Ethanol withdrawal: Difference between revisions

Revision as of 22:10, 14 May 2011

Background

Withdrawal symptoms due to reduced GABA and increased glutamate
Benzos useful due to cross tolerance at ethanol GABA receptor
Sx triggered Tx
- As effective as fixed dose tx with more rapid detox

Diagnosis

Diaphoresis, anxiety, tremor, hallucinations, N/V, HA, visual disturbance, disorientation
Symptoms peak in 72hr

Treatment

Do not need meds for more than 7 days unless have DT's

Banana Bag
- Thiamine 100mg IV
- Folate 1mg IV (cheaper PO)
- MVI 1 tab IV (cheaper PO)
- Magnesium sulfate 2mg IV
- NS 1L IV

Benzodiazapines
- Diazepam 5-10mg IV q5-10min
- Lorazepam 2-4mg IV Q10min

Beta blockers
- Improves VS, reduces craving
Alpha agonists (clonidine)
- Decrease severity of sxs

Delirium Tremens

Diagnosis

Delirium
- Disconnected from the environment

Hyerdynamic vital signs

Febrile

Treatment

Goal = sleepy, but arousable w/ HR <110
Diazepam
- Long duration of action, max effect within 5min
- Start 10mg IV
  - Redose q5min after observing effect
  - Can double subsequent doses until achieve goal
Propfol
- Consider intubation + propofol gtt if benzo-nonresponsive
Thiamine 100mg

Disposition

Admit:
- Status
- DTs
- Focal/first sz
- Decr loc
- Inability to control withdrawal

Consider D/C with 3 day course if want to quit

@@ Line 1: / Line 1: @@
 ==Background==
+*Withdrawal symptoms due to reduced GABA and increased glutamate
+*Benzos useful due to cross tolerance at ethanol GABA receptor
-* Withdrawal symptoms due to reduced GABA pathway and increased glutamate transmission
+*Sx triggered Tx
-* Benzos useful due to cross tolerance at ethanol GABA receptor (same place carbemazipine and valproate also work
+**As effective as fixed dose tx with more rapid detox
-* Symptom Triggered Tx- quantify sx and give meds upon reaching threshold- as effective as fixed dose tx  and needs less drug and get more rapid detox
 ==Diagnosis==
+*Diaphoresis, anxiety, tremor, hallucinations, N/V, HA, visual disturbance, disorientation
+*Symptoms peak in 72hr
-* Sweating, anxiety, tremor, hallucinations, N/V, HA, visual disturbance, disorientation
-* Alcohol withdrawal symptoms peak in 72 hrs
 ==Treatment ==
 *Do not need meds for more than 7 days unless have DT's
@@ Line 24: / Line 19: @@
 **NS 1L IV
-*Benzodiazapines PRN
+*Benzodiazapines
-**Valium 5-10mg IV or Ativan 2-4mg IV Q10min until no tremor, then Q1hr
+**Diazepam 5-10mg IV q5-10min
-**Valium quicker to theraputic CNS levels
+**Lorazepam 2-4mg IV Q10min
-*Dilantin
-*Consider in non-classic cases
-Medications
--    benzos- decrease severity of sx, sz, dt
+*Beta blockers
+**Improves VS, reduces craving
+*Alpha agonists (clonidine)
+**Decrease severity of sxs
--    anticonvulsants- same
+==Delirium Tremens==
+===Diagnosis===
--    beta blockers- improve vital signs and reduce craving
+*Delirium
+**Disconnected from the environment
--    alpha agonists- decrease severity of sxs
+Hyerdynamic vital signs
+*Febrile
+===Treatment===
+*Goal = sleepy, but arousable w/ HR <110
+*Diazepam
+**Long duration of action, max effect within 5min
-Adjuvant Txs- not sole txs but for combination
+**Start 10mg IV
+***Redose q5min after observing effect
--    phenothiazines- reduce signs and sxs but less effective than benzos for sz and dt
+***Can double subsequent doses until achieve goal
+*Propfol
--    beta blockers/ clonidine- no sz protection, not for benzo wd
+**Consider intubation + propofol gtt if benzo-nonresponsive
+*Thiamine 100mg
-Anticonvulsants
--    dilantin no role
--    carb- less emotional distress and has anti sz prop too, does not inhibit mem like benzos, less abuse potential
-o    can have dizzy, n/v
-o    not for dts
-o    has fewer protracted sxs than benzos, less relapse, less side effect
--    carb may be used for benzo wd
--    valproate- also useful
 ==Disposition==
@@ Line 81: / Line 56: @@
 ==See Also==
 [[Beer Potomania Syndrome]]