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  • Werinicke’s encephalopathy- may cause brain damage id left untreatedThiamine supplementation will aid in the treatment and cessation from alcohol.Complications? Alcohol withdrawal S/SS/SConfusionLoss of muscle coordination (ataxia) Leg tremorVision changes Abnormal eye movements (back and forth movements called nystagmus)Double visionEyelid drooping
  • Chronic use of alcohol leads to malnutrition because there are calories in alcohol and no essential nutrients. Hunger is satisfied by the calories provided in the beverage so muscle mass will decline and fat mass increases leading to many chronic diseases seen later in life. Malabsorption is associated with damage to gastric and intestinal mucosa. Those who chronically consume alcohol are at an increased risk for malnutrition because they are drinking empty calories and not eating the correct amount of nutrients from food. Folate: Alcohol interferes with dietary folate intake,absorption, transport of folate to necessary tissues, and the storage and release of folate by the liver.Vitamin B12: Studies have shown that both moderate and heavy alcohol consumption will affect vitamin B12 levels.One study showed a 5% decrease in mean serum vitamin B12 concentrations when consumption of alcohol increased from 0 to 30 grams of alcohol/day.Vitamin A: Alcohol has been found to promote a deficiency of vitamin A Alcohol enhances its toxicity when taken in excessive amounts.Calcium: Alcohol consumption can cause a loss of calcium in the body by increasing urinary calcium excretion.
  • The patient was found on the floor of a grocery store heavily intoxicated and nonresponsive. She was immediately sent to the ICU for rapid treatment.With an ETOH level of 296 a person will show signs of: Sleep or stupor, marked muscular incoordination, markedly decreased response to stimuli, incontinenceThe patient went for a tracheostomy and was intubated because she was unable to breath on her own. It was also easier for the nurses to clear secretions, and because a trach was administered, the patient was unable to speak nor eat by mouth.The patient was sedated because she was pulling on her tubes while awake and she had delerium tremors due to the alcohol withdrawal syndrome. Also, propolfolThis was when the dietitian was notified and the patient needed a nutrition consult. Before I begin about the diet, I would like to review some of the medications that typically seen for a patient with alcohol withdrawal syndrome.
  • Folic acid was supplemented because when a patient abuses alcohol this will decrease the absorption of thiamine. Also, if one is deficient in folic acid this can also lead to a decrease in the absorption of thiamine. This will promote the best absorption of thiamine as to prevent Wernicke- Korsakof syndrome which can lead to a further disruptence in mental status.The patient was experiencing episodes of constipation and episodes of diarrhea on various days. This was related to some of the medications like:fentanyl was causing her diarrhea and when they were finished with the dose, she slowly returned to her normal bowel patternZofran to prevent nausea and vomiting since she was on a ventilator They noticed that she was then constipated and had no bowel movements for a few days and once she was given a smaller dose of Zofran, they symptoms seemed to improve. Also, the patient maintained her weight throughout her time in the ICU showing that the medications did not cause a shift in her weight. The patient was sedated throughout her time in the ICU for comfort reasons and avoid any anxiety because she was intubated, on a ventilator, and initially suffering from delerium tremors.
  • The patient has micronutrient malnourishment because her chronic intake of alcohol has caused a thiamine and b12 deficiency. The patient is 59 years old which puts her at risk for malnourishment because her body has decreased absorption for the vitamins. As we age, the body’s absorption of vitamins decrease along with the loss of lean body mass which can increase the risk for falls.Note: Gastric residuals were noted to be 50-75ml and feedings were stopped until it cleared up. However, this was not necessary because according to the Evidence Analysis Library, when gastric residuals are > 250 ml is when a feeding should be held.
  • A standard formula which maintained her weight and provided enough energy to allow her body to recover and heal.The patient was on a tube feed for roughly 10 days and provided the correct amount of nutrition because her weight was maintained. The patient tolerated her feeds well and there were no signs of discomfort when the rate was increased. When the patient is hemodynamically stable, speech shall provide an evaluation to incorporate PO intake.Tube feed rate was Jevity 1.2 @ 30 ml/hr because that was where the rate began and it was slowly increased to 65 ml/hr after the propofol was administered
  • The focus is on helping the person arrive at the conclusion that they need to change a behavior.Ie. Alcohol and focus on a balanced dietUse open-ended rather than closed-ended questions."Tell me about your drinking.""What concerns do you have about your drinking?""How can I help you with your drinking?"Use reflective listening to focus on students' concerns and ambivalence toward their alcohol use."I hear you.""Please say more."Use affirmative statements in order to gain students' trust and confidence."You are very courageous to be so revealing about this.""I can understand why drinking feels good to you."Use summary statements.Elicit self-motivational statements - these statements fall into four categories.Problem recognition - "I never realized how much I am drinking." "Maybe I have been taking foolish risks."Expression of concern - "I am really worried about my grades and how alcohol may be affecting them."Intention to change - "I don't know how but I want to try."Theme about optimism - "I think I can do it. I am going to overcome this problemThe best diet for a recovering alcoholic is one that is balanced and full of fruit, vegetables, and whole grains. It is important for the client to try new things in order to break the habit that was instilled while they were drinking.Avoiding caffeine and sugary foods prevents the sensation for another addiction. When one recovers from an addiction they may feel inclined to cling on to another food item.
