ELDER TIP Remember to consider the possibility of alcohol abuse when evaluating older patients. Research suggests that alcoholism affects 2% to 10% of adults older than age 60. More than half of all elderly hospital admissions are due to alcohol-related problems.
» READ BOOK EXCERPT ONLINE »
Source: Professional Guide to Diseases (Eighth Edition), 2005
Substance abuse and induced disorders:
Signs and symptoms
(Professional Guide to Diseases (Eighth Edition))
The signs and symptoms of acute intoxication vary, depending on the drug. The drug user seldom seeks treatment specifically for his drug problem. Instead, he may seek emergency treatment for drug-related injuries or complications, such as a motor vehicle accident, burns from freebasing, an overdose, physical deterioration from illness or malnutrition, or symptoms of withdrawal. Friends, family members, or law enforcement officials may bring the patient to the hospital because of respiratory depression, unconsciousness, acute injury, or a psychiatric crisis.
Examine the patient for signs and symptoms of drug use or drug-related complications as well as for clues to the type of drug ingested. For example, fever can result from stimulant or hallucinogen intoxication, from withdrawal, or from infection caused by I.V. drug use.
Inspect the eyes for lacrimation from opiate withdrawal, nystagmus from central nervous system (CNS) depressants or phencyclidine intoxication, and drooping eyelids from opiate or CNS depressant use. Constricted pupils occur with opiate use or withdrawal; dilated pupils, with the use of hallucinogens or amphetamines.
Examine the nose for rhinorrhea from opiate withdrawal and the oral and nasal mucosa for signs of drug-induced irritation. Drug sniffing can result in inflammation, atrophy, or perforation of the nasal mucosa. Dental conditions commonly result from the poor oral hygiene associated with chronic drug use. Also inspect under the tongue for evidence of I.V. drug injection.
Inspect the skin. Sweating, a common sign of intoxication with opiates or CNS stimulants, also accompanies most drug withdrawal syndromes. Drug use sometimes induces a sensation of bugs crawling on the skin, known as formication; as a result, the patient’s skin may be excoriated from scratching.
Needle marks or tracks are an obvious sign of I.V. drug abuse. Keep in mind that the patient may attempt to conceal or disguise injection sites with tattoos or by selecting an inconspicuous site such as under the nails. In addition, self-injection can sometimes cause cellulitis or abscesses, especially in the patient who also is a chronic alcoholic. Puffy hands can be a late sign of thrombophlebitis or of fascial infection due to self-injection on the hands or arms.
Auscultation may disclose bilateral crackles and rhonchi caused by smoking and inhaling drugs or by opiate overdose. Other cardiopulmonary signs of overdose include pulmonary edema, respiratory depression, aspiration pneumonia, and hypotension. CNS stimulants and some hallucinogens may precipitate refractory acute-onset hypertension or cardiac arrhythmias. Withdrawal from opiates or depressants also can provoke arrhythmias and, occasionally, hypotension.
During opiate withdrawal, the patient may report abdominal pain, nausea, or vomiting. He may also complain of hemorrhoids, a consequence of the constipating effects of these drugs. Palpation of an enlarged liver, with or without tenderness, may indicate hepatitis.
Neurologic symptoms of drug abuse include tremors, hyperreflexia, hyporeflexia, and seizures. Abrupt withdrawal may precipitate signs of CNS depression (ranging from lethargy to coma), hallucinations, or signs of overstimulation, including euphoria and violent behavior.
Carefully review the patient’s medical history. Suspect drug abuse if he reports a painful injury or chronic illness but refuses a diagnostic workup. In his attempt to obtain drugs, the dependent patient may feign illnesses, such as migraine headaches, myocardial infarction, and renal colic; claim an allergy to over-the-counter analgesics; or even request a specific medication. Also be alert for a history of overdose or a high tolerance for potentially addictive drugs. An I.V. drug user may have a history of hepatitis or human immunodeficiency virus (HIV) infection from sharing dirty needles. A female drug user may report a history of amenorrhea.
A patient who abuses drugs may give you a fictitious name and address, be reluctant to discuss previous hospitalizations, or seek treatment at a medical facility across town rather than in his own neighborhood. If possible, interview family members to verify his responses.
