I’m just drunk NOT vitamin deficient so stop with the ‘bananas’

Most of our intoxicated patients are not vitamin deficient, and don’t need supplementation. The real kicker is that  we almost never really try to find out if the patient might be a chronic abuser and potentially at risk. We just hang the bag. Remember, everything we do in medicine has a potential downside. And if the patient really doesn’t need a banana bag in the first place, there is no benefit to balance that risk. The next time you ask for that little yellow bag, think again!

Are you an Alcoholic? Test and get help

The CAGE questions are 4 simple and easy-to-remember to screen for alcohol use problems. CAGE is a screening tool: screening measures are NOT intended to provide a diagnosis; diagnosis occurs if/when a patient screens positive. An abnormal or positive screening result may thus “raise suspicion” about the presence of an alcohol use problem, while a normal or negative result should suggest a low probability of an alcohol use problem.
take test

 

Alcohol withdrawal – the Clinical Institute Withdrawal Assessment of Alcohol Scale, Revised (CIWA-Ar)

For those dealing with alcohol withdrawal in Kenya…the Clinical Institute Withdrawal Assessment of Alcohol Scale, Revised (CIWA-Ar) objectifies alcohol withdrawal symptoms to help guide therapy;

  • patients should be scored every 2 hours;
  • frequently treatment begins with benzodiazepines when CIWA-Ar scores reach 8-10, with standing or as needed dosing for scores 10-20
  • consider transfer to the ICU for scores >20.

Were James Bond’s drinks shaken because of alcohol induced tremor?

After exclusion of days when Bond was unable to drink, his weekly alcohol consumption was 92 units a week, over four times the recommended amount. His maximum daily consumption was 49.8 units. He had only 12.5 alcohol free days out of 87.5 days on which he was able to drink.

Treating delirium tremens

Introduction

Recently the New England Journal published a review article about delirium tremens which is somewhat misguided (see a scathing critique by The Poison Review).  The article focused on traditional benzodiazepine therapy, overlooking recent evidence about phenobarbital.  This post will explore how phenobarbital might fit into the treatment regimen for delirium tremens.