Friday, November 23, 2007

When to seek medical care

When to Seek Medical Care

People who drink alcohol to the point that it interferes with their social life, professional life, or health should contact a doctor to discuss the problem. The great difficulty lies in the fact that denial plays a large part in alcoholism. Consequently, alcoholics rarely seek professional help voluntarily.

Often a family member or employer convinces or forces the alcoholic to seek medical treatment. Even if an alcoholic accepts treatment because of pressure from family, an employer, or a medical professional, he or she can benefit from it. Treatment may help this person develop motivation to change the alcohol problem.

Several alcohol-related conditions require immediate evaluation in a hospital's Emergency Department.

Alcohol is involved in greater than 50% of motor vehicle deaths, 67% of drownings, 70-80% of fire-related deaths, and 67% of murders. It is imperative that emergency care be sought immediately when alcohol has contributed to an injury. This is very important because someone who is intoxicated may not be able to reliably assess the severity of the injury they have sustained or inflicted. An intoxicated person may, for example, not notice that they have a fractured neck vertebra (broken neck) until it is too late (that is, paralysis has occurred).

* Alcohol withdrawal requires emergency treatment. When withdrawing from alcohol, a person classically goes through 4 phases: tremulousness (the shakes), seizures, hallucinations, and delirium tremens (DTs). These stages are described in further detail:

o During the tremulous stage, the person will exhibit a tremor of his or her hands and legs. This can be seen if the person extends his or her hand and tries to hold it still. This symptom is often accompanied by anxiety and restlessness.

o Seizures often follow the tremulous stage. They are commonly generalized seizures during which the entire body shakes uncontrollably and the person loses consciousness. Seizures occur in up to 25% of people withdrawing from alcohol. If you see someone having a seizure, attempt to lay the person on one side so they don't inhale any vomit or secretions into their lungs. If possible, protect the person's head or other body parts from knocking uncontrollably onto the floor or against other potentially harmful objects. Do not place anything inside the person's mouth while they are having a seizure.

o Hallucinations affect about 25% of people undergoing major alcohol withdrawal. Visual hallucinations are the most common type of hallucination experienced during alcohol withdrawal. People will classically "see" insects or worms crawling on walls or over their skin. Often this is associated with tactile (feeling) hallucinations in which alcoholics think they feel insects crawling on their skin. This phenomenon is called formication. Auditory (hearing) hallucinations can also occur during withdrawal, although less commonly than the other types of hallucinations.

o The most dangerous stage of alcohol withdrawal is called delirium tremens (DTs). About 5% of people withdrawing from alcohol experience DTs. This condition occurs about 48-72 hours after drinking stops. The hallmark of this stage is profound delirium (confusion). People are awake, but thoroughly confused. This is accompanied by agitation, delusions, sweating, hallucinations, rapid heart rate, and high blood pressure. This is a true emergency. Studies have shown that death will occur in about 35% of these people if they are not treated promptly. Even with appropriate medical treatment, this condition is associated with a high death rate.

* Alcoholic ketoacidosis (AKA) is another condition for which emergency medical treatment should be sought. AKA often starts within 2-4 days after an alcoholic has stopped consuming alcohol, fluids, and food, often because of gastritis or pancreatitis. Not uncommonly, AKA and alcohol withdrawal syndromes are seen at the same time. AKA is characterized by nausea, vomiting, abdominal pain, dehydration, and an acetone-like odor on the person's breath. This occurs when the alcoholic has become depleted of carbohydrate fuel stores and water. Therefore, the body begins to metabolize fat and protein into ketone bodies for energy. Ketone bodies are acids that accumulate in the blood changing its acidity and causing the person to feel even sicker, thus perpetuating a vicious cycle.

* Alcoholism is often associated with other psychiatric disorders such as anxiety, depression, and psychosis. This psychiatric illness, often combined with a reduced level of sound judgment while intoxicated, leads to suicides, suicide attempts, and suicidal gestures by alcoholics. Obviously, a person who has attempted suicide, or is believed to be in serious or imminent danger of committing suicide, should be taken quickly to the Emergency Department.

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