Alcohol use disorder: Clinical sciences

Alcohol use disorder is a medical condition characterized by the inability to control the consumption of alcohol, despite adverse health and social consequences. The cause of alcohol use disorder is multifactorial and includes psychological, biological, social, and environmental factors. Based on criteria defined in the Diagnostic and Statistical Manual of Mental Disorders, 5th edition, or DSM-5, you can categorize alcohol use disorder as mild, moderate, and severe.

Okay, if a patient presents with chief concerns suggesting alcohol use disorder, first perform an ABCDE assessment to determine if the patient is unstable or stable. If unstable, stabilize the airway, breathing, and circulation, which might require endotracheal intubation with mechanical ventilation. Next, obtain IV access and put your patient on continuous vital sign monitoring including blood pressure, heart rate, pulse oximetry, and cardiac telemetry.

Now, here’s a clinical pearl! Patients with alcohol use disorder might present with a few potentially unstable conditions. The first to consider is alcohol intoxication, which can cause significant CNS depression, coma, and even death. Next, always look out for alcohol withdrawal, which typically begins 12 to 48 hours after the last drink and can result in fatal generalized tonic-clonic seizures. Finally, don’t forget about delirium tremens, which is a rare but severe form of alcohol withdrawal typically occurring 48 hours or more after the last drink.

These patients will have fever, agitation, hallucinations, and extreme hypertension, with the potential for cardiovascular collapse. Treatment of acute intoxication is largely supportive with IV fluids and electrolyte replacement, while withdrawal symptoms are best managed with benzodiazepines.