If the patient admits to drug use, try to determine the extent to which this behavior interferes with his normal functioning. Note whether he expresses a desire to overcome his dependence on drugs. If possible, obtain a drug history consisting of substances ingested, amount, frequency, and last dose. Expect incomplete or inaccurate responses. Drug-induced amnesia, a depressed level of consciousness, or ignorance may distort the patient’s recollection of the facts; he also may fabricate answers to avoid arrest or to conceal a suicide attempt.
The hospitalized drug abuser is likely to be uncooperative, disruptive, or even violent. He may experience mood swings, anxiety, impaired memory, sleep disturbances, flashbacks, slurred speech, depression, and thought disorders. He may resort to plays on sympathy, bribery, or threats to obtain drugs, or he may try to pit one caregiver against another.
Psychoactive substances may be used in cultural practices. For instance, some Native Americans use hallucinatory drugs to help achieve spiritual experiences. Therefore, use and abuse must be carefully distinguished.
» READ BOOK EXCERPT ONLINE »
Source: Professional Guide to Diseases (Eighth Edition), 2005
Cirrhosis and fibrosis:
Signs and symptoms
(Professional Guide to Diseases (Eighth Edition))
Clinical manifestations of cirrhosis and fibrosis are similar for all types, regardless of the cause. Early indications are vague, but usually include GI signs and symptoms (anorexia, indigestion, nausea, vomiting, constipation, or diarrhea) and a dull abdominal ache. Major and late signs and symptoms develop as a result of hepatic insufficiency and portal hypertension:
❑ Respiratory — pleural effusion and limited thoracic expansion due to abdominal ascites, interfering with efficient gas exchange and leading to hypoxia
❑ Central nervous system — progressive signs or symptoms of hepatic encephalopathy — lethargy, mental changes, slurred speech, asterixis (flapping tremor), peripheral neuritis, paranoia, hallucinations, extreme obtundation, and coma
❑ Hematologic — bleeding tendencies (nosebleeds, easy bruising, and bleeding gums) and anemia
❑ Endocrine — testicular atrophy, menstrual irregularities, gynecomastia, and loss of chest and axillary hair
❑ Skin — severe pruritus, extreme dryness, poor tissue turgor, abnormal pigmentation, spider angiomas, palmar erythema, and possibly jaundice
❑ Hepatic — jaundice, hepatomegaly, ascites, edema of the legs, hepatic encephalopathy, and hepatorenal syndrome comprise the other major effects of full-fledged cirrhosis
❑ Miscellaneous — musty breath, enlarged superficial abdominal veins, muscle atrophy, pain in the right upper abdominal quadrant that worsens when the patient sits up or leans forward, palpable liver or spleen, and temperature of 101° to 103° F (38.3° to 39.4° C). Bleeding from esophageal varices results from portal hypertension.
» READ BOOK EXCERPT ONLINE »
Source: Professional Guide to Diseases (Eighth Edition), 2005
Alcoholism:
Signs and symptoms
(Handbook of Diseases)
Because people with alcohol dependence may hide or deny their addiction and may temporarily manage to maintain a functional life, assessing a patient for alcoholism can be difficult. However, there are various physical and psychosocial symptoms that can facilitate assessment.
The patient’s history may suggest a need for daily or episodic alcohol use to maintain adequate functioning, an inability to discontinue or reduce alcohol intake, episodes of anesthesia or amnesia (blackouts) during intoxication, episodes of violence during intoxication, or interference with social and familial relationships and occupational responsibilities.
Many minor complaints that the patient may have may also be alcohol related. He may mention malaise, dyspepsia, mood swings, depression, or more infections. Note any evidence of an unusually high tolerance for sedatives and narcotics.
Secretive behavior is another indication. When confronted, the patient may deny or rationalize his problem with alcohol. Alternatively, he may be guarded or hostile in his response. He also may project his anger or feelings of guilt or inadequacy onto others to avoid confronting his illness.
With chronic alcohol abuse, the patient may experience malnutrition, cirrhosis of the liver, peripheral neuropathy, brain damage, or cardiomyopathy.
After abstaining from alcohol or significantly reducing his intake, the patient may experience signs and symptoms of withdrawal, and they may last for 5 to 7 days. The patient initially experiences anorexia, nausea, anxiety, fever, insomnia, diaphoresis, and tremor, progressing to severe tremulousness, agitation and, possibly, hallucinations and violent behavior. Major tonic-clonic seizures (known as rum fits) can occur during withdrawal. Suspect alcoholism in any patient with unexplained seizures.
