Respiratory alkalosis

Alcohol produces a depressant effect on the respiratory center, depressing a person's respirations and increasing the level of CO2. Once the person ceases intake of alcohol, the respiratory center depressions cease, leaving an increased sensitivity to CO2. This increase in sensitivity produces an increase in the rate and depth of the person's respirations (hyperventilation) and lowered levels of CO2 (respiratory alkalosis).

Low magnesium levels

Many people with chronic alcohol dependence have low magnesium intake because of inadequate nutrition. Compounding the problem is the loss of magnesium from the gastrointestinal tract that is caused by alcohol-related diarrhea and the loss of magnesium in the urine that is caused by alcohol-related diuresis. Maintaining magnesium levels in the normal range of 1.8-2.5 mEq/L decreases neuromuscular irritability during withdrawal.

CNS excitation

Chronic alcohol use alters cell membrane proteins that normally open and close ion channels to allow electrolytes to enter and exit the cell. With the cessation of alcohol intake, the altered proteins produce an increase in neurologic excitement.

Approximately 30% of the patients on a general hospital unit are alcohol-dependent; however, only 2% of them have a diagnosis of alcohol dependence or alcoholism. The other 28% have been admitted for a variety of reasons. Illnesses such as esophagitis, gastritis, ulcers, hypoglycemia, pancreatitis, and some anemias can be attributed directly to alcohol usage. Chronic alcohol dependence is the most common cause of cardiomyopathy. There is also an increased incidence of injuries, falls, and hip fractures related to high blood alcohol levels.

Alcohol withdrawal is a life-threatening condition. It can begin within 12 to 24 hours of admission or as late as 5 days after admission. Early-stage withdrawal usually occurs within 48 hours of the patient's last drink, with generally mild symptoms. Late-stage alcohol withdrawal, or alcohol withdrawal delirium, begins 72 to 96 hours after the patient's last drink. It occurs in approximately 5% of all patients hospitalized with alcohol dependence and is the most acute phase of alcohol withdrawal.

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