Ethanol withdrawal

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

1. Reduction in alcohol use that has been heavy and prolonged
2. At least 2 of the following
   1. Autonomic hyperactivity (e.g., diaphoresis, HR>100)
   2. Increased hand tremor
   3. Insomnia
   4. Nausea/vomiting
   5. Transient visual, tactile, or auditory hallucinations
   6. Psychomotor agitation
   7. Anxiety
   8. Grand mal seizures

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

See Also

Beer Potomania Syndrome

Alcohol (ETOH) Intoxication