I need the case study writen in APA, citations, and provide 3 references
Case Study on
Acute alcohol withdrawal
A 54-year-old man was evaluated for acute altered mental
status after being hospitalized for alcohol withdrawal. The patient was
homeless but had recently been enrolled in an addiction treatment program in a residential
clinical stabilization service. He reportedly left the program 4 days before
admission to this hospital and then “blacked out” daily in tandem with drinking
0.5 to 1 gallon of vodka throughout the day. On the evening before admission,
he decided to stop drinking alcohol. Approximately 10 hours later, he awoke on
the ground without recollection of lying down; he had had vivid dreams and
tremulousness and was worried that he may have had a seizure. He presented it
to the emergency department of this hospital.
The patient reported diffuse headache, nausea, non-bloody
and nonbilious emesis, restlessness, auditory hallucinations, and a sensation
of insects crawling on the skin. A review of systems was notable for heartburn
and was negative for confusion, ataxia, dizziness, focal weakness and numbness,
tongue laceration, incontinence, visual hallucinations, fever, chills, dyspnea,
chest pain, abdominal pain, diarrhea, and dysuria. His medical history was
notable for seizure disorder in childhood, hypertension, and glaucoma, and he
had undergone umbilical hernia repair. He reported that he was taking
gabapentin and hydroxyzine and had no adverse drug reactions. The patient had a
lengthy history of alcohol use, with associated delirium tremens and withdrawal
seizures, although he had abstained from alcohol use over a 7-year period,
which coincided with incarceration and ended 8 years before admission. He
smoked cigarettes and had smoked 0.5 to 1 pack daily since he was 18 years of
age. He had previously used marijuana, hash oil, and lysergic acid
diethylamide. His family history was notable for alcohol use disorder in his
parents and two brothers.
On examination, the temperature was 36.7°C, the heart rate
108 beats per minute, the blood pressure 161/96 mm Hg, the respiratory rate 22
breaths per minute, and the oxygen saturation 98% while the patient was
breathing ambient air. The weight was 55.4 kg, the height was 68 inches.
The diagnosis for this patient likely centers around
complications of acute alcohol withdrawal, given his history and symptoms. His
report of “blacking out” daily after consuming significant amounts of
alcohol, followed by a sudden cessation, supports the diagnosis of acute
alcohol withdrawal syndrome (AWS). Symptoms such as tremulousness, vivid
dreams, restlessness, auditory hallucinations, and the sensation of insects
crawling on his skin are consistent with severe AWS, which can also include
delirium tremens (DTs) and withdrawal seizures. His history of prior alcohol
withdrawal seizures and DTs further supports this diagnosis.
I would assess vital signs, hydration status, and glucose
level. I would administer thiamine to
prevent Wernicke-Korsakoff syndrome.
Administer
benzodiazepines (e.g., lorazepam or diazepam) to manage withdrawal symptoms and
prevent seizures. Adjust the dose based on symptom severity and response to
treatment.
Continuous monitoring for signs of worsening withdrawal,
DTs, and other complications like cardiac or respiratory distress.
Continue benzodiazepine regimen, possibly tapering based on
the patient’s response. Consider anticonvulsants if there’s a history of
seizures unrelated to withdrawal.
Ensure adequate nutrition, hydration, and address any
comorbid conditions (e.g., hypertension, glaucoma).
Consultation for social services, and psychiatric to
assist with housing, follow-up care, psychiatric and substance abuse
counseling.
Arrange outpatient
follow-up with addiction services, primary care, and psychiatry.
Prescribe medications to manage withdrawal symptoms and any
ongoing conditions, provide prescriptions for continuation of gabapentin and
hydroxyzine.
Ensure the patient has access to a supportive environment,
possibly a residential treatment facility if appropriate.
Monitoring for escalation of withdrawal symptoms to DTs or
seizures is crucial.
Medication Management for Risk of benzodiazepine
overuse or misuse, particularly given the patient’s history of substance use.
Continuing to monitor and evaluate his Mental Status is at
risk of harm to self-due to altered mental status or hallucinations.
I would be concerned for the patient’s low body weight and
potential malnutrition could complicate recovery and increase vulnerability to
other health issues.
My ethical concerns would be Consent and Capacity, assessing
the patient’s capacity to consent to treatment, considering his altered mental
status.
Respecting the patient’s privacy and confidentiality by
handling sensitive information about the patient’s medical history, substance
use, and social circumstances with care.
As a health care provider continue to unbiased and
nonjudgmental and continue providing compassionate care without stigma or
discrimination, particularly important given the patient’s background and
social challenges (e.g., homelessness, incarceration).
Continue with the intensive resources that might be needed
for one individual against the broader needs of other patients, especially in
high-demand settings like emergency departments.
