Alcohol withdrawal: a medical view of the hangover problem. Withdrawal syndrome: signs and symptoms, treatment, drugs

Ethyl alcohol is a substance that has narcotic effect on the human body. Its long regular use leads not only to the formation psychological dependence, but also to changes in the functioning of internal organs. The metabolism of a person with alcoholism is rebuilt in accordance with the new mode of operation of the body, ethanol begins to play important role in metabolic processes. In addition, toxins formed during the breakdown of alcohol accumulate in the blood and tissues, which leads to the development of chronic intoxication.

Alcohol withdrawal and hangover syndrome- different phenomena. The latter develops against the background of general intoxication with ethanol breakdown products and persists for several hours, a maximum of one day. It develops in almost all people who drank alcohol the day before.

Abstinence phenomena occur only with a sharp cessation of alcohol or a significant reduction in consumed doses of an alcohol-containing product in people suffering from chronic alcoholism.

The development of withdrawal syndrome is based not so much on intoxication as on the lack of a substance that is directly involved in OB.

What is alcohol withdrawal syndrome

Withdrawal syndrome in alcoholism is a complex of neurological, mental and somatic disorders that arise in response to abstinence from habitual alcohol consumption. Actually, the presence of signs of the phenomenon under consideration is one of diagnostic signs physiological dependence in alcoholism. The answer to the question of how long withdrawal symptoms last may vary depending on the duration of alcohol consumption and the characteristics of the patient’s body. On average, this figure is 3-5 days.

Important: alcohol withdrawal is serious condition requiring medical attention!

The causes of the disease include chronic alcoholism, and the severity of clinical manifestations depends on whether the patient suffers from a constant or binge form of alcoholism. In regular alcoholics, withdrawal symptoms are much more severe than in people who periodically abuse alcohol. The symptoms of the disease are as follows.

The first stage of alcoholism – abstinence does not develop.

The symptoms of withdrawal syndrome in the second stage of alcoholism depend on its degree:

• 1st degree – vegetative-asthenic disorders:
• sweating;
• tachycardia;
• dry mouth;
• desire to drink alcohol.
• 2nd degree – somatic and neurological disorders:
• facial skin hyperemia;
• sweating;
• tachyarrhythmia;
• tremor;
• gait disturbance;
• impaired coordination of movements;
• vomit;
• nausea;
• headache.
• 3rd degree – predominantly mental pathology:
• sleep disturbance;
• anxiety;
• guilt;
• mood instability;
• nightmare visions;
• hallucinations.

At the third stage of alcoholism, withdrawal manifests itself in the form of all the symptoms described above. On the 2-3rd day after withdrawal, the patient may experience visions; the patient is not aware of where he is, sees non-existent monsters, and imagines conspiracies against him. Developing delirium delirium("delirium tremens").

Withdrawal symptoms gradually subside as metabolic processes and detoxification normalize. The moment of recovery from delirium, if present, is considered to be the patient's sleep (people suffering from delirium tremens may not sleep for several days).

Diagnosis of the disease

As a rule, diagnosing withdrawal syndrome is quite simple. When interviewing the patient and his relatives, it becomes clear what the duration daily use alcohol and how much time has passed since the patient gave up drinking. As a rule, regular consumption of alcohol-containing products must take place over several weeks for withdrawal symptoms to develop. Abstinence develops within 12-24 hours after the last intake of alcohol.

The presence of signs of alcoholic delirium is an indication for soft fixation of the patient to the bed. Otherwise, a person in an altered state of consciousness may harm himself or others.

Objectively, a person suffering from alcoholism experiences a full or partial set of the symptoms described above. The patient may be aggressive or depressed, seek to repeat drinking, or require medical attention. In a toxicological analysis of urine and blood, ethanol may not be detected if more than 1-2 days have passed since the last time it was consumed.

Treatment methods

Treatment alcohol withdrawal can be done at home only if it is mild and not accompanied by mental disorders. If they are present, the patient requires hospitalization in a toxicology or drug addiction hospital.

First aid and home treatment

The main task of the person providing first aid to the patient is to relieve intoxication and prevent mental disorders. A patient suffering from withdrawal syndrome is given symptomatic treatment(painkiller tablet for headaches), detoxification therapy.

Detoxification at home consists of “restaurant” gastric lavage, the use of enterosorbents and drinking plenty of fluids. To remove gastric contents, the patient is given a large amount of water to drink, after which they induce vomiting. The procedure is repeated until the vomit consists of pure water.

After washing, the person must be given Activated carbon at the rate of 1 tablet per 10 kg of body weight. The drug allows you to bind and remove from the body those toxic substances, which will be released into the stomach after it is cleansed.

To relieve intoxication, you should drink large amounts of fortified drinks. Natural juices, compotes, and fruit drinks are well suited for this. In addition to saturating the body with vitamins, they help eliminate alcohol breakdown products through the kidneys.

In order to stabilize the psyche, a person suffering from withdrawal syndrome is recommended to use decoctions sedative herbs(motherwort, chamomile). This will make it easier to endure a temporary deterioration in your condition and avoid returning to your previous lifestyle. Use medical supplies without a doctor's prescription is not allowed.

Specialized medical care

Specialized medical care is provided after the patient is hospitalized. Here, a person suffering from withdrawal syndrome undergoes massive infusion therapy followed by the administration of diuretics (up to 5-6 liters saline solutions+ 80-100 mg furosemide). For the purpose of detoxification, hemodez and reopolyglucin can also be used.

As an antidote, the patient is prescribed unithiol or sodium thiosulfate. These substances, in fact, are parenteral sorbents - they precipitate alcohol toxins contained in the blood and promote their rapid elimination.

The patient also receives vitamins, antiplatelet agents, and nootropic drugs that allow for the correction of cerebral blood supply disorders.

Correction of mental disorders is carried out by prescribing psychotropic drugs (aminazine, haloperidol, relanium). The first two drugs are more often used for delirium, Relanium is used to relieve anxiety and get good sleep. Of course, patients with signs of mental disorders require constant monitoring. In case of severe psychomotor agitation, the patient must be fixed to the bed.

