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By Stanley Davidson, Sir; J Alastair Innes

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V. Pabrinex). There is no treatment for Korsakoff’s syndrome once it has arisen. • Disulfiram can be given as a deterrent to patients who have difficulty resisting the impulse to drink after becoming abstinent. It blocks the metabolism of alcohol, causing acetaldehyde to accumulate, and leads to an unpleasant reaction if alcohol is consumed (headache, flushing and nausea). • Acamprosate has recently been introduced to maintain abstinence by reducing the craving for alcohol. • Many but not all who become dependent on alcohol relapse after treatment.

Other features include nausea, vomiting, tinnitus, deafness, headache and tremor. In large overdoses, ataxia, drowsiness, coma, respiratory depression, haemolysis and cardiac effects can occur (hypotension, arrhythmias). Treatment is with activated charcoal and ventilatory support, as required. g. gliclazide, glipizide), biguanides (metformin) and insulins. All can cause hypoglycaemia in overdose, although insulin is non-toxic if ingested. • The onset and duration of hypoglycaemia vary, but can last for several days with the longer-acting agents such as isophane and lente insulins.

ARDS, may initially be unable to sustain even a modest degree of respiratory work due to reduced lung compliance and muscle weakness and hence require a programme of gradual weaning from ventilation. Tracheostomy: Usually performed electively when endotracheal intubation is likely to be prolonged (>14 days). Tracheostomies help patient comfort, aid weaning from ventilation, and allow access for tracheal toilet and intermittent respiratory support. RENAL SUPPORT Oliguria requires explanation and early intervention to correct renal hypoperfusion.

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