» READ BOOK EXCERPT ONLINE »
Source: Handbook of Diseases, 2003
Cirrhosis:
Signs and symptoms
(Handbook of Diseases)
Signs and symptoms of cirrhosis and fibrosis are similar for all types, regardless of cause. Early indications are insidious and vague but usually include weakness, fatigue, muscle cramps, weight loss, GI signs and symptoms (anorexia, indigestion, nausea, vomiting, constipation, diarrhea), and abdominal pain (which may be attributed to an enlarged liver).
Major and late signs and symptoms develop as a result of hepatic insufficiency and portal hypertension and include the following:
❑ respiratory — pleural effusion and limited thoracic expansion because of abdominal ascites, interfering with efficient gas exchange and leading to hypoxia
❑ central nervous system — progressive signs and symptoms of hepatic encephalopathy: lethargy, mental changes, slurred speech, asterixis (flapping tremor), peripheral neuritis, paranoia, hallucinations, extreme obtundation, and coma
❑ hematologic — bleeding tendencies (nosebleeds, easy bruising, bleeding gums), anemia, and hematemesis
❑ endocrine — testicular atrophy, menstrual irregularities, gynecomastia, loss of chest and axillary hair, loss of libido, and sterility
❑ skin — severe pruritus, extreme dryness, poor tissue turgor, abnormal pigmentation, spider nevi (on upper half of body), palmar erythema, jaundice, and peripheral edema
❑ hepatic — jaundice, hepatomegaly, ascites, edema of the legs, hepatic encephalopathy, and hepatorenal syndrome constitute the other major effects of full-fledged cirrhosis
❑ miscellaneous — musty breath, enlarged superficial abdominal veins, muscle atrophy, pain in the right upper abdominal quadrant that worsens when the patient sits up or leans forward, splenomegaly, and wasting appearance of chronic illness. Fever may be present and usually associated with portal hepatitis, spontaneous bacterial peritonitis, or cholangitis. Bleeding from esophageal and rectal varices results from portal hypertension.
» READ BOOK EXCERPT ONLINE »
Source: Handbook of Diseases, 2003
Toxic Alcohols:
Toxic Alcohols - signs & symptoms
(The 5-Minute Pediatric Consult)
- Inebriation may occur after exposure.
- Isopropyl alcohol may cause severe GI irritation or hemorrhage.
» READ BOOK EXCERPT ONLINE »
Source: The 5-Minute Pediatric Consult, 2008
Article Excerpts About Symptoms of Alcohol abuse:
Alcohol Abuse and Treatment: NWHIC (Excerpt)
The four known symptoms are:
Craving: A strong need, or compulsion, to drink.
Impaired control: The inability to limit one’s drinking.
Physical dependence: Withdrawal symptoms (nausea, sweating,
shakiness, anxiety) when alcohol is stopped after a period of heavy
drinking.
Tolerance: The need for increasing amounts of alcohol in order
to feel its effects. (Source: excerpt from Alcohol Abuse and Treatment: NWHIC)
Alcohol Abuse and Treatment: NWHIC (Excerpt)
An alcoholic is dependent upon alcohol. This dependence grows as
the disease progresses. A person who abuses alcohol may not be dependent
upon it but still drinks excessively. Even if you are not an alcoholic,
abusing alcohol has negative results. This includes failure to meet major
work, school, or family responsibilities; alcohol-related legal trouble;
automobile crashes due to drinking; as well as a variety of medical
problems. Under some circumstances, problems can result from even moderate
drinking--for example, when driving, during pregnancy, or when taking
certain medicines. (Source: excerpt from Alcohol Abuse and Treatment: NWHIC)
Alcohol Abuse and Treatment: NWHIC (Excerpt)
Menstrual disorders (e.g. painful menstruation, heavy flow,
premenstrual discomfort, and irregular or absent cycles) have been
associated with chronic heavy drinking. These disorders can have adverse
effects on fertility. Further, continued drinking may lead to early
menopause. (Source: excerpt from Alcohol Abuse and Treatment: NWHIC)
Aging and Alcohol Abuse - Age Page - Health Information: NIA (Excerpt)
Not everyone who drinks regularly has a drinking problem. You
might want to get help if you:
- Drink to calm your nerves, forget your worries, or reduce
depression
- Lose interest in food
- Gulp your drinks down fast
- Lie to try to hide your drinking habits
- Drink alone more often
- Hurt yourself, or someone else, while drinking
- Were drunk more than three or four times last year
- Need more alcohol to get "high"
- Feel irritable, resentful, or unreasonable when you are not
