Alcohol Withdrawal and Delirium Tremens: Fast recognition may save a patient from the worst of withdrawal

The Prophylactic and Therapeutic Effects of Saffron Extract and Crocin on Ethanol Withdrawal Syndrome in Mice

Objectives

Ethanol withdrawal following its chronic use is a serious outcome and challenging to treatment. The chronic use of ethanol induces a progressive neuroplasticity in different reigns of brain. In this study we evaluated the effects of aqueous extract of Crocus sativus L. (saffron) and its active compound, crocin, on the withdrawal behavior induced after repeated administration of ethanol, in two regimens of prophylactic (administration of drugs concomitant with the induction of dependence) and treatment (administration of drugs during the period of ethanol withdrawal) in mice which received ethanol.

Methods

Ethanol dependence was induced by oral administration of 10% v/v ethanol (2 g/kg) for 7 days. The aqueous extracts of saffron (40, 80 and 160) and crocin (10, 20 and 40 mg/kg) were administered to mice in two regimens of prophylactic (along with ethanol) and treatment (during withdrawal period). Diazepam (1 mg/kg) was used as a positive control. Six hours after discontinuation of the ethanol, seizure was evaluated by the sub-convulsive dose of pentyleneltetrazole (PTZ) (30 mg/kg). The open field test and Rota rod test were used for evaluation of locomotor activity and motor incoordination, respectively.

Results

Both extracts and crocin increased the number of crossed lined in the open field test. PTZ kindling seizure was inhibited in animals received extract (80 and 160 mg/kg) in both regimens. Motor incoordination was only improved following administration of crocin.

Conclusion

The aqueous extract of saffron and crocin can be considered as safe agents and reliable alternative to diazepam in management of ethanol withdrawal syndrome.

How is alcohol withdrawal syndrome best managed in the emergency department?

Alcohol abuse is a major cause of morbidity and mortality and subsequently presents a substantial burden on the NHS. Whether presentations are directly or indirectly linked, the emergency department (ED) holds a predominant role in dealing with this matter. Alcohol withdrawal syndrome is a common complication of alcohol misuse. Given its pathophysiology and manifestation of symptoms, early recognition and treatment is paramount in preventing a medical emergency. From a review of the associated literature, a standardised protocol for its management in ED is consequently advocated. This includes: Identification of those at risk via routine screening; Monitoring progression and severity using an alcohol withdrawal scale; Implementation of symptom-triggered therapy on the basis of objective evidence collected. Nonetheless, further studies are required to aid the choice of tools and ascertain the efficacy of such protocols within the ED department. Due to time constraints of this real-world setting, feasibility may be considered as important as reliability and validity if new practices are to be considered.