. Patient counselling regarding medication
 Optineuron:
Opti neuron Tablets (Vitamin B12 (Cyanocobalamin)) refers to a
group of water-soluble vitamins. It has high biological activity.
 Adverse effects:.Drowsiness 2.Headache 3.Diarrhoea 4.Nausea.
5.Numbness of the skin
 Librium: is used to treat anxiety and acute alcohol withdrawal. It
is also used to relieve fear and anxiety before surgery. This
medication belongs to a class of drugs called benzodiazepines
which act on the brain and nerves (central nervous system to
produce calming effect.

9.  Adverse effects:
 Fainting
 mood or mental changes
 shakiness and unsteady walk
 unsteadiness, trembling, or other problems with muscle control or
coordination
 Levofloxacin: is a broad-spectrum antibiotic of the
fluoroquinolone drug class, and the levo isomer of its predecessor
ofloxacin. Its spectrum of activity includes most strains of
bacterial pathogens.

10.  Adverse effects
 change in taste
 constipation
 dizziness
 drowsiness
 headache
 lightheadedness
 nausea
 nervousness
 trouble sleeping:

11.  Metriondazole: a generic synthetic antibacterial compound
available for both oral and intravenous use. It is indicated in the
treatment of serious infections caused by susceptible anaerobic
bacteria.
 Adverse effects:
 dizziness, loss of balance;
 vaginal itching or discharge;
 dry mouth or unpleasant metallic taste;
 cough, sneezing, runny or stuffy nose; or.
 swollen or sore tongue.

12. Patient counselling regarding life style
modification
 Avoid seizure triggers as alcohol, lack of sleep, stress,
recreational drugs.
 Avoid anxiety and sadness.
 Avoid smoking, tobacco.
 Exercise regularly.
 Avoid triggers as flash lights, computer screens, etc; though they
have little effect in recurring.
 Eat healthy diet rich in vitamins and minerals.
 Limit alcohol intake.

13. DRUG INTERACTION
 Levofloxacin+Chlordiazepoxide:Levofloxacin increases levels of
Chlordiazepoxide by decreasing metabolism .Minor or non
Significant interaction.

14. DRUG INFORMATION QUERY
 Q. Why Thiamine ( Vit B1 ) is prescribed in alcohol withdrawal
syndrome.
 A. Because of chronic intake of alcohol, nutritional deficiency
occurs; hence Vit B1 should be supplemented. Alcohol causes
deficiency of Vit B1 in body. People dependent on alcohol donot
eat properly and can lack certain vitamins. Lack of Vit B1 is most
common which may lead to serious brain damage. Vit B1 may aid
in decreasing fatigue, maintaining mental clarity and maintaining
disorientation. Dose of Vit B1 is 25 mg/ day in alcohol
withdrawal syndrome.

15. THANKYOU