Consequences of withdrawal for the body

Abstinence itself does not have delayed consequences if it can be managed correctly. However, many people who drank alcohol for a long time and then gave it up suffer from diseases caused by alcoholism itself. As a rule, patients who quit drinking experience:

• heart and cardiovascular diseases;
• kidney disease;
• liver diseases, up to cirrhosis;
• tendency to intestinal bleeding;
• tendency to ischemic strokes;
• muscular asthenia.

Of course, as the body recovers after long-term intoxication, its condition will improve. However, it will not be possible to restore health to the level of an average person who has never abused alcohol.

What's happened quick consequences withdrawal symptoms? These include mechanical harm that the patient inflicts on himself while in delirium. He can bang his head against walls, break objects, break glass, injuring himself with their fragments. There are cases where delirious patients have jumped out of the windows of their own houses.

In addition, in patients with bright pronounced syndrome withdrawal, convulsions, respiratory arrest, cardiac arrest and other pathology requiring urgent care may develop. medical intervention. That is why treatment of severe forms of withdrawal syndrome is recommended to be carried out in a drug treatment clinic.

Withdrawal syndrome in alcoholism is not a simple hangover that happens after a “good” drink. This is a condition when a physical, nervous disorder begins.

Patients with chronic alcoholism of the 2nd and 3rd degrees are susceptible to it, when they stop drinking alcohol, reducing the dose. You can get out of this thanks to another one.

What is it, symptoms

Signs of the condition vary. A hangover is a poisoning of the body with all the ensuing consequences:

• Heaviness in the head, migraine-type pain.
• Unpleasant feeling in the stomach, nausea, vomiting.
• Weakness.
• Hand trembling.
• Intense thirst.
• Aversion to alcoholic drinks.

This state lasts for several hours and disappears without a trace. Many recommend in the morning, after libations, to drink a small dose in therapeutic purposes. The opinion is wrong. Poisoning cannot be treated with alcohol.

The symptoms of the syndrome are much more severe, lasting 3-5 days. This is due to the accumulation of toxins in the blood, which are formed as a result of the breakdown of alcohol. A person can no longer live without it.

Ethanol becomes a component of the blood, takes part in metabolic processes, the body requires it, causing the following conditions:

• Feelings of anxiety, worry, fear.
• Changes in blood pressure.
• Problems with coordination, dizziness.
• Nausea, vomiting, diarrhea.
• Aversion to food, pale complexion.
• General weakness, hand tremors, fever.
• Confused consciousness, hallucinations.

Stages of the syndrome

Typically, each stage is identified by various symptoms:

1. The first (initial) manifests itself in impaired concentration, anxiety, weakness, and the desire to drink.
2. Second (moderate). The clinical picture is more pronounced. Loss of appetite is added, heartbeat and breathing become more frequent. Running glance.
3. The third is dangerous condition mental illness with hallucinations, anxiety, insomnia, nightmares.
4. Fourth (hard). The symptoms of withdrawal syndrome are clearly defined and require medical attention. People call it “delirium tremens.” Possible death.

Features of withdrawal

IN easy person You can go without alcoholic drinks for several hours, your condition hardly worsens. It happens at the beginning of the second stage of alcoholism. In moderate cases, the need to drink occurs immediately after sleep; to improve the condition, take a dose of alcohol.

A person can still abstain from alcohol by force of will. Occurs in the middle of the second stage of alcoholism with chronic dependence. Expressed is characterized by the fact that it is almost impossible to live without alcohol.

The symptoms persist for several days and will not go away without a dose of alcohol. This happens at the end of the second, beginning of the third stage of alcoholism. A severe case with all the symptoms can last a very long time. Without appropriate treatment, it leads to mental disorders and death.

Stages of alcoholism

Even in ancient times, the great Horace said: “Intoxication is voluntary madness.” It’s hard to disagree with this. Modern medicine defines four, when a normal, healthy person turns into a morally and physically sick person, with obvious signs of insanity.

First. There is no strong psychological dependence. A man can abstain from drinking for a while if he cannot buy it. At the first opportunity he will find and bite. Company, friends, depression, loneliness, the desire to relax lead to alcoholism.

At this stage, a person can free himself from addiction if he reconsiders his attitude towards the world around him and changes his priorities. Complete refusal of ethanol, exercise, new friends. Life without alcohol can be much more joyful and happier. If you continue to aggravate it, a persistent addiction will appear.

Second. The obsessive desire is constantly pursuing. All thoughts are occupied with the search for alcohol. The dose is increased to achieve a “high” without symptoms of poisoning. Concepts about the negativity of drunkenness disappear. There is a transition to the next severe form.

Third. Irreversible harm is caused to mental and physical health. The dose used exceeds acceptable standards. Alcohol burns internal organs, fabrics.

The liver and kidneys are primarily affected. Alcoholic severe swelling, due to poor functioning of the urinary system, the skin turns yellow caused by stagnation of bile, pathological changes in the liver.

Mental health has suffered irreparable damage. At compulsory treatment“withdrawal” occurs. A person commits inappropriate, crazy actions, becomes violent, and irresponsible.

Stage 4: complete indifference to the outside world. The only thought is to drink. All organs and systems practically do not work. A person is lost not only to society, but also to himself. During this period, everything that contains alcohol is consumed: cologne, glass cleaner, and other alcohol-containing substances.

They are no longer amenable to forced treatment. They may die during withdrawal from the binge. 99% die a painful death from cirrhosis, renal failure, heart attacks, cerebral hemorrhages.

It is believed that stages 3 and 4 are a one-way ticket. Such patients are no longer treated. As Plutarch said: “No body can be so strong that wine cannot damage it.” At these stages, the immune system is practically destroyed.

Relief of the syndrome

Conclusion from the difficult alcohol intoxication When the body cannot cope with a large dose of ethanol, mental and physical disorder begins. Symptoms of poisoning are eliminated medically.

Individually assigned complex therapy. Cupping is not a treatment method; after it, a consultation with a psychologist and long-term recovery are indicated, which will depend on the degree of the disease.

How to remove

Elimination of withdrawal syndrome in alcoholism consists of gently withdrawing a person from alcohol dependence, eliminating signs caused by the lack of drinking. At different stages of alcoholism, the relief of symptoms will be approximately equal, but the duration will not be the same.

