Wednesday, May 18, 2005

Alcoholism, Merck Manual plus...

THE MERCK MANUAL, Sec. 15, Ch. 195, Drug Use And Dependence< : "Alcoholism is considered a chronic illness of undetermined etiology, with an insidious onset and with recognizable symptoms and signs proportionate to its severity. Consumption of large amounts of ethanol usually causes significant clinical toxicity and tissue damage, physical dependence, and a dangerous withdrawal syndrome. The term alcoholism also refers to the social impairment in the lives of alcoholics and their families. Usually, both aspects of alcoholism are recognized simultaneously, but occasionally one predominates to the apparent exclusion of the other. Ethanol is dangerous partly because it is weak. A satisfactory dose is measured in glassfuls, not micrograms or milligrams. Repeated consumption exposes many cells to toxicity.

An alcoholic is identified by severe dependence or addiction and a cumulative pattern of characteristic behaviors. Frequent intoxication is obvious and destructive; it interferes with the ability to socialize and to work. Eventually, drunkenness may lead to failed relationships as well as job loss due to work absenteeism. Alcoholics may incur physical injury, be apprehended for driving while intoxicated, or be arrested for drunkenness. Alcoholics may seek medical treatment for their drinking. Eventually, they may be hospitalized for delirium tremens or cirrhosis. The earlier in life these behaviors are evident, the more crippling the disorder. Women alcoholics are, in general, more likely to drink alone and are less likely to experience some of the social stigmas."

The DT's: Delirium tremens usually begins 48 to 72 h after alcohol withdrawal, with anxiety attacks, increasing confusion, poor sleep (with frightening dreams or nocturnal illusions), marked sweating, and profound depression. Fleeting hallucinations that arouse restlessness, fear, and even terror are common. Typical of the initial delirious, confused, and disoriented state is a return to a habitual activity; eg, the patient frequently imagines that he is back at work and attempts to perform some related activity...

Detoxification: First, alcohol is withdrawn. After correction of nutritional deficiencies associated with excessive alcohol intake (see Thiamine Deficiency and Dependency in Ch. 3), the patient's behavior must be changed to achieve sobriety. Maintaining sobriety is difficult. The patient should be warned that after a few weeks, when he has recovered from his last bout, he is likely to find an excuse to drink. He should also be told that he may be able to drink in a controlled manner for a few days or, rarely, for a few weeks, but he will most likely drink without control again."

Detoxification and withdrawal. Treatment may begin with a program of detoxification, usually taking about four to seven days. You may need to take sedating medications to prevent delirium tremens or other withdrawal seizures.
Medical assessment and treatment. Common medical problems related to alcoholism are high blood pressure, increased blood sugar, and liver and heart disease.
Psychological support and psychiatric treatment. Group and individual counseling and therapy support recovery from the psychological aspects of alcoholism. Sometimes, emotional symptoms of the disease may mimic psychiatric disorders.

Sticky red blood cells?????
Alcoholism: "Laboratory Tests. Tests for alcohol levels in the blood are not useful for diagnosing alcoholism because they reflect consumption at only one point in time and not long-term usage. Certain blood tests, however, may provide biologic markers that suggest medical problems associated with alcoholism or indications of alcohol abuse:
Carbohydrate-deficient transferrin (CDT). This compound is a marker for heavy drinking and can be helpful in monitoring patients for progress towards abstinence.
Gamma-glutamyltransferase (GGT). This liver enzyme is very sensitive to alcohol and can be elevated after moderate alcohol intake and in chronic alcoholism.
Aspartate (AST) and alanine aminotransaminases (ALT). These are liver enzymes and are markers for liver damage.
Testosterone. Male hormone levels in men with alcoholism may be low. (Such results sometimes persuade men with alcoholism to seek help.)
Mean corpuscular volume (MCV). This blood test measures the size of red blood cells, which increase with alcohol use over time."


diagnosticians resources said...

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