What Are the Significant Diagnostic Markers (“red flags”) that Indicate Acute Alcohol Withdrawal Syndrome for Mark?
Mark who is a patient at a psychiatric and a detoxification facility has several symptoms, which have indicated acute alcohol withdrawal syndrome. Acute alcohol withdrawal syndrome is a condition, which has symptoms that occur to individuals after a reduction or a discontinued use of alcohol intake after a long period and an excessive usage of the substance (Hanson, 2017). These symptoms increase in their severity if the patients stay more than six hours without taking alcohol or seeking medical attention (Hanson, 2017). Mark has been without alcohol for approximately twenty-four hours, which have worsened the symptoms.
These symptoms continue becoming worse if attention is not sought within three days but may improve in a week’s time (Hanson, 2017). Alcohol withdrawal syndrome occurs to patients who have been depended on alcohol for a long time however, if they stop the consumption abruptly or reduce its intake, the alcohol withdrawal symptoms kick in (Hanson, 2017). The seriousness of the withdrawal symptoms are analyzed using the Clinical Institute Withdrawal Assessment of Alcohol Scale (CIWA), (Hanson, 2017). According to Mark’s CIWA scale, the significant diagnostic markers that indicate acute alcohol withdrawal syndrome include an increased blood pressure, which has risen from 149/97 to 154/103 in three hours. This is an increased heart rate beyond the normal rate an indication of an underlying problem (Neuberger & DiMartini, 2015).
The CIWA scale also indicates a score of seven on nausea and vomiting indicating constant nausea, frequent dry heaves, vomiting and moderate tremors. Mark is also sweating a lot as his dry shirt has sweat stains on the back and chest. Sweat beads are also noticeable on his forehead and neck. Tremors are indicators of acute alcohol withdrawal syndrome, which can be caused by psychological and emotional aspects (Neuberger & DiMartini, 2015). The trembling and shaking in Mark has been because of Mark not having a drink for over twenty-four hours. Mark during a previous visit to the healthcare facility was warned about of liver cirrhosis due to the elevated liver enzymes. Liver cirrhosis is a condition associated with alcohol dependence (Neuberger & DiMartini, 2015). Mark had an earlier episode of seizure after a religious intervention that led him to stop drinking abruptly.
What Is The Most Appropriate/Safest Course Of Action For Mark?
The side effects should be controlled and monitored to enable Mark to return to a normal level (Neuberger & DiMartini, 2015). Mark should get medications to ease the symptoms of the alcohol withdrawal disorder. Medications can include painkillers due to the continuous headaches Mark is experiencing and antiperspirants to treat the sweating problem that he is having (Neuberger & DiMartini, 2015). A healthcare practitioner can administer Benzodiazepines, which can help in calming the nervous system (Lowinson, Ruiz, & Millman, 2015). Blood pressure, heart rate, and the respiration should be controlled to normal and safe levels. Mark should not stop alcohol usage at once and a controlled tapering schedule can be used to reduce the consumption of alcohol slowly with certain levels. A qualified and experienced healthcare practitioner can control this to avoid more serious withdrawal effects (Lowinson, Ruiz, & Millman, 2015).
A good diet can help in improving the side effects including a good sleeping pattern, which can give Mark rest and relaxation (Lowinson, Ruiz, & Millman, 2015). Mark should also start a detoxification and a recovery process from alcohol dependency. Mark can then proceed to join a rehabilitation centre since it is very difficult to recover from alcohol dependence alone (Lowinson, Ruiz, & Millman, 2015). After the physical withdrawal side effects have been successfully controlled, the healthcare practitioner can proceed to deal with other mental, emotional, and psychological effects (Lowinson, Ruiz, & Millman, 2015). Mark reports a mild anxiety, which can be better addressed by therapy and counseling. Therapy and counseling can help Mark from relapsing again as he had done before. This can also give mark support through the recovery process. This support can include help from the alcohol cravings that come during the treatment process (Lowinson, Ruiz, & Millman, 2015).
Assess the Appropriate DSM Diagnoses for Mark
For a patient to meet the DSM diagnosis for alcohol withdrawal syndrome, he/she must have more than two alcohol related symptoms (Dziegielewski, 2015). These symptoms must also have affected the normal functioning of the individual. The symptoms should have been caused by the sudden stopping or reducing the alcohol intake and not due to other medical causes (Dziegielewski, 2015). The alcohol dependency should also be a prolonged one or a heavy intake. Diagnostic factors should be alcohol related factors which may include alcohol use, tremors, hypertension, seizures, and tachycardia which is a heart rate exceeding the normal rate (Dziegielewski, 2015).
The risk factors should include a history of alcohol withdrawal side effects and an abrupt stopping or reduction in alcohol consumption (Gross, 2014). The withdrawal symptoms may depend on the alcohol consumption period and the amount of alcohol consumed. The symptoms are heighted after twenty-four hours to seventy-two hours as is the case of Mark (Gross, 2014). The DSM diagnosis for Mark includes sweating where Mark has excess sweat within three hours, which is not normal. Mark has also an increased heart rate, which has increased from 149/97 to 154/103 in three hours.
Another diagnosis for Mark is tremors, which are evident after the healthcare practitioner asks Mark to stand up and stretch his hands and the tremors could be seen on his hands and shoulders (Gross, 2014). Mark has also reported a mild anxiety and has a score of seven for nausea and vomiting an indication of constant nausea, vomiting, and dry heaves. Mark had an earlier episode of seizure after a religious intervention that led him to stop drinking abruptly which is a symptom of alcohol withdrawal syndrome (Gross, 2014). Mark has also a reduced appetite and is only able to keep in little amounts of fluids and continuous headaches that he uses Advils to calm them. These symptoms are an indication of alcohol withdrawal syndrome (Gross, 2014).
Dziegielewski, S. F. (2015). DSM-5 in action. Hoboken, NJ: John Wiley & Sons.
Gross, G. M. (2014). Alcohol Intoxication and Withdrawal: Experimental Studies II. Springer: Verlag.
Hanson, G. R. (2017). Drugs and society. Jones & Bartlett Learning.
Lowinson, J. H., Ruiz, P., & Millman, R. B. (2015). Substance Abuse: A Comprehensive Textbook. Philadelphia: Wolters Kluwer.
Neuberger, J., & DiMartini, A. F. (2015). Alcohol abuse and liver disease. Chichester, West Sussex: John Wiley & Sons Inc.