Alcoholism differential diagnosis
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Kiran Singh, M.D. [2]
Overview
Alcoholism must be differentiated from other diseases such antisocial personality disorder, conduct disorder in childhood, and nonpathological use of alcohol.[1]
Differential Diagnosis
Alcoholism must be differentiated from other diseases that cause personality changes, altered level of consciousness and hand tremors (asterixis). The differentials include the following:[2][3][4][5][6][7][8][9][10][11][12]
| Diseases | History and Symptoms | Physical Examination | Laboratory Findings | |||||||
|---|---|---|---|---|---|---|---|---|---|---|
| Personality changes | Altered level of consciousness | Hand tremors (asterixis) | Slurred speech | Writing disturbances | Voice monotonous | Impaired memory | Elevated blood ammonia | Hyponatremia | hypokalemia | |
| Hepatic encephalopathy | ++ | ++ | ++ | ++ | ++ | ++ | ++ | ++ | ++ | ++ |
| Alcohol intoxication | + | + | -/+ | ++ | + | - | + | - | -/+ | -/+ |
| Alcohol withdrawal | + | + | - | ++ | + | - | + | - | -/+ | -/+ |
| Uremia | ++ | ++ | + | -/+ | -/+ | -/+ | - | ++ | Hyperkalemia | |
| Wernicke encephalopathy | + | + | -/+ | + | + | + | ++ | - | - | - |
| Toxic encephalopathy from drugs | + | + | -/+ | -/+ | + | -/+ | + | + | -/+ | -/+ |
| Altered intracranial pressure | + | -/+ | - | -/+ | -/+ | - | -/+ | - | - | - |
| Intoxication by chemical agents | -/+ | -/+ | -/+ | -/+ | -/+ | - | - | - | -/+ | -/+ |
| Malnutrition | -/+ | - | - | - | -/+ | - | -/+ | - | -/+ | -/+ |
| Hypoxic brain injury | - | -/+ | - | -/+ | -/+ | -/+ | -/+ | - | - | - |
| Meningitis and encephalitis | -/+ | -/+ | - | -/+ | + | - | - | - | -/+ | - |
| Hypoglycemia | -/+ | -/+ | - | -/+ | -/+ | - | - | - | -/+ | -/+ |
Acute Intoxication
- Other medical conditions
- Cerebellar ataxia
- Diabetic acidosis
- Multiple sclerosis
- Sedative, hypnotic, or anxiolytic intoxication
- Antihistamines
- Anticholinergic drugs[1]
Alcohol Use Disorder/Alcoholism
- Adult antisocial personality disorder
- Conduct disorder in childhood
- Nonpathological use of alcohol
- Sedative, hypnotic, or anxiolytic use disorder[1]
References
- ↑ 1.0 1.1 1.2 Diagnostic and statistical manual of mental disorders : DSM-5. Washington, D.C: American Psychiatric Association. 2013. ISBN 0890425558.
- ↑ Meparidze MM, Kodua TE, Lashkhi KS (2010). "[Speech impairment predisposes to cognitive deterioration in hepatic encephalopathy]". Georgian Med News (181): 43–9. PMID 20495225.
- ↑ Kattimani S, Bharadwaj B (2013). "Clinical management of alcohol withdrawal: A systematic review". Ind Psychiatry J. 22 (2): 100–8. doi:10.4103/0972-6748.132914. PMC 4085800. PMID 25013309.
- ↑ Roldán J, Frauca C, Dueñas A (2003). "[Alcohol intoxication]". An Sist Sanit Navar. 26 Suppl 1: 129–39. PMID 12813481.
- ↑ Seifter JL, Samuels MA (2011). "Uremic encephalopathy and other brain disorders associated with renal failure". Semin Neurol. 31 (2): 139–43. doi:10.1055/s-0031-1277984. PMID 21590619.
- ↑ Handler CE, Perkin GD (1983). "Wernicke's encephalopathy". J R Soc Med. 76 (5): 339–42. PMC 1439130. PMID 6864698.
- ↑ Kim Y, Kim JW (2012). "Toxic encephalopathy". Saf Health Work. 3 (4): 243–56. doi:10.5491/SHAW.2012.3.4.243. PMC 3521923. PMID 23251840.
- ↑ Hartmann A, Buttinger C, Rommel T, Czernicki Z, Trtinjiak F (1989). "Alteration of intracranial pressure, cerebral blood flow, autoregulation and carbondioxide-reactivity by hypotensive agents in baboons with intracranial hypertension". Neurochirurgia (Stuttg). 32 (2): 37–43. doi:10.1055/s-2008-1053998. PMID 2497395.
- ↑ Kumar N (2011). "Acute and subacute encephalopathies: deficiency states (nutritional)". Semin Neurol. 31 (2): 169–83. doi:10.1055/s-0031-1277986. PMID 21590622.
- ↑ Chiu GS, Chatterjee D, Darmody PT, Walsh JP, Meling DD, Johnson RW; et al. (2012). "Hypoxia/reoxygenation impairs memory formation via adenosine-dependent activation of caspase 1". J Neurosci. 32 (40): 13945–55. doi:10.1523/JNEUROSCI.0704-12.2012. PMC 3476834. PMID 23035103.
- ↑ Peate I (2004). "An overview of meningitis: signs, symptoms, treatment and support". Br J Nurs. 13 (13): 796–801. doi:10.12968/bjon.2004.13.13.13501. PMID 15284663.
- ↑ Abdelhafiz AH, Rodríguez-Mañas L, Morley JE, Sinclair AJ (2015). "Hypoglycemia in older people - a less well recognized risk factor for frailty". Aging Dis. 6 (2): 156–67. doi:10.14336/AD.2014.0330. PMC 4365959. PMID 25821643.