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Vol. 50. Issue 1.
Pages 52-56 (January - March 2021)
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Vol. 50. Issue 1.
Pages 52-56 (January - March 2021)
Case report
DOI: 10.1016/j.rcpeng.2019.10.002
Therapeutic dilemma: alcohol withdrawal syndrome and concurrent hepatic encephalopathy. A case report
Dilema terapéutico: síndrome de abstinencia alcohólica y encefalopatía hepática concurrentes. A propósito de un caso
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Alejandra Lópeza, Roberto Chavarríaa, Gabriel Oviedob,
Corresponding author
goviedo@javeriana.edu.co

Corresponding author.
a Médico psiquiatra, Universidad de Costa Rica, subespecialistas en Psiquiatría de Enlace, Pontifica Universidad Javeriana
b Médico Psiquiatra, subespecialista en Psiquiatría de Enlace, coordinador académico Especialidad en Psiquiatría de Enlace, candidato a Magíster en Psicofarmacología Clínica, Pontificia Universidad Javeriana, Departamento de Psiquiatría y Salud Mental, Hospital Universitario San Ignacio, Bogotá, Colombia
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Table 1. Clinical Classification of Hepatic Encephalopathy according to the West Haven Criteria
Table 2. Patient's alcohol use pattern
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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.

Keywords:
Hepatic encephalopathy
Alcohol withdrawal
Delirium tremens
CIWA-Ar
Resumen

El trastorno por consumo de alcohol es una de las principales causas de morbimortalidad en el mundo. La enfermedad hepática alcohólica es una complicación común de este trastorno y la encefalopatía hepática es una seria comorbilidad de la cirrosis alcohólica. Los factores precipitantes pueden relacionarse con infección, sangrado gastrointestinal, deshidratación o efectos de psicofármacos (p. ej., benzodiacepinas e hipnóticos no benzodiacepínicos). Se expone un caso del manejo hospitalario de un paciente con un trastorno severo por consumo de alcohol, cirrosis y encefalopatía hepática, quien desarrolla síntomas de abstinencia alcohólica durante su hospitalización y la complejidad del manejo antagónico de un delirium gabaérgico propio de la encefalopatía hepática en el contexto de un delirium glutamatérgico-noradrenérgico por abstinencia alcohólica.

Palabras clave:
Encefalopatía hepática
Abstinencia alcohólica
Delirium tremens
CIWA-Ar

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