IN severe cases drug treatment, which includes many procedures, is carried out in a hospital under the supervision of a narcologist.

Every other day, glucose, sodium chloride with thiamine, riboflavin, biotin, ascorbic acid, antiallergic drugs (Telfast, Gismanal), drugs for blood circulation (Cavinton, Neurovit) are injected drip-wise.

All this helps to remove toxic effect alcohol in the blood. Strong diuretic medications are prescribed to remove toxins that are formed during the breakdown of ethanol and reduce swelling.

• Medicines that reduce cravings for alcohol (crotenal, Antabuse).
• Sedatives, hypnotics (gidazepam, clozapine).
• Means for improving liver function and cleansing the body (essentiale, milk thistle-based preparations).

After the acute course, the second stage begins, where you should continue to take drugs that improve metabolism. These include therapy for organs that have been damaged by heavy libations.

For alcohol addiction, treatment includes drugs that cause aversion to alcohol, vomiting, increased heart rate, and fear of death. They help relieve cravings for alcohol and get rid of addiction on a psychological level.

Treatment at home

Withdrawal syndrome can be relieved on your own. This could be on early stages alcoholism. Medichronal is usually used, which is available in pharmacies without a prescription.

After taking it, toxins are quickly eliminated from the body and unpleasant symptoms disappear. You need to take it for three days. For treatment to be successful, long, full sleep is necessary. Are used sedatives, plants.

Pharmaceutical herbal sedatives Gerbion, Novo-passit, Fitosed. You can drink decoctions of valerian and motherwort. For nervousness and increased heartbeat, use Corvalol, Corvalment, Glycine. Alcohol disrupts the functioning of the system and destroys B vitamins needed for cells.

To speed up the recovery process, it is necessary to take minerals, useful substances and ascorbic acid in double dose. It is advisable to drink natural juices with a high content of it - grapefruit, orange. Eat lemon, kiwi.

Food should be varied and high in calories. Good to drink dairy products, which restore intestinal flora and remove toxins. Yogurt, fermented baked milk, kefir should be in the diet constantly. Meat soups, cereals, vegetables will help restore strength.

Any type of alcohol to relieve symptoms is prohibited. Its complete abolition will speed up recovery. Typical mistakes (using beer, vodka to soften the symptoms) will lead to another binge.

Treatment at home is not always possible. The appearance of severe concomitant diseases, advanced degree of alcoholism, self-therapy may not produce results and cause harm. Such patients should undergo rehabilitation in a hospital under the supervision of a specialist.

What is withdrawal syndrome - a serious dangerous condition. Untimely, poor-quality assistance can cause serious consequences:

• Exacerbation of concomitant diseases.
• Alcohol destroys the liver - cirrhosis.
• The condition of blood vessels worsens - leading to hemorrhages, cerebral edema, and heart attacks.
• Mental disorders - nightmares, visions, fears.
• Delirium (madness). Delirium tremens - inappropriate behavior, anxiety, panic. In this state, a person is dangerous to himself and others.

Alcohol withdrawal syndrome can begin after 1.5-2 years of constant worsening alcohol consumption. As the great Charles Darwin said, alcohol abuse is worse than war. The habit of solving problems with a bottle leads to sad consequences.

Doctors, speaking about withdrawal syndrome (ICD 10 code - F10-F19) in narcology, mean a group of symptoms that occur when stopping the use of psychoactive substances or reducing their quantity. The signs and duration of withdrawal depend on the type of substances used and the duration of their use. The appearance of withdrawal syndrome is evidenced by neurological, somatic, and mental disorders that disappear after the use of habitual psychoactive substances. In psychiatry, alcohol withdrawal is the most studied.

Causes

The development of withdrawal syndrome occurs after long-term use alcoholic drinks. With chronic alcoholism, a large number of toxins accumulate in a person’s blood. They are products of the breakdown of ethanol. Toxic compounds are formed in the liver and intestines.

In a healthy adult, when drinking alcohol, special enzymes begin to be produced that neutralize toxins. But if alcohol has been taken for a long time in large quantities, then the body cannot cope with the process of processing it. After heavy drinking, ethanol is gradually broken down by the liver, the breakdown products enter various organs through the bloodstream, affecting nerve fibers, brain.

In newborns

If a pregnant woman has used narcotic substances, alcohol, then after birth the child develops neonatal abstinence syndrome. Prohibited substances penetrate the placenta to the fetus, so the baby is born dependent. When children abuse alcohol, fetal alcohol syndrome occurs.

Manifestations occur 3-5 days after birth. The child may have increased appetite, but no weight gain is observed. Some children begin vomiting, diarrhea, and an unreasonable increase in temperature. To clarify the diagnosis, a general urine test and toxicological examination of stool are performed.

Symptoms

When the intake of alcohol in the body stops after 7-10 hours, a person’s health worsens. It is expressed in the form of a compulsive (physical) craving for alcohol and the development acute syndrome intoxication. The main manifestations include:

• feeling of weakness, fatigue;
• psychomotor agitation;
• increased heart rate;
• temperature increase;
• hypertension;
• trembling of limbs;
• severe headaches;
• dizziness;
• thinking disorder;
• deterioration in concentration;
• insomnia;
• the appearance of auditory and visual hallucinations;
• vomiting, which may be accompanied by bleeding.

Some people experience withdrawal symptoms seizures. The severity of symptoms depends on the stage of alcoholism. What matters is how long a person drank alcohol and how much alcohol entered the body during the specified period.

Delirium

If the patient, in addition to the characteristic signs of uncomplicated withdrawal syndrome, experiences clouding of consciousness, the occurrence of strong hallucinations, and delirium begins, then a diagnosis of withdrawal with delirium is made. Otherwise called delirium tremens.

The condition is accompanied by strongly expressed fear and apprehension of trouble. General health worsens, the following conditions are observed:

• severe anxiety arises, the person cannot sit in one place;
• eyes and face turn red;
• severe hallucinations occur before sleep;
• After falling asleep, nightmares begin, which are difficult for alcoholics to distinguish from reality.

