Transcription - 20251021T 16-13.mp3

Next patient sharon mcgrath

Medical ST5 Miller Clerking

Presenting Complaint:
Alcohol withdrawal

History of Presenting Complaint:
Patient presented this morning with alcohol withdrawal symptoms. She has been experiencing intermittent tight chest pains radiating to abdomen and leg, which improved with benzodiazepines. She has not been able to drink alcohol as per her discharge plan due to vomiting. She reports increased shaking. She was referred to the Alcohol Care Team and discharged home. No other change in symptoms since last review.

Past Medical History:
• Alcohol dependence (October 2023)
• Alcoholic gastritis (July 2025 - resolved October 2025)
• Deep venous thrombosis - left leg (October 2024)
• Ketoacidosis (June-September 2025)
• Fracture of left clavicle (May-August 2025)
• Collapse (May-August 2025)
• Total abdominal hysterectomy and bilateral salpingo-oophorectomy (May 2017)
• Emergency caesarean section (2002) - due to severe pre-eclampsia at 29 weeks, child has cerebral palsy
• Elective caesarean delivery (May 2007)
• Left pneumothorax (2000, 2005)
• Miscarriages (2002, 2003)
• Bilateral congenital cataracts (2007)
• Appendicectomy (1981)
• Anaemia (2003)

Drug History:
• Thiamine 100mg PO OD
• Rivaroxaban 20mg PO OD (for DVT history)
• Lansoprazole 15mg PO BD
• Blood glucose testing strips and lancets (FastClix 0.3mm/30gauge)

Recently Stopped Medications:
• Ondansetron 4mg BD PRN - for abdominal pain

Allergy History:
• Latex allergy
• Allergic reaction to insect bite

Social History:
Significant alcohol dependence with recent withdrawal episodes.
Has children including one with cerebral palsy from premature birth.
Currently struggling with alcohol cessation due to withdrawal symptoms.

On Examination:
General Appearance: Alert, experiencing withdrawal symptoms with increased tremor
Observations: Not documented
• Other: Intermittent chest pain radiating to abdomen and leg, improved with benzodiazepines

Investigations:
• D-Dimer: 2.41
• Troponin T: 4
• ALT: 37
• CRP: <1
• AST: 95
• Platelets: 134
• Bilirubin: 7
• Chest X-ray: Normal heart and mediastinal contours. Lungs and pleural spaces clear.

Impression:
Alcohol withdrawal syndrome
Secondary issues: History of alcohol dependence, chest pain possibly anxiety-related, elevated AST suggesting ongoing liver involvement

Management Plan:
1. Symptomatic management of withdrawal symptoms with benzodiazepines as required
2. Continue thiamine supplementation for alcohol-related nutritional deficiency
3. Referred to Alcohol Care Team for ongoing support
4. Discharge home with safety-netting advice
5. Continue current medications including rivaroxaban for DVT prophylaxis
6. Monitor liver function given elevated AST
7. Follow-up with GP for ongoing alcohol cessation support
8. Patient suitable for community management of withdrawal symptoms

Summary

Investigations

Plans