Alcohol Withdrawal Syndrome: Complication in Traumatic Patient at Maharat Nakhon Ratchasima Hospital

Abstract

          Background: Delirium is the most common problem in consultation-liaison psychiatry, most of the cause is due to alcohol withdrawal and severity may also occur in co-morbid trauma from any accidents. Objective: To study data of alcohol withdrawal in traumatic patients at Maharat Nakhon Ratchasima Hospital in aspects of general data, history of alcohol intake, result of accident, clinical course of alcohol withdrawal and treatment. Patients & Methods: The descriptive study was designed by reviewing the consultation record and inpatient chart of traumatic patient, who were admitted between 1 January to 31 December 2007. Results: Fifty-three patients were enrolled in this study. Most of them were male with the mean age of 44.3 years. The injury were found at extremities and spine. The pattern of use is alcohol dependence. Alcohol withdrawal delirium (AWD) usually occurs in alcoholic with a history of drinking for 10- 20 years. Symptoms generally develop within 3 days after cessation of drinking. Psychiatric treatment was given by considering targeted symptoms and also concern about medical and surgical conditions. Most of  treatments were used diazepam intravenous injection mean12.7+20 mg followed by lorazepam oral route mean14.5+14 mg. Result of treatment eliminated confusional state, mean course of treatment is 6.2 days. Conclusion: The patients were consulted by behavior change problem, which is due to alcohol withdrawal in traumatic patient at Maharat Nakhon Ratchasima Hospital in 2007. Most were AWD. We recommended  identifying alcohol withdrawal by using Clinical Institute Withdrawal Assessment for Alcohol Scale, Revised (CIWA-Ar) in male, age 30-50 years, accident with drunken, history of drinking over10 years, site of injury involves extremities and spine. To early diagnose alcohol withdrawal that usually found within 3 days, regiment of treatment was diazepam titrated intravenous injection within 2 days which leads to rapid and safe detoxification.