Ethanol withdrawal: Difference between revisions
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==Treatment== | ==Treatment== | ||
===General=== | |||
*Benzos | *Benzos | ||
**Diazepam 5-10mg IV (depending on severity) | |||
***May repeat q5-10min for severe withdrawal (titrated to effect) | |||
**Lorazepam 1-4mg IV (depending on severity) | |||
***May repeat q15-20min for severe withdrawal (titrated to effect) | |||
*** | *Beta blockers | ||
**Improve VS, reduces craving | |||
*Alpha agonists (clonidine) | |||
**Decrease severity of sxs | |||
*Banana Bag | *Banana Bag | ||
**Thiamine 100mg IV | **Thiamine 100mg IV | ||
| Line 31: | Line 34: | ||
**Magnesium sulfate 2mg IV | **Magnesium sulfate 2mg IV | ||
**NS 1L IV | **NS 1L IV | ||
===Seizures=== | ===Seizures=== | ||
Revision as of 22:20, 18 February 2012
Background
- Withdrawal symptoms due to reduced GABA and increased glutamate
- Benzos useful due to cross tolerance at ethanol GABA receptor
- Symptom triggered therapy
- As effective as fixed dose therapy, but w/ more rapid detox
Diagnosis
- Reduction in alcohol use that has been heavy and prolonged
- At least 2 of the following
- Autonomic hyperactivity (e.g., diaphoresis, HR>100)
- Increased hand tremor
- Insomnia
- Nausea/vomiting
- Transient visual, tactile, or auditory hallucinations
- Psychomotor agitation
- Anxiety
- Grand mal seizures
Treatment
General
- Benzos
- Diazepam 5-10mg IV (depending on severity)
- May repeat q5-10min for severe withdrawal (titrated to effect)
- Lorazepam 1-4mg IV (depending on severity)
- May repeat q15-20min for severe withdrawal (titrated to effect)
- Diazepam 5-10mg IV (depending on severity)
- Beta blockers
- Improve VS, reduces craving
- Alpha agonists (clonidine)
- Decrease severity of sxs
- Banana Bag
- Thiamine 100mg IV
- Folate 1mg IV (cheaper PO)
- MVI 1 tab IV (cheaper PO)
- Magnesium sulfate 2mg IV
- NS 1L IV
Seizures
- Onset after last drink: 6-48h
- Multiple seizures: 60% of pts
- Progression to DTs: 33% of pts
- Treat with benzos (not phenytoin)
Alcoholic Hallucinosis
- Onset after last drink: 12-24hr
- Visual hallucinations are most common
- Different from delirium tremens
- Resolves within 24-48 from last drink (before onset of DTs)
- No delirium
- Normal vital signs
Delirium Tremens
Diagnosis
- Onset after last drink - 48 to 96hrs
- 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 drip if benzo-nonresponsive
- Thiamine 100mg
Disposition
- Admit:
- Multiple seizures
- DTs
- Decr LOC
- Inability to control withdrawal
- Consider D/C with 3 day course if want to quit
See Also
Source
- UpToDate