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INTRODUCTION

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CASE LEARNING OBJECTIVES

  • Identify signs and symptoms associated with alcohol withdrawal

  • Recommend appropriate agents for the treatment of alcohol withdrawal on the basis of specific individualized needs

  • Design a comprehensive treatment plan and monitoring program to treat alcohol withdrawal, prevent relapse, and maintain abstinence

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PATIENT PRESENTATION

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Chief Complaint

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"My son needs help, he is really sick. He is really shaky and nervous, and he has also been vomiting since last night!"

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History of Present Illness

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Michael Jones is a 23-year-old male who has a history of alcoholism. His father died 6 months ago and since then he has been drinking on a daily basis. The patient's family states that he is not the same. Recently he has been extremely pessimistic about life, is generally sad, and only gets out of his bed to drink. His mother is getting really frustrated because it has now been 6 months and the patient has still not accepted his father's death and continues to drink. Yesterday afternoon the patient's mother and sister got into an argument with him regarding his drinking. He is tired of all the nagging and wanted to show them that he does not need alcohol and therefore he stopped drinking.

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Past Medical History

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Perennial allergies × 4 years

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Chronic pain × 6 months

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Alcohol dependence × 3 years

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Bipolar disorder I × 4 years

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Family History

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Father died at the age of 49 due to a motor vehicle accident. Mother is 51 and has a diagnosis of HTN, generalized anxiety disorder, and migraine. He has an older brother and younger sister; both are healthy.

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Social History

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The patient has a history of alcohol dependence for 3 years. He had been sober for the past 2 years until recent death of his father. The patient and father were in a motor vehicle accident. The patient survived, but father did not. Currently, he lives with mother and 2 siblings. He is an elementary school teacher; however, he has not worked since the accident.

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Tobacco/Alcohol/Substance Use

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Denies tobacco use; drinks one bottle (750 mL) of vodka daily; occasional illicit drug use (marijuana); denies abuse of prescription medications

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Allergies/Intolerances/Adverse Drug Events

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None

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Medications (Prior to Admission)

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Cetirizine 10 mg PO daily

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Acetaminophen 500 mg PO every 4–6 hours PRN pain

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Lithium carbonate 300 mg PO in morning and 600 mg at bedtime

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Review of Systems

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(−) Chest pain, (−) palpitations, (+) nausea and vomiting since last drink, (+) decreased appetite for past 3 months; ...

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