A person can throw off non-existent insects and talk to someone. In severe forms of delirium tremens, personality disorders are observed and disturbances occur mental activity. It is also possible sudden death. With delirium tremens, the patient becomes dangerous; he can maim another person or commit suicide.

How is it different from a hangover?

A few hours after taking large doses of alcohol, the condition of a healthy person worsens. Severe signs of intoxication appear. This is how alcohol breakdown products act on the body.

A hangover appears after most of the alcohol has been processed in the body. After sleep, a person experiences thirst, nausea, and a feeling of weakness and exhaustion. But at the same time there is no craving for alcohol, it causes disgust. Drinking alcohol only makes it worse.

During withdrawal, drinking alcohol can relieve all unpleasant symptoms. This is the main difference between a hangover and withdrawal symptoms.

How long does it last

Post-alcohol withdrawal when quitting alcohol can last 1-2 days in people with a mild form of withdrawal syndrome. But for most it ends with another drink.

With moderate withdrawal symptoms when quitting alcohol, symptoms may bother a person for 3-4 days. It is not possible to cope with the craving for alcohol on your own, so a person drinks it at the first opportunity.

In advanced cases, the alcoholic may suffer from withdrawal symptoms for more than a week. For most people, physical discomfort lasts no more than 10 days. After normalization of the condition, psychological dependence remains.

Treatment of alcohol withdrawal syndrome

To reduce the severity of symptoms, it is prescribed. It is necessary to remove alcohol breakdown products from the body. Therapy is aimed primarily at detoxifying the body and reducing the likelihood of developing complications of addiction. After eliminating the main symptoms, treatment involves suppressing cravings for alcohol.

In mild forms, a person can be helped at home. For moderate to severe withdrawal, therapy should be carried out in a clinic. When delirium is diagnosed, the patient is taken to the psychiatric ward.

Medicines

In case of mild withdrawal symptoms, it will be possible to relieve symptoms with the help of enterosorbents and drugs designed to reduce hangovers: Alcostop, Medichronal.

To relieve severe withdrawal symptoms, it is required urgent Care doctors Doctors prescribe intravenous administration of saline solution, glucose, Hemodez, Polyfer. In the drug treatment department, magnesium sulfate, sodium thiosulfate, and Unithiol can also be administered. If necessary, anticonvulsant therapy is used. Doctors prescribe tranquilizers, sleeping pills, and antipsychotics to many patients.

Traditional methods

To relieve symptoms, a cleansing enema is done at home. The condition can be alleviated by drinking plenty of fluids. It is recommended to drink water and water-electrolyte solutions. A contrast shower helps speed up the elimination of toxic substances. Connoisseurs traditional methods It is advised to steam an alcoholic in a bathhouse.

Forecast

It is difficult to say how recovery will proceed and whether a sick person will be able to survive withdrawal without negative consequences for the nervous system. It all depends on the degree of alcoholism, the severity of symptoms and the patient’s health condition. The life expectancy of a person dependent on psychoactive substances is influenced by the speed of withdrawal. addiction. If a person wants to get rid of addiction, then he will be able to get help.

Complications and consequences

If a patient has developed an addiction to alcohol, then when he refuses it, signs of withdrawal appear. Lack of adequate treatment can lead to negative consequences. People experience the following complications:

• renal and hepatic failure;
• extensive bleeding;
• ischemic brain damage;
• cardiovascular failure;
• exacerbation chronic diseases;
• metabolic disorders.

How to treat a hangover (alcohol withdrawal syndrome)?

Withdrawal syndrome. Help with withdrawal symptoms

In severe forms, there is a possibility of developing mental illness. Only complete abstinence from alcohol will help you return to a normal lifestyle and reduce the likelihood of early death.

Alcohol addiction poses a danger to a person by acquiring a whole range of mental and physical disorders. Pathological disorders actively manifest themselves, dealing a crushing blow to all the mechanisms of the body’s vital functions. Getting rid of a bad habit is not so easy. After all, a sudden stop in the consumption of alcoholic beverages after long drinking bout provokes withdrawal syndrome in alcoholism.

What is withdrawal

The concept of Abstinencia is synonymous with the definition of “abstinence”. Since pathology is diagnosed in alcoholics, it is recognized as a primary sign of addiction. Alcohol withdrawal syndrome is characterized by the fact that after stopping the constant cycle of using substances that contribute to the development of addiction, changes in the functional state of the body occur. Such a substance becomes a vital need for the body, since it has become part of the biochemical processes of the blood. In the absence of the required dose of alcohol, abstinence occurs, causing alcohol withdrawal syndrome.

What is the difference between withdrawal symptoms and a hangover?

Special teaching aids give a clear definition of what alcohol withdrawal syndrome is. The formulation characterizes alcohol withdrawal syndrome, taking into account the signs of a hangover. This syndrome appears in chronic alcoholism. He is characterized by deterioration of health due to the inability to take a dose of alcohol. The presence of symptoms indicates the need for secondary consumption of alcoholic beverages.

Usually in everyday life there is a terminological interweaving when a hangover is the body’s response to an excessive amount of alcohol drunk, which provoked poisoning with toxic substances. A well-known reaction of the body is vomiting. The presence of vomiting indicates the inclusion of the adaptive function of the body in response to a health-damaging factor.

The morning of “post-toxication syndrome” is known for headache, weakness, acute sensation thirst. A person experiences an aversion to alcohol, and if consumed repeatedly, the condition worsens. Therefore, the popular belief that you can relieve a hangover with a new dose ethyl alcohol, is a fallacy.

With alcohol withdrawal, symptoms appear in the absence of alcohol in the blood of alcoholics, since metabolism and the body’s normal functioning during alcoholism are disrupted. In case of chronic alcoholism, even the first glass in the morning quickly normalizes well-being and physiological parameters.

Withdrawal symptoms

Let's highlight the main symptoms of withdrawal symptoms alcohol syndrome(AAS):

• jumping blood pressure;
• a feeling of uncertainty in determining one’s spatial position;
• loss of balance;
• vomiting, diarrhea;
• trembling of limbs;
• aversion to food;
• pale skin;
• prostration;
• mental disorganization of behavior;
• depression.

