Ethanol withdrawal: Difference between revisions
No edit summary |
|||
| Line 16: | Line 16: | ||
##Anxiety | ##Anxiety | ||
##Grand mal seizures | ##Grand mal seizures | ||
==Treatment== | ==Treatment== | ||
| Line 44: | Line 37: | ||
***Decrease severity of sxs | ***Decrease severity of sxs | ||
==Delirium Tremens== | ===Seizures=== | ||
===Diagnosis=== | *Onset after last drink - 6-48hr | ||
*Multiple sz - 60% of pts | |||
*Progression to DTs - 33% | |||
*Tx with benzos (not phenytoin!) | |||
===Alcoholic Hallucinosis== | |||
*Onset after last drink - 12-24hr | |||
*Visual hallucinations are most common | |||
*Different from delirium tremens | |||
**Resolves w/in 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 | *Delirium | ||
**Disconnected from the environment | **Disconnected from the environment | ||
*Hyerdynamic vital signs | *Hyerdynamic vital signs | ||
*Febrile | *Febrile | ||
====Treatment==== | |||
===Treatment=== | |||
*Goal = sleepy, but arousable w/ HR <110 | *Goal = sleepy, but arousable w/ HR <110 | ||
*Diazepam | *Diazepam | ||
Revision as of 22:25, 26 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
- 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
- Benzos
- PO route
- Diazepam 10-20mg PO q1-2hr
- Chlordiazepoxide 50-100mg PO q1-2hr
- IV route
- Diazepam 5-10mg IV q5-10min
- Lorazepam 2-4mg IV Q10min
- PO route
- Banana Bag
- Thiamine 100mg IV
- Folate 1mg IV (cheaper PO)
- MVI 1 tab IV (cheaper PO)
- Magnesium sulfate 2mg IV
- NS 1L IV
- Other
- Beta blockers
- Improve VS, reduces craving
- Alpha agonists (clonidine)
- Decrease severity of sxs
- Beta blockers
Seizures
- Onset after last drink - 6-48hr
- Multiple sz - 60% of pts
- Progression to DTs - 33%
- Tx with benzos (not phenytoin!)
=Alcoholic Hallucinosis
- Onset after last drink - 12-24hr
- Visual hallucinations are most common
- Different from delirium tremens
- Resolves w/in 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 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