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Included under this title is the symptom complex of tremulousness, hallucinations, seizures, confusion, and psychomotor and autonomic overactivity. Although a sustained period of chronic inebriation is the most obvious factor in the causation of these symptoms, they become manifest only after a period of relative or absolute abstinence from alcohol hence the designation abstinence, or withdrawal, syndrome. This concept is illustrated in Fig. 42-1. Each of the major manifestations of the withdrawal syndrome may occur in more or less pure form and are so described later, but usually they occur in various combinations. Major withdrawal symptoms are observed mainly in the binge, or periodic, drinker, although the steady drinker is not immune if for some reason he stops drinking. The full syndrome, depicted further on, is called delirium tremens. Tremulousness and Associated Symptoms The most common single manifestation of the abstinence syndrome is tremulousness, often referred to as the shakes or the jitters, combined with general irritability and gastrointestinal symptoms, particularly nausea and vomiting. These symptoms rst appear after several days of drinking, usually in the morning after a night s abstinence. The patient quiets his nerves with a few drinks and is then able to drink for the rest of the day without undue distress. The symptoms return on successive mornings with increasing severity. The duration of drinking of this type varies greatly. The symptoms then become greatly augmented, reaching their peak intensity 24 to 36 h after the complete cessation of drinking. Generalized tremor is the most obvious feature of this illness. It is of fast frequency (6 to 8 Hz), slightly irregular, and variable in severity, tending to diminish when the patient is in quiet surroundings and to increase .net pdf 417 reader Packages matching PDF417 - NuGet Gallery
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