Data gathering
- Red flags – seizures, tremors, DSH, haematemesis
- Others – cut down, others noticed, guilty, morning drink, mood, abdo pain, yellow skin, increasing amounts, neglecting things, driving, hallucinations
- Examine – BP, abdo, tremor
Clinical management
- Investigations
- Bloods – FBC, B12, folate, LFTs inc GGT
- Liver USS
- Treatment
- Oral vitamins – vit B co-strong 30mg OD, thiamine 200mg OD
- Drug and alcohol service
- supervision for detox
- psychological support
- medications to help calm down
- specific medications – reduce cravings
- Follow-up / Safety net
- Refer if – signs of DT (tremor/confusion/fits/hallucinatons)
- DVLA
NB:
- Wernickes – ataxia, opthalmoplegia, confusion
- Korsakoff – chronic Wernickes – amnesia, confabulation