|
Tag: Redirect target changed |
| (3 intermediate revisions by 2 users not shown) |
| Line 1: |
Line 1: |
| ==Management==
| | #REDIRECT [[Ethanol withdrawal]] |
| ''Start aggressive [[Benzodiazepines|Benodiazepine]] therapy at CIWA score of 8. Consider ICU admission with score >20''
| |
| | |
| ===[[Benzodiazepines]]===
| |
| *[[Diazepam]] (Valium) 5-10mg IV (depending on severity)
| |
| **May repeat q5-10min for severe withdrawal (double dose until desired effect achieved)
| |
| *[[Lorazepam]] (Ativan) 1-4mg IV (depending on severity)
| |
| **May repeat q15-20min for severe withdrawal (titrated to effect)
| |
| **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>
| |
| | |
| ====Special Situations====
| |
| *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]]
| |
| | |
| ===Alpha-2 agonists ([[Dexmedetomidine]])===
| |
| *Decrease severity of sxs, but only supplemental to GABA-ergic first-lines
| |
| * Dexmedetomidine drip, start 0.2 mcg/kg/min, likely needing no more than 0.7 mcg/kg/min
| |
| | |
| ===[[Barbituates]] ([[Phenobarbital]])===
| |
| *Used when refractory to [[benzodiazepines]]
| |
| * [[Phenobarbital]] 130-260 mg IV q 15-20 minutes
| |
| | |
| ===[[Ketamine]]===
| |
| *May have some use in refractory cases
| |
| *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>
| |
| | |
| ===Nutritional supplementation===
| |
| *Banana bag
| |
| **Thiamine 100mg IV
| |
| **Folate 1mg IV (cheaper PO)
| |
| **MVI 1 tab IV (cheaper PO)
| |
| **[[Magnesium sulfate]] 2mg IV
| |
| **Normal saline as needed for hydration
| |
| | |
| ==See Also==
| |
| *[[Beer Potomania Syndrome]]
| |
| *[[Alcohol (ETOH) Intoxication]]
| |
| *[[Alcoholic ketoacidosis]]
| |
| *[[Alcohol withdrawal]]
| |
| *[[Alcohol withdrawal: Inpatient management]]
| |
| *[[Alcohol withdrawal: Outpatient management]]
| |
| *[[Alcohol withdrawal seizures]]
| |
| *[[Altered mental status]]
| |
| *[[Delerium tremens]]
| |
| *[[EBQ:Outpatient use of benzodiazepines for the treatment of acute alcohol withdrawal]]
| |
| *[[Sedative/Hypnotic]]
| |
| *[[Wernicke-Korsakoff Syndrome]]
| |
| | |
| ==External Links==
| |
| *[http://www.mdcalc.com/ciwa-ar-for-alcohol-withdrawal/#about-calculator MDCalc - CIWA-AR Calculator]
| |
| | |
| ==References==
| |
| <references/>
| |
| | |
| [[Category:Tox]][[Category:Psych]]
| |