drinking
- Have medical, social, or financial problems caused by drinking
(Source: excerpt from Aging and Alcohol Abuse - Age Page - Health Information: NIA)
Aging and Alcohol Abuse: NIAAA (Excerpt)
Not everyone who drinks regularly has a drinking problem. You might
want to get help if you:
- Drink to calm your nerves, forget your worries, or reduce depression
- Lose interest in food
- Gulp your drinks down fast
- Lie or try to hide your drinking habits
- Drink alone more often
- Hurt yourself, or someone else, while drinking
- Were drunk more than three or four times last year
- Need more alcohol to get "high"
- Feel irritable, resentful, or unreasonable when you are not drinking
- Have medical, social, or financial problems caused by drinking
(Source: excerpt from Aging and Alcohol Abuse: NIAAA)
Alcoholism Getting the Facts: NIAAA (Excerpt)
Alcohol abuse is defined as a pattern of
drinking that results in one or more of the following situations
within a 12-month period:
• Failure to
fulfill major work, school, or home responsibilities;
• Drinking in
situations that are physically dangerous, such as while driving a
car or operating machinery;
• Having recurring
alcohol-related legal problems, such as being arrested for driving
under the influence of alcohol or for physically hurting someone
while drunk; and
• Continued
drinking despite having ongoing relationship problems that are
caused or worsened by the drinking.
Although
alcohol abuse is basically different from alcoholism, many effects
of alcohol abuse are also experienced by alcoholics. (Source: excerpt from Alcoholism Getting the Facts: NIAAA)
Alcoholism Getting the Facts: NIAAA (Excerpt)
How can
you tell whether you may have a drinking problem? Answering the
following four questions can help you find out:
• Have
you ever felt you should cut down on your drinking?
• Have
people annoyed you by criticizing your drinking?
• Have
you ever felt bad or guilty about your drinking?
• Have you ever
had a drink first thing in the morning (as an “eye opener”) to
steady your nerves or get rid of a hangover?
One “yes”
answer suggests a possible alcohol problem. If you answered “yes” to
more than one question, it is highly likely that a problem exists.
In either case, it is important that you see your doctor or other
health care provider right away to discuss your answers to these
questions. He or she can help you determine whether you have a
drinking problem and, if so, recommend the best course of
action. (Source: excerpt from Alcoholism Getting the Facts: NIAAA)
How to Cut Down on Your Drinking: NIAAA (Excerpt)
If you are drinking too much, you can improve your life and
health by cutting down. How do you know if you drink too much? Read these
questions and answer "yes" or "no":
- Do you drink alone when you feel angry or sad?
- Does your drinking ever make you late for work?
- Does your drinking worry your family?
- Do you ever drink after telling yourself you won't?
- Do you ever forget what you did while you were drinking?
- Do you get headaches or have a hang-over after you have been
drinking?
If you answered "yes" to any of these questions, you may
have a drinking problem. Check with your doctor to be sure. Your doctor
will be able to tell you whether you should cut down or abstain. (Source: excerpt from How to Cut Down on Your Drinking: NIAAA)
Alcohol abuse as a symptom:
For a more detailed analysis of Alcohol abuse as a symptom, including causes, drug side effect causes, and drug interaction causes, please see our Symptom Center information for Alcohol abuse.
Medical articles and books on symptoms:
These general reference articles may be of interest
in relation to medical signs and symptoms of disease in general:
Full list of premium articles on symptoms and diagnosis
About signs and symptoms of Alcohol abuse:
The symptom information on this page
attempts to provide a list of some possible signs and symptoms of Alcohol abuse.
This signs and symptoms information for Alcohol abuse has been gathered from various sources,
may not be fully accurate,
and may not be the full list of Alcohol abuse signs or Alcohol abuse symptoms.
Furthermore, signs and symptoms of Alcohol abuse may vary on an individual basis for each patient.
Only your doctor can provide adequate diagnosis of any signs or symptoms and whether they
are indeed Alcohol abuse symptoms.
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