The issues of alcohol withdrawal syndrome: current state of the problem


Keywords: delirium tremens, sedation, NMDA-receptors, GABA, magnesium.

Abstract

Annotation. Alcohol addiction is one of the three main health problems in the world, which directly or indirectly increases the mortality rate, wherein it poses the greatest threat to the developed countries of Europe and America. Identification of promising directions for resolving the issue of alcohol withdrawal syndrome with delirium is one of the levers to reduce the consequences of its harmful use. It was made an analysis of the electronic database of scientific publications Pubmed and the latest WHO data, the main approaches to the pathogenesis and intensive care of alcoholic delirium in Ukraine and abroad were highlighted and displayed, clinical and laboratory diagnostic aspects were distinguished. There is a certain vision of the pathogenesis of alcohol withdrawal syndrome as an imbalance in the GABA and glutamate-ergic systems in brain neurons. Diagnostic criteria have been developed and introduced into clinical practice to determine the severity of withdrawal status, as well as sedation-agitation scales, it is not completely determined the influence of electrolyte disturbances, namely magnesium deficiency on the severity of the condition, the effectiveness of sedation and mortality. The optimal way to increase the effectiveness of the treatment of alcoholic delirium, which would ensure an adequate level of sedation, has not yet been found all over the world, at the same time, without increasing the risk of complications in the form of an overdose of tranquilizers and hypnotics, both in case of their isolated and combined use. The possibility of using chelate compounds containing GABA in themselves, as well as organic magnesium salts, namely gluconic acid salts, is promising.

References

1. Abrahao, K. P., Salinas, A. G., & Lovinger, D. M. (2017). Alcohol and the Brain: Neuronal Molecular Targets, Synapses, and Circuits. Neuron, 96(6), 1223–1238. https://doi.org/10.1016/j.neuron.2017.10.032.

2. Airagnes, G., Ducoutumany, G., Laffy-Beaufils, B., Le Faou A.-L., & Limosin, F. (2019). Alcohol withdrawal syndrome management: Is there anything new? La Revue de Médecine Interne, 40(6), 373–379. https://doi.org/10.1016/j.revmed.2019.02.001.

3. Bolewska, P., Martin, B. I., Orlando, K. A., & Rhoads, D. E. (2019). Sequential Changes in Brain Glutamate and Adenosine A1 Receptors May Explain Severity of Adolescent Alcohol Withdrawal after Consumption of High Levels of Alcohol. Neuroscience Journal. https://doi.org/10.1155/2019/5950818.

4. Eloma, A. S., Tucciarone, J. M., Hayes, E. M., & Bronson, B. D. (2018). Evaluation of the appropriate use of a CIWA-Ar alcohol withdrawal protocol in the general hospital setting. Am. J. Drug Alcohol Abuse, 44(4), 418–425. doi: 10.1080/00952990.2017.1362418.

5. Griswold, M. G., Fullman, N., Hawley, C., Arian, N., Zimsen, S.R.M., Tymeson, H. D., … Abbafati, C. (2018). Alcohol use and burden for 195 countries and territories, 1990–2016: a systematic analysis for the Global Burden of Disease Study 2016. The Lancet, 392, 1015–1035. DOI:https://doi.org/10.1016/S0140-6736(18)31310-2.

6. Gruol, D. L., Huitron-Resendiz, S., & Roberts, A. J. (2018). Altered brain activity during withdrawal from chronic alcohol is associated with changes in IL-6 signal transduction and GABAergic mechanisms in transgenic mice with increased astrocyte expression of IL-6. Neuropharmacology, 138, 32–46. https://doi.org/10.1016/j.neuropharm.2018.05.024.

7. Hughes, D. W., Vanwert, E., Lepori, L., & Adams, B. D. (2014). Propofol for benzodiazepine-refractory alcohol withdrawal in a non-mechanically ventilated patient. Am. J. Emerg. Med., 32(1), 3–4. https://doi.org/10.1016/j.ajem.2013.08.044.

8. Kang, Y., Saito, M., & Toyoda, H. (2020). Molecular and Regulatory Mechanisms of Desensitization and Resensitization of GABAA Receptors with a Special Reference to Propofol/Barbiturate. Int. J. Mol. Sci., 21, 563. doi: 10.3390/ijms21020563.

