case presentation on alcohol withdrawal syndrome

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 Indication Dose Route of administration Frequency T.optineuron Thiamine Vitamin supplement 1amp IV OD T.librium chlordiazepoxide antianxiety 25mg PO OD T.benalgis benfortamine vitaminb1supplement 100mg PO OD I.monocef ceftriaxone antibiotic 1gm IV BD I.rantac ranitidine H2receptor antagonist 150mg IV BD

6. Drug brand name Generic name Indication Dose Route of administration Frequency I.levoflox levofloxacin antibiotic 750mg IV OD I.pantop pantaprazole Proton pump inhibitor 40mg IV OD I.metrogyl metriondazole antibiotic 100ml IV TID 25%dextrose IVF dextrose Glucose supplement I.mannitol mannitol Osmotic diuretic 100ml IV TID I.piptaz pipperacillin antibiotic 4.5mg IV TID I.neurogard multivitamin vitaminsupplement 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.

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