Increases in alcoholics heartbeat, shortness of breath appears. This set of symptoms in chronic alcoholism is complemented by increased body temperature and a feverish state. A person’s consciousness becomes confused, insomnia sets in, nightmares occur at night, and upon waking up, a hallucinogenic syndrome sets in. Such a person becomes socially dangerous. Need to provide necessary help aimed at drug relief of symptoms.

These signs allow the doctor to diagnose alcoholism in the patient. Alcohol withdrawal syndrome occurs several hours after stopping drinking. The appearance of symptoms without drinking alcohol again, a strong desire to drink, and an improvement in the condition when drinking is resumed indicates that alcohol use is regular and long-term. And the result of alcoholics’ addiction was the “infusion” of alcohol into metabolic processes. This phenomenon is due to the onset of the condition chronic alcoholism 2 stages. The development of alcohol withdrawal occurs after a two-year “experience” of alcoholics’ addiction. There are known cases of the disease appearing much earlier.

Signs of withdrawal

The onset of a certain stage of withdrawal syndrome can be determined by the following signs:

1. Uncomplicated withdrawal state. Characterized by a person’s need to consume alcoholic beverages. Feeling worsens due to tongue trembling, eye twitching, excessive sweating, vomiting, increased heart rate, blood pressure problems and other characteristic signs of alcohol dependence.
2. Withdrawal symptoms convulsive state. Accompanied by epileptic convulsions of a patient with associated symptoms alcoholic.
3. Withdrawal state with impaired consciousness. The condition is caused by the presence of characteristic AAS symptoms, aggravated by psychosomatic disorders: confusion, hallucinations and other somatic abnormalities.

Only a few patients can make a firm decision to give up alcohol. Usually the patient abstains from alcohol for a while, and then returns to his previous lifestyle. If treatment for alcohol withdrawal syndrome is not applied in time, the patient will again fall into another binge. The duration of the spree will gradually increase. After prolonged heavy drinking, more severe alcohol withdrawal occurs.

Getting through the first three days is not easy. This period is accompanied by alternating convulsions with involuntary urination. It is difficult for a weak-willed person to withstand such withdrawals and he breaks down. The new dose eliminates the signs of a seizure, and the patient experiences relief. But this is a deceptive cure and the road to drunkenness becomes open again. Typically, withdrawal symptoms last 4-5 days.

Complications of alcohol withdrawal syndrome

There are known cases of complex clinical picture due to alcohol withdrawal. Let's consider the following precedents:

1. Excretion of copious vomit with the presence of blood and bile. Dangerous phenomenon causing bleeding gastrointestinal tract.
2. Inflammation of hemorrhoids.
3. Intestinal bleeding. Define dangerous complication maybe by the color of the feces. If the masses have dark color, you can’t hesitate, call an ambulance immediately.
4. Toxic cerebral edema. In the absence of necessary therapeutic measures the person first falls into a coma and after a while may die.

Methods of treating the disease

Treatment in a specialized clinic will help neutralize the effects of alcohol withdrawal and prevent further mental disorders.

Hospital treatment

Having installed clinical picture diseases, the narcologist determines the method of treatment and the necessary drug therapy. The doctor will tell you how long the treatment lasts and what is needed for it during the examination of the patient. Drug therapy is usually prescribed after diagnosing a patient with prolonged alcoholic state. Thus, at the third stage, alcohol withdrawal syndrome is relieved, neutralizing all symptoms of the disease by using special drugs. Each type of treatment is selected taking into account existing chronic diseases and individual characteristics the patient's body.

Relief of alcohol withdrawal syndrome is carried out by drip intravenous infusions of hemodez, rheopolyglucin, 5% glucose. Injections of drugs containing thiol groups, vitamins are used groups B, C. Drug therapy is also carried out in combination with the following drugs:

1. Central nervous system depressants - benzodiazepines. Popular representatives of this pharmacological group are chlordiazepoxide, valium. Medicines provide relief psychomotor agitation and anxious agitation, providing a sedative effect. The drugs usually do not cause side effects and are not addictive. If contraindications to some components are identified, therapeutic treatment Treated with nozepam or lorazepam tablets.
2. B-blockers. The drug has an antihypertensive as well as antiarrhythmic effect, and is indicated in combination therapy with benzodiazepines. In the case of mild forms of AAS, drug monotherapy with beta-blockers is used.
3. Derivatives of barbituric acid - barbiturates. Before the advent of benzodiazepines, these drugs were used in addiction medicine. IN modern world medications are used more often to eliminate the symptoms of a hangover.

Correctly prescribed treatment by a narcologist will help the patient give up the desire for alcohol and stabilize his condition.

Treating alcohol withdrawal does not cure chronic form diseases. After the necessary therapy, treatment using psychotherapeutic procedures is allowed.

Psychic therapy

When alcohol-containing liquids enter the body, they initially affect the central nervous system. As a result, the disease cannot disappear only after taking medication. Doctors drug treatment clinics methods of influencing the human psyche are used. Psychotherapy sessions are considered an effective method. An experienced psychotherapist quickly finds mutual language with the patient and conducts frank conversations during which the patient outlines the presence of disturbances in general condition- moral and physical. He can talk about his fears, anxieties, and apathetic mood.

There is a known variant of coding alcoholism using the Dovzhenko method. The essence of this technique is to instill in the patient a negative attitude towards alcohol under hypnosis. This treatment is considered humane, harmless and is indicated for anyone who wants to get rid of this evil disease. The method is especially effective for people who have a voluntary desire to quit drinking, but did not come at the insistence of loved ones and relatives.

Vitamin replacement therapy

The removal of useful substances from the body of an alcoholic or their complete absence due to poor nutrition threatens vitamin deficiency. Insufficient amounts of vitamins and minerals cause poor health general health alcoholic. Vitamin therapy helps speedy recovery. In addition to glucose, patients are usually prescribed fructose and lactoflavin. Vitamin therapy brings only benefits; no contraindications or side effects were observed in any patient.

Resuming proper nutrition

It is known that people who abuse alcohol often use food only as a snack. Therefore, the diet of an alcoholic is quite meager and can be no less dangerous than the alcohol-containing liquids that he drinks. The peculiarity of a person suffering from alcoholism going without food for a long time is that alcohol is considered high-calorie product, so drunkards do not immediately feel hungry.

