Guía Completa Alcohol en AP

8/10/2019 Guía Completa Alcohol en AP

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Box 1: Screening and brief interventions

ASSESS

elicit patient’s concernshow does alcohol f it in?

ELICIT AND RECORD

typical day’s drinking

maximum

in

a

dayalcohol related physical, emotional and social problems

CONSIDER

FAST or CAGE plus two consumption questions MCV, GGT

DELIVER BRIEF INTERVENTION

discuss

costs

and

benef its

of

drinking

f rom

patient’s

perspectiveoff er inf ormation about health risks

(patient may not be receptive on

f irst consultation;

repeated interviews / reviews may

be necessary)

IS THE PATIENT INTERESTED?

AGREE GOAL SOW SEEDS

REDUCTION ABSTINENCE*

Assisting goal of reduction Assisting goal of abstinence

Elicit patient’s concerns

Regular review to off er encouragement

Enlist support of f amily and

f riends

Consider use of local alcohol services

Plan

medically assisted

withdrawal if indicated, at home or in hospital

Yes

* Absolute indications for

abstinence:

alcohol related organ

damage severe dependence (eg

morning drinking to stop

h h k i f il d

No









































Beverage type Alcohol by

volume (%)

Measure Alcohol content

(units)

Beers /lagers Barbican

Kaliber

Tennents LA

Mild/ ligh

t beer s(vari

ous bran

ds

)Best bitter (various brands)

Skol

McEwans / Labatt

Guinness draf t stout

Gr olsch

Pr emium beer / lager (various brands)

Stella Ar tois

Lowenbrau Pils

Hof meister Special

Kestral Super

0.02

0.05

1.2

3.1

3.5

3.6

4.0

4.1

5.0

5.0

5.2

6.0

9.0

9.5

440ml

Pint

440ml

Pint

Pint

Pint

Pint

Pint

440ml

Pint

330ml

440ml

440ml

440ml

<0.01

0.03

0.5

1.8

2.0

2.0

2.3

2.3

2.2

2.8

1.7

2.6

4.0

4.2

Ciders /Perries Str ongbow LA

Woodpecker

Str ongbow

Old English

Str ongbow Super

Diamond White

Str ong White Cider

0.9

3.5

4.5

5.5

8.0

8.2

8.4

330mlPint

1000ml

Pint

Pint

275ml

1000ml

0.3

2.0

4.5

3.1

4.5

2.3

8.4

Spirit based drinks

with mixers

(alcopops)

Hooch

WKD Original Vodka Blue or Ir on Br ew

Smirnoff Ice

Bacar di Br eezer

Metz Snapps (Black, Still or Original)

Vodka Red Squar e (Barr s Irn Br u)

Af ter shock

4.7

5.5

5.5

5.4

5.4

5.5

40.0

330ml

330ml

275ml

275ml

275ml

275ml

700ml

1.6

1.8

1.5

1.5

1.5

1.5

28.0

Vodka Hooch Lemon / Apple / Orange / Hooper s Hooch 4.7-5.1 330ml 1.6-1.7

Shooters (addition to

main drink)

Jelly Pots

SidekickAf ter shock

Fr ostbite

Absinthe

15.0

20.0

40.0

50.0

75.0

47ml

30ml

30ml

30ml

30ml

0.7

0.6

1.2

1.5

2.3

Wines Various brands 9-14 750ml 6.8

-10.5

A purchased glass of wine can var y f r om 125 to 250 ml and can contain 1.1-3.5 units per glass depending on % alcohol.A small (125ml) glass of average str ength (12%) wine contains 1.5 units.

Fortified Wines and

similar

Cinzano bianco/ Buckf ast

Cr of t Original Sherr y

Cockburn’s Port

14.7

17.5

20.0

750ml

750ml

750ml

11.0

13.1

15.0







>





1. If you have been chemically dependent on alcohol, stopping drinking causes you to gettense, edgy, perhaps shaky or sweaty, and unable to sleep. There can be vomiting ordiarrhoea. This “rebound” of the nervous system can be severe. Medication controls thesymptoms while the body adjusts to being without alcohol. This usually takes three to

seven days from the time of your last alcoholic drink. If you don’t take medication, thesymptoms would be worst in the first 48 hours, and then gradually disappear. This is why,if you do take medication, the dose starts high and then reduces. If you have beenprescribed 10 mg tablets of chlordiazepoxide, use the table below to remind you when totake the right number of tablets.

2. YOU HAVE AGREED NOT TO DRINK ALCOHOL. You may get thirsty. Drink fruit juicesand water but do not overdo it. You do not have to “flush” alcohol out of the body. Morethan three litres of fluid could be too much. Don’t drink more than three cups of coffee or

five cups of tea. These contain caffeine which disturbs sleep and causes nervousness.3. AIM TO AVOID STRESS. The important task is not to give in to the urge to take alcohol.

Help yourself relax by going for a walk, listening to music, or taking a bath.

4. SLEEP. You may find that even with the capsules, or as they are reduced, your sleep isdisturbed. You need not worry about this - lack of sleep does not seriously harm you,starting to drink again does. Your sleep pattern will return to normal in a month or so. It isbetter not to take sleeping pills so that your natural sleep rhythm returns. Try going to bedlater. Take a bedtime snack or milky drink.

5. The capsules may make you drowsy so you must not drive or operate machinery. Ifyou get drowsy, miss out a dose.

6. MEALS. Even when you are not hungry, try to eat small amounts regularly. Your appetitewill return.

Number of chlordiazepoxide (10 mg) tablets to take and when to take them whenwithdrawing from alcohol as an outpatient

First thing 12 noon 6 pm Bedtime

Day 1 - 3 3 3

Day 2 2 2 2 3



Yes, if patient: is conf used or has hallucinations has a histor y of pr evious complicated withdr awal has epilepsy or histor y of fits

is under nour ished has sever e vomiting or diarrhoea is at r isk of suicide has sever e dependence coupled with unwillingness

to be seen daily has a pr eviously failed home-assisted withdr awal has uncontrollable withdr awal symptoms has an acute physical or psychiatr ic illness has multiple substance misuse has a home environment unsuppor tive of abstinence

Advise the patient that he / she may have mild anxiety / insomnia f or a few days

Is medication required?

Is admission necessary?

Yes, if r ecent withdr awal symptoms, or dr inking

>15 units / day (men),

>10 units / day (women)

No, if patient sober and has no withdr awal symptoms













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Guía Completa Alcohol en AP