Severe Alcohol Use Disorder with Multi-System Complications in Young Adult
Case at a Glance
A 26-year-old female restaurant worker presents with severe alcohol use disorder, consuming 12-20 drinks daily, experiencing withdrawal symptoms, gastrointestinal complications, and seeking medical detoxification due to fear of seizures.
Patient's Story
The patient reports a 10-year history of alcohol use that progressively escalated from 4-6 drinks nightly to her current consumption of 12-20 drinks daily over the past few years. She works in a restaurant and has noticed significant functional decline, including muscle weakness, tremors severe enough to cause her to drop items at work, and widespread pain affecting her abdomen, shoulders, wrists, ankles, knees, and hips. She experiences morning withdrawal symptoms including tremors, panic attacks, and diaphoresis that require continued alcohol consumption for relief. On her days off, she sleeps 15-17 hours daily. Her diet consists primarily of plant-based foods and fruits/vegetables, eaten once daily, but she experiences immediate bowel movements with fatty, pale, floating stools after eating, along with abdominal cramping. Morning vomiting is frequent, and she experiences nausea and vomiting at work. She reports abdominal bloating but denies ascites. The patient acknowledges her condition's severity and has scheduled time off work to pursue detoxification, expressing fear of withdrawal seizures.
Initial Assessment
Physical examination reveals a young female with evidence of chronic alcohol use disorder. Notable findings include muscle weakness, tremors, abdominal tenderness, and signs of malnutrition. The patient appears anxious and demonstrates visible tremors. Vital signs show mild tachycardia consistent with early withdrawal. The patient exhibits signs of steatorrhea and possible pancreatic insufficiency based on her description of bowel movements.
The Diagnostic Journey
Initial workup included comprehensive metabolic panel, liver function tests, lipase, amylase, complete blood count, and coagulation studies. Imaging studies were considered to evaluate for pancreatitis and liver pathology. The patient's symptoms of steatorrhea, abdominal pain, and digestive issues raised concerns for pancreatic dysfunction. Her muscle weakness and widespread joint pain suggested possible nutritional deficiencies common in chronic alcohol use disorder.
Final Diagnosis
Primary diagnosis: Severe Alcohol Use Disorder with physiological dependence. Secondary diagnoses include: Alcohol withdrawal syndrome, suspected chronic pancreatitis with exocrine insufficiency, malnutrition with probable vitamin deficiencies, and gastritis. The floating, fatty stools indicated pancreatic exocrine insufficiency, likely secondary to chronic alcohol-induced pancreatitis.
Treatment Plan
The patient was admitted for medically supervised alcohol detoxification using a standardized withdrawal protocol with benzodiazepines (diazepam) for seizure prophylaxis and symptom management. IV thiamine, folate, and multivitamin supplementation were initiated to address nutritional deficiencies. Pancreatic enzyme replacement therapy was started for exocrine insufficiency. The patient received IV fluids for hydration and electrolyte management. A proton pump inhibitor was prescribed for gastritis. Social work consultation was arranged for discharge planning and referral to outpatient addiction treatment programs.
Outcome and Follow-up
The patient completed a 5-day inpatient detoxification without complications. Her withdrawal symptoms were well-controlled with the benzodiazepine protocol. Liver function tests showed mild elevation but no signs of end-stage liver disease. The patient was discharged with a tapering schedule of diazepam, pancreatic enzymes, vitamin supplementation, and referrals to outpatient addiction counseling and AA meetings. Follow-up appointments were scheduled with internal medicine for ongoing medical management and addiction medicine for continued sobriety support. The patient expressed motivation for continued recovery and was provided with resources for peer support groups.