In addition to the lack of vitamins and minerals, the stomach of an alcoholic is constantly under stress and toxic attack. The consequence of such connivance is obvious gastroenterological diseases. A number of complementary procedures will help eliminate such an annoying violation. Will need to be restored water-salt balance, remove toxins, normalize the functions of the gastrointestinal tract. This is facilitated by balanced diet, represented by the inclusion of vegetable crops, lean meat, and lactic acid products.

Conditioned reflex method

Alcohol withdrawal syndrome is treated at the reflex level. This type of treatment for alcoholics is based on the development of a negative reaction by the body to the presence of alcohol. So, having used the right drug, the patient begins to experience nausea, dizziness, and palpitations due to the taste or smell of alcohol-containing products. Usually a product of natural herbal origin is used, which initially causes slight intoxication, which progresses only after drinking ethanol alcohol derivatives. The procedure requires supervision, so it is often performed as an inpatient procedure.

Treating withdrawal symptoms at home

Treatment at home for a patient with alcoholism is quite common. After all, many people do not consider themselves alcoholics, but subconsciously admit the presence of the fact. Therefore, almost every person diagnosed with alcoholism had their first experience of dealing with the disease at home. Pharmacy chains freely dispense some drugs that help overcome alcohol addiction, for example Proprothene. The medication promotes rapid elimination of alcohol and neutralizes bright severe symptoms, providing an antihypoxic, neuroprotective, anti-withdrawal effect. Drugs prescribed by a doctor help those suffering from alcoholism to improve their disordered sleep. These medications may include:

• phenibut;
• relanium;
• donormil;
• phenazepam.

You cannot purchase the drugs yourself; only a doctor can write a prescription. Self-use allowed sedatives valerian, motherwort. They improve sleep and slightly calm the pronounced symptoms of alcohol poisoning.

A decoction based on the herb wormwood has shown its effectiveness quite well. Having a softening effect, it quickly eliminates withdrawal symptoms. You can find many herbal recipes using readily available herbs, spices, and even grains. You can get rid of feelings of anxiety, concern, and rapid heartbeat with the help of Valocardine or Corvalol. Such manipulations contribute to the body’s rejection of ethanol-based products.

Home treatment for alcohol withdrawal syndrome is considered self-medication and involves certain risks. After an incorrect combination medications and even methods traditional medicine, can worsen the physical condition of an alcoholic. Advanced stages of alcohol withdrawal in a patient pose a social danger to others. Aggression and lack of control over oneself can bring physical suffering to relatives.

The term " alcohol withdrawal syndrome" was offered F.E. Rybakov in 1914, as a designation of the patient's condition after stopping alcohol consumption. Alcohol withdrawal syndrome is a gradually progressive process that develops 12 to 96 hours after the last drink.

!!! many disorders characteristic of alcohol withdrawal syndrome (headache, dizziness, asthenia, feeling of weakness, thirst, coated tongue, nausea, bloating, loose stool, increase blood pressure, discomfort or pain in the heart, bad mood, etc.), occur not only in patients with alcoholism, but also in other people who are in a hangover state, those in the period after alcohol abuse

Signs that make up the fundamental difference between alcohol withdrawal syndrome and post-intoxication state - these are signs of a secondary pathological attraction to alcohol, which occurs only in patients with alcoholism; These include :
strong desire to drink alcohol (hangover)
internal tension
irritability
dysphoria
depression
motor restlessness

In some patients, against the background of many months of abstinence from alcohol, conditions sometimes arise that completely or partially repeat the picture of alcohol withdrawal syndrome, although they represent exacerbations of the primary pathological craving for alcohol. This kind of condition is called “ dry withdrawal», « delayed withdrawal syndrome».

The severity of alcohol withdrawal syndrome depends on:
duration of previous alcoholism
presence of diseases associated with alcoholism
general physical condition of the patient
quality and quantity of alcohol consumed

Duration of manifestations of alcohol withdrawal syndrome At first it lasts 1-2 days, then it increases to 3-4 days, and as alcoholism progresses, it reaches a maximum of 6-10 days.

Pathogenesis

Alcohol is a neurotropic toxin, and its frequent use forms an addiction. An intermediate product of alcohol metabolism is acetaldehyde, which in turn activates the processes of lipid peroxidation (LPO), stimulating the production of dopamine, which determines a number of clinical vegetative reactions that constitute the essence of withdrawal syndrome. Acetaldehyde is involved in a combination of oxidation disruption fatty acids, increasing their absorption and esterification with the formation of triglycerides, reducing the synthesis and secretion of lipoproteins, which leads to the development of fatty liver degeneration - alcoholic hepatitis, liver cirrhosis. These negative effects of acetaldehyde affect the mitochondrial enzymes responsible for oxidation, in particular acetaldehyde dehydrogenase. The combination of ethanol and acetaldehyde toxicity leads to the occurrence of clinical conditions associated with disorders, mainly of the liver and central nervous system.

Mechanisms of development of alcohol dependence

Endogenous alcohol is produced normally in every cell of our body; it promotes tissue respiration. Its concentration is 0.4-0.5 mg%, and among the population 0.1-0.9 mg%.

In the body of a healthy person, alcohol is broken down primarily by the enzyme alcohol dehydrogenase(ADG). It is found in many organs, but ADH is most active in the liver. ADH does not have strict specificity only for ethanol. With its help, the oxidation of primary and secondary alcohols, vitamin A, some fatty acids occurs, ADH is heterogeneous in various animals and plants. In humans it is known at least, 10 of its isoforms. Their quantitative ratio also varies. This largely determines the differences in ethanol metabolism between different people. When exogenous alcohol is consumed, it is broken down by the enzyme alcohol dehydrogenase (ADH) into acetaldehyde + N. NAD (nicotine aminoadenine nucleotide).

The body has another pathway for the oxidation of ethyl alcohol, in which the enzyme participates catalase. This enzyme is very widespread in nature and is found in all plant and animal cells that have cytochrome systems. A small amount of ethanol (usually no more than 10%) is oxidized in this way. At long-term use ethanol, the catalase oxidation pathway is noticeably enhanced. This is one of the alternative mechanisms for ethanol oxidation.

