this case gives a brief idea about treatment , diagnosis, management , pharmacist interventions, patient counselling & discussion about alcohol withdrawal syndrome. please comment thank u

1. CASE STUDY ON ALCOHOL
WITHDRAWAL SYNDROME
Presented By ;
MARTIN SHAJI
PHARM.D

2. DEMOGRAPHIC DETAILS
Patient Name: Mr. H Age/Gender: 28y/M
Admission (IP) No.: 38862 Ward/Unit:
psychiatry
Date of Admission: 1/02/19 Date of Discharge:
9/02/19
Name of the Consultant Doctor/Physician: Dr. Y.
Provisional/Admitting diagnosis: Alcohol withdrawal syndrome
Chief Complaints: Tremors, palpitations, headache.
Past Medical History: Jaundice 5yrs back, appendicitis surgery done
before 3yrs back

3. Allergies (Drug/Food/Other): Nothing Significant
Personal/Social history and habits:
Height/Weight: 53 kg
Education: 10th standard
Diet (veg/non-veg): Mixed
Appetite: Decreased
Sleep: Decreased
Alcoholic: alcoholic since 2yrs stopped 1 month back.
Bowel & Bladder habit: normal
Occupation: Electrician

4. SOAP NOTE:
SUBJECTIVE EVALUATION
A 28years old male patient was admitted in psychiatry ward with the
chief complaints of head ache , palpitations, tremors, abdominal pain
since 3 days and decreased sleep
OBJECTIVE EVALUATION
On general examination, the patient was conscious and coherent.
On physical examination, he had temperature of 102.5°F,pulse rate was
82 bpm and B.P was found to be 130/90mmHg so he was send to lab
investigations.
On lab investigations Hb – 10gm,TC – 9000cells,ESR-30mm/hr,RBS-
96mg/dl,BU-25mg/dl ,S.Cr-0.5mg/dl,U-5.7mg/dl

5. LIVER FUNCTION TESTS
1 Bilirubin 4.2 Up to 1.0mgs/dl
2 Direct
Indirect
1.7
2.5
up to 0.2 mgs/dl
0.2-0.8mgs/dl
3 SGOT
SGPT
81
87
0-45IU/L
0-45IU/L
4 Alkaline Phosphate 94 42-128 IU/L

6. ASSESMENT
Based upon the subjective and objective evaluation, the patient was
diagnosed as ALCOHOLIC WITHDRAWAL SYNDROME.

7. DRUG CHART
SL.
NO
DRUG NAME GENERIC
NAME
CLASS DOSE ROA FREQUEN
CY
DURATION
1 Tab. Ativan Lorazepam Anti-Anxiety 2mg p/o BD 01/2/19 -9/2/19
2 Tab.Valproate Sodium valproate Anti-Convulsant 200mg p/o BD 01/2/19 -5/2/19
3 Inj.MVT Multi vitamin Vit.suppliment 355.1mg IV BD 01/2/19 -5/2/19
4 T. Reheptin Hepatoprotectant 250mg p/o BD 04/2/19 -7/2/19
5 T.Hepaliar Hepatoprotectant 250mg p/o BD 8/2/19 -9/2/19
6. T.Rantac Ranitidine H2 receptor antagonist 150mg p/o BD 01/2/19 -4/2/19
7 T.BC B-complex Vit.suppliment 66.4mg p/o OD 7/2/19 -9/2/19
8. T.PCT Paracetamol Anti-Pyretic 500mg p/o BD 9/2/19
9 T.Cetrizine Cetirizine Anti-pyretic 10mg p/o OD 9/2/19

8. PLANNING
As the patient was diagnosed as Alcoholic withdrawal syndrome
so planned to treat him as follows
On Day 1
The patient complains about tremors, palpitations, decreased
sleep and appetite, abdominal pain, Headache since 3 days so he
was treated with
 T.Lorazepam 2mg BD
T.Sodium valproate 200mg TID
Inj.MVT in 100ml NS BD
T. Rantac 150mg BD

9. On Day 2&3
As patient have similar complaints as like day1 so he was
treated with same medication.
On Day 4
On intervention Reheptin 250mg BD a hepatoprotectant was
added.
On Day 5
As patient was in prognosis state so he was treated with same
medication.
On day 6,7
Inj.MVT, T. Sodium valproate was stopped from the above
medication.

10. On day 8
No fresh complaints were seen so same treatment was continued but
the T.Reheptin was replaced with T.Hepliar.
On day 9
He complaints of Nasal bleeding and fever in his medication T.PCT
500mg BD, T.Cetrizine 10mg OD was added.
On day 10
The patient feels better and so he was discharged with the following
medication.
T.Hepaliar 250mg BD
T.BC 67.4mg OD
T.Rantac 150mg BD

11. PHARMACEUTICAL CARE ISSUES/CLINICAL
PHARMACIST INTERVENTION
The above prescription was irrational.
•On lab investigations bilirubin levels were increased
but no hepatoprotectants were prescribed and on
intervention they prescribed T.Hepaliar 250mg
•No ADR and No Drug interactions were found.

12. PATIENT COUNSELLING
Regarding Disease
Alcoholic withdrawal syndrome is a set of symptoms
that can occur when an individual stops alcohol consumption after long
periods of use.
Regarding medications:
T. Hepliar: It is a liver protective agent and should be taken twice daily
after food.
T. B-Complex: It is a vitamin supplement and should be taken once
daily.
T. Rantac: It is an anti ulcerative agent and should be taken twice a day
before food.

13. Regarding lifestyle modifications:
 Strictly adhere to the prescription
 Avoid drinking alcohol
 Avoid eating oily and spicy foods
 Salt restricted diet may be necessary
 Drink sugar cane juice, Lemon tea and Green tea
 Drink plenty of water
 Take Adequate rest
 Don't take any OTC drugs without consulting physician

14. DISCUSSION
Alcoholic withdrawal syndrome is a set of symptoms that
can occur when an individual stops alcohol consumption after long periods
of use. Prolonged and excessive alcohol tends to tolerance and physical
dependence. It is largely a hyper excitable response of the CNS due to lack
of alcohol.
SYMPTOMS
Anorexia
Abdominal pain
Nausea and vomiting
Palpitations
Tremors
Jaundice
Hepatomegaly
Ascites

15. DIAGNOSIS
Physical examination
Liver function test
Ultrasound
TREATMENT
 Hepatoprotectants ex; Hepamerz
 Antibiotics
 Vitamin supplements