9. Latt, N., & Dore, G. (2014). Thiamine in the treatment of Wernicke encephalopathy in patients with alcohol use disorders. Internal Medicine Journal, 44, 911–915. doi:10.1111/imj.12522.

10. Long, D., Long, B., & Koyfman, A. (2017). The emergency medicine management of severe alcohol withdrawal. The American Journal of Emergency Medicine, 35(7), 1005–1011. https://doi.org/10.1016/j.ajem.2017.02.002.

11. Maguire, D., Ross, D. P., Talwar, D., Forrest, E., Naz Abbasi, H., Leach, J‐P., ... McMillan, D. C. (2019) Low serum magnesium and 1-year mortality in alcohol withdrawal syndrome. Eur. J. Clin. Invest, 49(10), 128–136. https://doi.org/10.1111/eci.13152.

12. Riker, R. R., Picard, J. T., & Fraser, G. L. (1999). Prospective evaluation of the Sedation-Agitation Scale for adult critically ill patients. Crit Care Med, 27(7), 1325–1329. DOI: 10.1097/00003246-199907000-00022.

13. Schmidt, K. J., Doshi, M. R., Holzhausen, J. M., Natavio, A., Cadiz, M., & Winegardner, J. E. (2016). Treatment of severe alcohol withdrawal. Ann. Pharmacother, 50, 389–401. doi: 10.1177/1060028016629161.

14. Shah, P., McDowell, M., Ebisu, R., Hanif, T. & Toerne, T. (2018). Adjunctive Use of Ketamine for Benzodiazepine-Resistant Severe Alcohol Withdrawal: a Retrospective Evaluation. J. Med. Toxicol, 14, 229. https://doi.org/10.1007/s13181-018-0662-8.

15. Sullivan, J. T., Sykora, K., Schneiderman, J., Naranjo, C. A., & Sellers, E. M. (1989). Assessment of alcohol withdrawal: The revised Clinical Institute Withdrawal Assessment for Alcohol scale (CIWA-Ar). British Journal of Addiction, 84(11), 1353–1357. http://dx.doi.org/10.1111/j.1360-0443.1989.tb00737.x.

16. VanderWeide, L. A., Foster, C. J., MacLaren, R., Kiser, T. H., & Fish, D. N., Mueller, S. W. (2016). Evaluation of early dexmedetomidine addition to the standard of Care for Severe Alcohol Withdrawal in the ICU: a retrospective controlled cohort study. J. Intensive Care Med., 31, 198–204. doi: 10.1177/0885066614554908.

17. WHO. (2018). Global status report on alcohol and health. Executive summary, 4. Retrieved from https://www.who.int/substance_abuse/publications/global_alcohol_report/en/.

18. Wong, A., Benedict, N. J., Lohr, B. R., Pizon, A. F., & Kane-Gill, S. L. (2015). Management of benzodiazepine-resistant alcohol withdrawal across a healthcare system: benzodiazepine dose-escalation with or without propofol. Drug Alcohol. Depend, 154, 296–299. doi: 10.1177/0885066614554908.

19. Wood, E., Albarqouni, L., Tkachuk, S., Green, C. J., Ahamad, K., Nolan, S., & Klimas, J. (2018). Will This Hospitalized Patient Develop Severe Alcohol Withdrawal Syndrome?: The Rational Clinical Examination Systematic Review. JAMA, 320(8), 825–833. doi:10.1001/jama.2018.10574.

20. Yanta, J. H., Swartzentruber, G. S., & Pizon, A. F. (2015). Alcohol withdrawal syndrome: improving outcomes through early identification and aggressive treatment strategies. EB Med., 6, 1–20. Retrieved from https://www.semanticscholar.org/paper/Alcohol-Withdrawal-Syndrome%3A-Improving-Outcomes-And-Yanta-Swartzentruber/5fcfc5f9b5ac399cf6f8d65382c9cdf6ca098c50
Published
2019-12-30
How to Cite
Havrylov, O. (2019). The issues of alcohol withdrawal syndrome: current state of the problem. Reports of Vinnytsia National Medical University, 23(4), 745-748. https://doi.org/https://doi.org/10.31393/reports-vnmedical-2019-23(4)-32