Much more important function in this process performs microsomal ethanol oxidation system(MEOS). It is localized in the smooth endoplasmic reticulum of liver cells. The oxidation of ethyl alcohol in this system refers to reactions involving the oxidation-reduction of cytochrome P-450. IN physiological conditions Up to 25% of alcohol is oxidized in the body through this pathway. Systematic consumption of alcoholic beverages significantly increases the activity of this system.

Regardless of the path of ethanol oxidation, acetaldehyde is an intermediate product of its metabolism. It is a highly toxic substance for the body. Acetaldehyde in large quantities does not allow red blood cells to take oxygen - hypoxia - tissue respiration is impaired, therefore, in intoxication, pyridosalphosphate (VitB 6) - phosphoethanolamine - endogenous alcohol is needed.

The further pathway of acetaldehyde metabolism is its oxidation by acetaldehyde dehydrogenase (AlDH) to acetate using NAD as a substrate. Currently, two AlDH enzymes are known in nature, significantly different in their activity. Acetic acid, formed as a result of the oxidation of acetaldehyde, becomes the acetate part of acetyl coenzyme A. The latter is partially involved in the Krebs cycle and, thus, the metabolism of alcohol ends with the formation of carbon dioxide, water and energy used for the life support of the body. Part of acetyl coenzyme A is involved in the synthesis of fatty acids and cholesterol, as well as in many biosynthetic reactions.

Aldehyde has the ability to release catecholamines and, due to its extreme reactivity, forms compounds with them - tetrahydroisoquinolines, which have morphine-like properties.

During its oxidation, the aldehyde attracts a significant amount of AlDH, which reduces its activity towards endogenous opiates.

In chronic alcohol intoxication, MEOS and the catalase oxidation system are stimulated, which leads to an increase in maximum concentrations of acetaldehyde. On the one hand this stimulates an increasing degree of release and then synthesis of catecholamines, including dopamine, on the other hand, increasing education opiates .

Constantly formed excess amounts of opiates and opiate-dopamine complexes are involved in the formation of mental and physical dependence on alcohol. At the same time, increased production of opiates, as in the case of chronic use of morphine, causes an increase in the activity of enkephalinase, an enzyme that destroys opiates. An adaptive decrease in the “sensitivity” of the brain’s dopamine system and an increase in enkephalinase activity form the basis for the development of tolerance to alcohol.

Clinical picture

There are two groups of symptoms:

Mild (early) symptoms(times of appearance from several hours to 10 days (usually 6-48 hours) after stopping drinking alcohol; when drinking alcohol is resumed, they often disappear):
gastrointestinal disorders: lack of appetite, nausea, vomiting, abdominal discomfort, diarrhea
muscle symptoms: muscle weakness, painful spasms
sleep disorders: insomnia, nightmares
autonomic disorders(excitation of the sympathetic nervous system): tachycardia, systolic arterial hypertension, sweating, tremor, hyperthermia,
behavioral disorders: irritability, aggressiveness, anxiety, agitation, enhanced quadrigeminal reflex (reaction to a sudden stimulus)
cognitive disorders: impaired attention, impaired memory, impaired judgment and other higher mental functions

Severe (late) symptoms(Appears 48-96 hours after stopping alcohol consumption):
worsening of early symptoms, especially the following: tremor, sweating, tachycardia, agitation, increased quadrigeminal reflex
confusion: rapid (within one hour) changes in symptoms and severity of the condition, cognitive dysfunction, disorientation in place and time
hallucinations: auditory, visual, tactile, often threatening hallucinations
delusions: usually paranoid, due to the content of hallucinations, may be accompanied by fear and agitation
epileptic seizures: usually primarily generalized, but there are also partial with secondary generalization; there may be no history of seizures; develop in the first 48 hours after the last intake of alcohol; usually resolve without treatment; a seizure is always preceded by severe agitation, confusion, and hallucinations

There is an opinion that mild symptoms without treatment always give way to severe ones and that severe symptoms are necessarily preceded by mild ones. However, in practice, this pattern is not observed in all patients, and one should not rely on it; late symptoms can develop immediately, without warning.

Sometimes alcohol withdrawal syndrome is called only the most severe form - delirium delirium. However, alcohol withdrawal syndrome is very diverse. Prodromal symptoms may be subtle (mild irritability and negativism). Sometimes only tremor and auditory hallucinations, but full-blown delirium tremens does not occur. Often, alcohol withdrawal syndrome begins with a grand mal seizure (in these cases, other causes of the seizure are excluded - traumatic brain injury, metabolic causes, infections, in particular meningitis). Therefore, the terms “alcoholic delirium” and “threatening alcoholic delirium” should be used only in cases where the diagnosis is beyond doubt.

Variants of alcohol withdrawal syndrome

neurovegetative variant- a basic variant observed in any case of alcohol withdrawal syndrome and capable of “overgrowing” additional symptoms; this option is characterized by poor sleep, asthenia, lethargy, sweating, swelling of the face, poor appetite, thirst, dry mouth, increased or decreased blood pressure, tachycardia, tremor of the fingers

cerebral variant- neurovegetative disorders are accompanied by severe headache with nausea, dizziness, hyperacusis, sudden shuddering, fainting, epileptiform seizures

visceral (somatic) variant- abdominal pain, nausea, vomiting, flatulence, loose stools, scleral subicterus, angina pectoris, cardiac arrhythmia, shortness of breath predominate

psychopathological variant- the presence of significantly expressed mental disorders: suicidal thoughts and behavior, anxiety, fear, depression, dysphoria, ideas of attitude and guilt, total insomnia, hypnagogic hallucinations, auditory and visual illusory deceptions, vivid “adventure” dreams, drowsy states with temporary disorientation in the environment

!!! highlighting different clinical options alcohol withdrawal syndrome has a significant practical significance, since it indicates the inferiority of the corresponding organs and systems and contributes to the selection of differentiated rehabilitation therapy

!!! withdrawal syndrome is considered one of the manifestations of addiction syndrome, therefore differential diagnosis must be carried out not only with other syndromes, the occurrence of which is associated with the use of psychoactive drugs, but also with anxiety states , depressive disorders