  • identify alcohol problems over the lifetime. Two positive responses are considered a positive test and indicate further assessment is warranted.
  • In a meta-analysis of 35 observational studies, Reynolds et al. (2003) found that, compared with abstainers, consumption of more than 4 drinks per day was associated with an increased risk of total stroke, increased risk of ischemic stroke, and increased risk of hemorrhagic stroke. First National Health and Nutrition Examination Study (NHANES), Liu et al. (1994) reported that drinkers were less likely to have either major weight gain or weight loss than nondrinkers over 10 years of follow-up.
  • heavy drinking and episodes of binge drinking impairs short- and long-term cognitive function as we agesmall to moderate amounts of alcohol consumption were associated with reduced incidence of dementia and Alzheimer’s disease CHD“Except for those individuals at particular risk… consumption of [up to] 2 drinks a day for men and 1 for women is unlikely to increase health risks” (NIAAA, 2003). On average, the relative risk of CHD associated with moderate drinking as defined by the DGAC is between 0.50 and 0.80 and is directly related to the benefits of alcohol on HDL-C, glucose, and clotting factors such as fibrinogen (Mukamal, 2005).
  • While drinking can lower the risk of cardiovascular disease, it does increase other health risks. In the following chart, mortality rates for non-drinkers serve as the baseline health risk (1.0 on the vertical axis). The risk for coronary heart disease even for heavy drinkers remains below the baseline; but risk of death from other causes goes up. The risk of death from liver disease skyrockets off the chart after only a couple of drinks a day.As dietitians, we never want to recommend alcohol to our clients because of the risk of abuse; however, these are the guidelines.
  • According to the Dietary Guidelines Advisory Committee

Case Study Presentation Case Study Presentation Presentation Transcript

  • Chronically Addicted to Alcohol
  • Alcohol Withdrawal Syndrome
  • Statistics Pharmacotherapy for Alcohol Dependence: Summary of Evidence Report/Technology Assessment No. 3." Agency for Healthcare Research and Quality (AHRQ) Home. Web. 30 Apr. 2011. <http://www.ahrq.gov/clinic/epcsums/alcosumm.htm>.
  • Pathophysiology Brief
  • Alcohol Manifestation
  • Delirium Tremens"Pharmacotherapy for Alcohol Dependence: Summary of Evidence Report/TechnologyAssessment No. 3." Agency for Healthcare Research and Quality (AHRQ) Home. Web. 30Apr. 2011. <http://www.ahrq.gov/clinic/epcsums/alcosumm.htm>.
  • How Alcohol Affects the Body DePetrillo, Paolo., and Mark McDonough. "Index of /resources." Alcohol Withdrawal Treatment Manual. Web. 30 Apr. 2011. <http://www.sagetalk.com/resources>.
  • How Alcohol Affects the Body
  • Case Study
  • Patient Profile
  • Patient in the ICU
  • MedicationsFolic Acid prevent deficiency of folic acid Anorexia, nausea, vomiting,1 mgThiamine HCL To treat low levels of vitamin Nausea sweating100 mg B1Sodium Chloride Increase fluid intake in the0.9% body and prevent dehydration1000 ml/dayMultivitamin To prevent micronutrient Gi discomfort: ie gas, nausea5ml deficienciesFentanyl Narcotic for patients with Constipation, diarrhea, dizziness,100cc/hr chronic pain management. drowsiness, dry mouth, headache, indigestion, loss of appetite, nausea, nervousness or anxietyZofran Prevents nausea and vomiting Diarrhea, constipation, and headache4mg every 6 hoursPropolfol reduces anxiety and tension, Swelling/pain tiredness1.5mg/kg and promotes relaxation and sleep or loss of consciousnessAtivan used to treat anxiety disorders Nausea, vomiting, diarrhea,2mg constipation, or appetite changes Pronsky ZM. Food Medication Interactions. 15th ed. Birchrunville, PA: Food Medication Interactions; 2008.
  • Nutritional Assessment"Monitoring Gastric Residual Volume." ADA Evidence Library. American DieteticAssociation. Web. 30 Apr. 2011. <http://www.adaevidencelibrary.com>.
  • What did the patient need?
  • Plan of Action
  • How can Dietitians Help?
  • Screening for Alcohol
  • Guidelines for Alcohol Related Problem National Institute on Alcohol Abuse and Alcoholism. Helping Patients Who Drink Too Much: A Clinician’s Guide. NIH Pub No. 05–3769. Bethesda, MD: the Institute, 2005.
  • Alcohol Benefits Wannamethee SG, Field AE, Colditz GA, Rimm EB. Alcohol intake and 8-year weight gain in women: a prospective study. Obes Res. 2004 Sep;12(9):1386-96 Dickinson HO, Mason JM, Nicolson DJ, Campbell F, Beyer FR, Cook JV, Williams B, Ford GA. Lifestyle interventions to reduce raised blood pressure: a systematic review of randomized controlled trials. J Hypertens. 2006 Feb;24(2):215-33.
  • Alcohol Benefits "Alcohol D-7." USDA Center for Nutrition Policy and Promotion. Web. 01 May 2011. <http://www.cnpp.usda.gov/dietaryguidelines.htm>.
  • Bofetta, P, and Garfinkel, L. "Alcohol drinking and mortality among men enrolled in an AmericanCancer Society prospective study." Epidemiology 1:342-348, 1990.
  • What are the Recommendations?
  • References