A CASE PRESENTATION ON

ALCOHOL WITHDRAWAL SEIZURE AND ALCOHOL

DEPENDENT SYNDROME

Presented by:
Bhoomika G S
5th Pharm D
 PATIENT DEMOGRAPHIC DETAILS

• PATIENT NAME:XYZ
• PATIENT AGE: 50 years
• SEX: Male
• UNIT: MED B
• IP No:23-22437
• DATE OF ADMISSION :20- 8-2023
• DATE OF DISCHARGE: 26-8-2023
 COMPLAINTS ON ADMISSION

• C/O sweating and chills at 1PM.

• C/O jerky movement of B/L upper and lower
limb.
• C/O epigastric pain since 2 months.
• Past medical history : Patient had 2 episodes of seizures
previously 6yrs and 10yrs back
• Past medication history: No previous medication history.
• Personal history : Diet-mixed
Sleep- adequate
Appetite – reduced
B /B-Normal and regular
• Family history : No history of similar complaints in the
family
• Social history : K/C/O chronic alcoholic since 25yrs
(540ml whisky for a day)
 PHYSICAL EXAMINATION

• BP - 110/70 mm of Hg
• PR- 108 bpm
• Temp- Afebrile
• CNS- Conscious And oriented
• CVS-S1,S2(+)
• RR-20cpm
• RS-B/L vesicular breath sounds heard
 SOAP ANALYSIS

S - Subjective evidence
O -Objective evidence
A -Assessment
P- Planning
Subjective evidence:
• C/O sweating and chills at 1PM.
• C/O jerky movement ofB/L upper and lower limbs.
• C/O epigastric pain since 2 months.

Objective evidence:
• D.B-2.8mg/dl
• T.B-4.6mg/dl
• SGOT-165U/L
• SGPT-65U/L
 Assessment
• From the subjective and objective evidence it has been
diagnosed as Alcohol withdrawal seizures and Alcohol
dependent syndrome.
THERAPEUTIC GOALS:
Patient specific:- to reduce chills, vomiting .

Disease specific:- to eradicate the malarial parasite from

the body.
Prevent the relapse of malaria.
To prevent the complications of malaria.
 THERAPEUTIC GOALS

Patient specific:-
• To relieve the patient from epigastric pain.
• To relieve the patient from jerky movement.

Disease specific:-
• To prevent from future complication.
• To normalize the liver function test.
 Assessment of current therapy
Drugs Dose Rou Freq
te 1 2 3 5 6 7
4
Inj.Cefotaxime 1g IV + + + + + + +
Inj. Pantoprazole 40mg IV 1-0-0 + + + + + + +
Inj.Ondansetron 4mg IV 1-0-0 + + - - - - -
Inj. Optineuron 200mg IV 1-0-1 + + + + + + +
in
100ml
Inj.Lorazepam 2mg IV SOS + + + + + + +
Inj.Leuetiracetam 1gm IV + + + + + + +
Tab.Ursodeoxycholi 300mg PO 1-0-1 - - + + + + +
c acid
Tab.Chlordiazepoxid 25mg PO 1-0-1 - + + - - - -
e
Tab.Dolo 650mg PO SOS - - - - + + +
 PROGRESS CHART
DAY PROGRESS
Day 1 c/o sweating and chills at IPM
c/o jerky movement of B/L upper and lower limb
c/o epigastric pain BP-110/70mmHg

Day 2 BP- 106/80mmHg

Day 3 BP-150/100mHg
Day 4 c/o fever 99°F
Day 5 c/o fever 99°F

Day 6 c/o fever 99°F

Day 7 No fresh complaints
 PLANNING
• Tab. Ciprofloxacin,tinidazole PO (1-0-1)
• Tab.Pantoprazole 40 mg PO (1-0-0)
• Tab.Neurobione forte PO ( 0-1-0)
• Tab.Leuetiracetam 2mg PO ( 0-0-1)
 Toxicity parameters
• Inj.Cefotaxime:nausea,vomiting,diarrhea,pain,redness
in place where it is injected
• Inj.Pantoprazole:nausea,vomiting headache
• Inj.Lorazepam:blurred
vision,confusion,sweating ,difficulty in breathing
• Inj.Leuetiracetam:weakness,unsteady
walking ,dizziness,headache
• Tab. Chlordiazepoxide:drowsiness,drymouth,stomach
upset
 Patient counselling
 Patient specific:
• Avoid smoking.
• Limit alcohol intake.
• Avoid seizure triggers as alcohol stress
• Eat healthy diet rich in vitamins and minerals.
 Disease Specific:
1. Inj.Leuetiracetam:
• Advice the patient to take it with or without food.
• Avoid alcohol intake while on this medication.
• Donot eat spicy food.
2. Tab.Chlordiazepoxide:
• Advice the patient to take 30mins before food.
• Take with or without food.
• Donot take larger dose.
• Avoid alcohol and excessive caffine.
3.Tab.Ciprofloxacin:
• Advice the patient to complete the course.
• Avoid administration of it with dairy
products/calcium fortified food.
THANK YOU