Indications for hospitalization for alcohol withdrawal syndrome

Pronounced tremor
hallucinations
severe dehydration
body temperature over 38.3°C
epileptic seizure without a history of epilepsy
confusion
Wernicke encephalopathy (ataxia, nystagmus, internuclear ophthalmoplegia)
head injury with confirmed loss of consciousness
presence of concomitant diseases
decompensated liver failure
respiratory failure
respiratory tract infections
gastrointestinal bleeding
pancreatitis
severe exhaustion
mental illness(severe depression, risk of suicide, exacerbation of schizophrenia or MDP)
a history of alcohol withdrawal syndrome accompanied by delirium, psychosis, and epileptic seizures

Treatment

Basic principles of treatment of alcohol syndrome. Thiamine is required. The first dose - 100-200 mg intravenously or intramuscularly is administered immediately upon hospitalization. In such dosages, thiamine is used for three days. Folic acid is prescribed. The dosage of folic acid for withdrawal symptoms is 1 mg/day/intramuscularly. Vitamin therapy. Prescribe multivitamins orally, provided there is no vomiting. Be sure to take B vitamins and ascorbic acid in large doses (as for the treatment of scurvy). If the patient has cirrhosis of the liver, vitamin therapy is prescribed after additional examination. Patients are provided with complete rest and necessary nutrition. To eliminate the symptoms of excessive motor excitation, drugs that have a depressant effect on the central nervous system can be prescribed. Treatment is carried out according to a special scheme, if necessary. epileptic seizures, anticonvulsant therapy is prescribed.

Outpatient scheme lung treatment alcohol withdrawal syndrome
thiamine, 100-200 mg IM
benzodiazepines (eg, chlordiazepoxide, 50-100 mg orally or IV)
then - observe for 1-2 hours
taking benzodiazepines throughout the day (for example, chlordiazepoxide, 25 mg 4 times a day orally)
consultations with specialists (preferably daily), explaining to the patient and relatives the essence of the disease and treatment

Treatment of patients with severe alcohol withdrawal syndrome

detoxification therapy- prescribing enterosorbents during the phase of alcohol intoxication or in patients with initial manifestations alcohol withdrawal syndrome (for example, activated carbon 4-6 g per day for three to four days). Infusion therapy is also prescribed for the purpose of detoxification.

metadoxil 600 mg per day, intravenously, for three days; in the future - 1000 mg per day, in tablets; course of treatment 5-14 days;

plasmapheresis - carried out once a day, for two to three days, the volume of plasma removed is 10-15% of the volume of circulating plasma (CVP)

infusion therapy- prescribed for the purpose of detoxification, as well as for the correction of water-electrolyte disorders and acid-base disorders, the volume of prescribed solutions is usually 10-20 ml/kg, infusion therapy should be carried out under the control of diuresis

psychopharmacotherapy- the following drugs are commonly used:
tranquilizers for the treatment of affective, autonomic disorders, sleep disorders. Drugs in this group reduce feelings of anxiety, fear, and affective tension; used: diazepam solution (Relanium) 0.5% 2-4 ml IM, IV, IV drip, daily dose up to 0.06 g; phenazepam solution 0.1% 1-4 ml IM, IV, IV drip or phenazepam tablets 0.0005, 0.001, in daily dose up to 0.01 g; lorazepam 0.0025 to 0.015 g per day;
sleeping pills- prescribed in cases where tranquilizers are ineffective or insufficiently effective in correcting sleep disorders; Phenobarbital 0.1-0.2 per night, or Imovan 0.0075 g per night, or Ivadal 0.01 per night, or Reladorm 0.11-0.22 per night are usually used; phenobarbital is sometimes used in patients with alcohol withdrawal syndrome and during the day as replacement therapy, in order to reduce the intensity of withdrawal disorders; Pagluferal 1-2 tablets three to four times a day or Corvalol 30-40 drops three to four times a day are prescribed
anticonvulsants- prescribed for the prevention of convulsive seizures (especially if there is a history of them), as well as for the treatment of pathological craving for psychoactive substances; in narcology, carbamazepine (finlepsin) is most often used, 0.2, in a daily dose of up to 1.2 g; this drug, which “evens out” the background of mood, is also effective for affective lability; in case of intolerance or insufficient effectiveness of fin-lepsin, clonazepam is prescribed at 0.001, in a daily dose of up to 0.008 g, or mydocalm at 0.05, in a daily dose of up to 0.1-0.2 g
neuroleptics - in the acute withdrawal period must be prescribed with extreme caution due to the risk of developing drug intoxication and psychotic disorders; in some cases, it is possible to recommend the prescription of certain antipsychotics for the treatment of suicidal or aggressive behavior, secondary craving for alcohol; preference is usually given to neuleptil (the most convenient form of this drug for use in narcology is its 4% solution for oral administration; one drop of solution contains 1 mg of neuleptil; the drug is prescribed in a dose of 15-20 mg per day, with a generalized craving for alcohol - up to 30 mg)

vegetative stabilizing therapy- drugs of this group are prescribed for severe autonomic disorders As a rule, the vegetative stabilizing effect of benzodiazepines is quite sufficient, otherwise pyrroxan is added to the treatment, usually 0.015 g three times a day

vitamin therapy- vitamins B and C are prescribed, which are involved in the formation of enzymes and coenzymes, which contribute to the normalization of redox processes in the body, affect tissue respiration, carbohydrate metabolism, and the activity of the peripheral nervous system; solutions of thiamine chloride 5% 2-4 ml IM, IV drip, pyridoxine hydrochloride 5% 5-8 ml IM, IV drip are used; nicotinic acid 0.1% 1-2 ml IM; ascorbic acid 5% 5-10 ml IM, IV drip; Parenteral vitamins are prescribed in the first few days of alcohol withdrawal, usually as part of infusion therapy, then the oral intake of multivitamin preparations continues - Aerovit, Complivit, Glutamevit, Centrum, 1 tablet per day, for a course of two to three weeks

nootropic therapy- drugs that do not have a disinhibiting effect are used: Semax two to four drops in the nose twice a day, or Pantogam 0.5 three times a day, or picamilon 0.05 three times a day, or Phenibut 0.5 three times a day once a day