see [Rosen Alcohol-related disease](x-devonthink-item://B2500D77-28F4-4FF9-89AE-A7B4F2306864?page=0) and [Rosen Alcohol use disorder and cirrhosis](x-devonthink-item://E22703E4-4E89-4FE0-87D8-E2B69F7264E3?page=10) see also: [[Alcohol Withdrawal Syndrome|AWS]] - predisposes to infection through immune suppression - complement deficency 2/2 liver disease (primary site of C3 synthesis) - impaired neutrophil recruitment **common infections in pts with cirrhosis** - e coli - klebsela pnemonia - salmonella - strep - vibrio vulnificus - aeromonas - spontaneous bacterial beritonitis - c dif ## diagnostic criteria for alcohol use disorder in the past year: - drinking more, longer than intended - more than once wanted to cut down or stop drinking, or tried, but couldn't - spent a lot of time drinking; tired of hangovers - wanting to drink so much cannot think of anything else - drinking or recovering from drinking often interferes with family, work, or education - continuing to drink in spite of problems caused with friends or family - finding oneself in dangerous or harmful situations as a direct result of drinking - continuing to drink in spite of adding to another health problem, feeling depressed, anxious, or blacking out - drinking more as a result of tolerance to EtOH - experiencing [[Alcohol Withdrawal Syndrome|alcohol withdrawal]] symptoms mild - 2-3 features mod - 4-5 features severe - ≥ 6 features ### medications used in alcohol use disorder - benzodiazepines -- for AWS - [[Thiamine]] - prevent wernicke - *naltrexone* -- opioid antagonist. modifies hypothalamic-pituitary-adrenal axis to suppress ethanol consumption - *acamprosate* -- NMDA antagonist and modulator of GABA receptors; causing anti-craving effect - *disulfiram* -- inhibits aldehyde dehydrogenase ; results in ↑ serum acetaldehyde, causing diaphoresis, palpitations, facial flushing, nausea, vertigo, and tachycardia. deterrent to drinking EtOH # ED SBIRT intervention - CAGE **SBIRT** – Screening, Brief Intervention and Referral to Treatment > ***CAGE*** > *C*ut down > *A*nnoyed > *G*uilty > *E*ye opener C: Have you ever felt the need to cut down on your drinking? A: Have people been annoyed by your drinking? G: Have you ever felt guilty about your drinking? E: Have you ever had a drink first thing in the morning to steady your nerves or get rid of a hangover?