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| ==Management==
| | #REDIRECT [[Ethanol withdrawal]] |
| ''Start aggressive [[Benzodiazepines|Benodiazepine]] therapy at CIWA score of 8. Consider ICU admission with score >20''
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| ===[[Benzodiazepines]]===
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| *[[Diazepam]] (Valium) 5-10mg IV (depending on severity)
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| **May repeat q5-10min for severe withdrawal (double dose until desired effect achieved)
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| *[[Lorazepam]] (Ativan) 1-4mg IV (depending on severity)
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| **May repeat q15-20min for severe withdrawal (titrated to effect)
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| **Rarely causes hepatitis, as opposed to diazepam which may cause a cholestatic hepatitis<ref>National Institute of Diabetes and Digestive and Kidney Diseases. Lorazepam Drug Record. http://livertox.nih.gov/Lorazepam.htm</ref>
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| ====Special Situations====
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| *The propylene glycol diluent in lorazepam, phenobarbital and diazepam, may induce a hyperosmolar anion gap metabolic acidosis if given as a drip in high doses ≥ 48hrs.<ref>Arroliga AC, Shehab N, McCarthy K, Gonzales JP. Relationship of continuous infusion lorazepam to serum propylene glycol concentration in critically ill adults*. Critical Care Medicine. 2004;32(8):1709–1714. doi:10.1097/01.CCM.0000134831.40466.39.</ref> Consider alternatives such as propofol or dexmedetomidine if patients need long term sedation for [[Delirum tremens]]
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| ===Alpha-2 agonists ([[Dexmedetomidine]])===
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| *Decrease severity of sxs, but only supplemental to GABA-ergic first-lines
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| * Dexmedetomidine drip, start 0.2 mcg/kg/min, likely needing no more than 0.7 mcg/kg/min
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| ===[[Barbituates]] ([[Phenobarbital]])===
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| *Used when refractory to [[benzodiazepines]]
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| * [[Phenobarbital]] 130-260 mg IV q 15-20 minutes
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| ===[[Ketamine]]===
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| *May have some use in refractory cases
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| *Blocks the NMDA receptor which is excited an unregulated. <ref>Wong, A et al. Evaluation of adjunctive ketamine to benzodiazepines for management of alcohol withdrawal syndrome. Ann Pharmacother. 2015 Jan;49(1):14-9. PMID: 25325907</ref>
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| ===Nutritional supplementation===
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| *Banana bag
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| **Thiamine 100mg IV
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| **Folate 1mg IV (cheaper PO)
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| **MVI 1 tab IV (cheaper PO)
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| **[[Magnesium sulfate]] 2mg IV
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| **Normal saline as needed for hydration
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| ==See Also==
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| *[[Beer Potomania Syndrome]]
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| *[[Alcohol (ETOH) Intoxication]]
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| *[[Alcoholic ketoacidosis]]
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| *[[Alcohol withdrawal]]
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| *[[Alcohol withdrawal: Inpatient management]]
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| *[[Alcohol withdrawal: Outpatient management]]
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| *[[Alcohol withdrawal seizures]]
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| *[[Altered mental status]]
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| *[[Delerium tremens]]
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| *[[EBQ:Outpatient use of benzodiazepines for the treatment of acute alcohol withdrawal]]
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| *[[Sedative/Hypnotic]]
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| *[[Wernicke-Korsakoff Syndrome]]
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| ==External Links==
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| *[http://www.mdcalc.com/ciwa-ar-for-alcohol-withdrawal/#about-calculator MDCalc - CIWA-AR Calculator]
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| ==References==
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| <references/>
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| [[Category:Tox]][[Category:Psychiatry]]
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