Seizures are typically single and generalized. They usually occur between 6 and 48 hours after the last drink and although in themselves are not life threatening, their importance lies in the fact that about one-third of those with seizures will go on to develop alcohol withdrawal delirium.
This is an infrequent disorder that tends to occur at about the age of 40 years in those who have been drinking heavily for more than 10 years. The essential features are vivid and persistent hallucinations, which develop shortly (usually within 48 hours) after cessation of alcohol intake. The hallucinations may be auditory or visual, and their content is usually unpleasant and disturbing. The disorder may last several weeks or months and is quite different from the fleeting hallucinations observed in other forms of alcohol withdrawal.
The frequency of tachyrhythmias in alcohol withdrawal is high, probably because of high adrenergic nervous system activity. Sudden deaths in alcohol withdrawal most likely result from such dysrhythmias. Adequate sedation will play a part in preventing such unwanted occurrences happening in police custody, although those with severe alcohol withdrawal are best admitted to the hospital, where they can be placed on a cardiac monitor.
Wernicke's encephalopathy is an acute, potentially reversible neurologic disorder that is believed to result from a deficiency of thiamine and is often secondary to chronic alcohol abuse. Features include disturbance of consciousness (ranging from mild confusion to coma), ophthalmoplegia, nystagmus, and ataxia. The disorder has a high mortality and can lead to death within 24 hours. If untreated, it can progress to Korsakoff's psychosis. This is a chronic condition that usually presents as impairment of short-term memory with inability to learn new information and compensatory confabulation. Korsakoff's psychosis probably represents irreversible brain damage secondary to the combined toxic-ity of alcohol and metabolic derangement resulting from thiamine deficiency.
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