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Published on: June 23, 2023
Therapeutic dilemma: alcohol withdrawal syndrome and concurrent hepatic encephalopathy. A case report
Alejandra López1, Roberto Chavarría1, Gabriel Oviedo2
1Médico psiquiatra, Universidad de Costa Rica, subespecialistas en Psiquiatría de Enlace, Pontifica Universidad Javeriana.
Abstract:
Alcohol use disorder is one of the main causes of morbidity and mortality in the world. Alcoholic liver disease is a common complication of this disorder, and hepatic encephalopathy is a serious complication of alcoholic cirrhosis. Precipitating factors may be related to infection, gastrointestinal bleeding, dehydration or the effects of psychotropic drugs (e.g. benzodiazepines and non-benzodiazepine hypnotics). We present a case of the hospital management of a patient with a severe alcohol use disorder, cirrhosis and hepatic encephalopathy who developed alcohol withdrawal symptoms while in hospital, and discuss the complexity of the antagonistic management of a GABAergic delirium characteristic of hepatic encephalopathy in the context of a glutamatergic-noradrenergic delirium due to alcohol withdrawal.
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