1993-2018 ,u ,p vkj lh % iPphl o’kZ&vla[; vk’kk,a Nhrc : Twenty Five Years-billion Hopes repeated, and usually prolonged and/or high-dose use. Alcohol withdrawal typically develops 6 to 8 hours after the cessation of drinking. Trembling/shaking is usually one of the earliest signs of alcohol withdrawal. The psychotic and perceptual symptoms begin in 8 to 12 hours after cessation of alcohol use. The withdrawal reaches peak intensity on the second or third day, and markedly diminishes by the fourth or ifth day. Alcohol withdrawal can cause signi icant illness and death. 70. What are the important aspects of general physical examination in suspected alcohol dependence? A thorough general and systemic examination must be carried out for all patients with alcohol dependence. Physical examination can reveal features of alcohol intoxication or withdrawal (described in the previous query). Additionally, physical examination helps identify presence of physical complications associated with alcohol use. Since patients with alcohol dependence may suffer from other medical disorders, physical examination helps identify the associated medical conditions. One needs speci ically to look at: • Pulse: Could be low (intoxication) or high (withdrawal) • Blood Pressure could be low (intoxication) or high (withdrawal or hypertension as a medical complication) • Pallor: Seen in co-morbid anaemia • Icterus: Indicative of hyperbilirubinemia (hepatic dysfunction) • Generalised oedema: Indicates hypoproteinaemia (due to hepatic dysfunction) • Abdomen examination: Look for hepatomegaly, ascites and signs of portal hypertension (caput medusa) 71. What are the investigations useful in a case of alcohol dependence? Investigations along with indications in a patient with alcohol dependence (list is not all inclusive) FORENSIC INVESTIGATION | 53