Ethanol withdrawal: Difference between revisions
m (moved Alcohol Withdrawl to Alcohol Withdrawal) |
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*Withdrawal symptoms due to reduced GABA and increased glutamate | *Withdrawal symptoms due to reduced GABA and increased glutamate | ||
*Benzos useful due to cross tolerance at ethanol GABA receptor | *Benzos useful due to cross tolerance at ethanol GABA receptor | ||
* | *Symptom triggered therapy | ||
**As effective as fixed dose | **As effective as fixed dose therapy, but w/ more rapid detox | ||
==Diagnosis== | ==Diagnosis== | ||
| Line 19: | Line 19: | ||
==Treatment== | ==Treatment== | ||
*Benzos | *Benzos | ||
**PO route | **PO route (appropriate for mild withdrawal) | ||
***Diazepam 10-20mg PO q1-2hr | ***Diazepam 10-20mg PO q1-2hr | ||
***Chlordiazepoxide 50-100mg PO q1-2hr | ***Chlordiazepoxide 50-100mg PO q1-2hr | ||
**IV route | **IV route (appropriate for moderate-severe withdrawal) | ||
***Diazepam 5-10mg IV q5-10min | ***Diazepam 5-10mg IV q5-10min (titrated to effect) | ||
***Lorazepam 2-4mg IV | ***Lorazepam 2-4mg IV Q15-20min (titrated to effect) | ||
*Banana Bag | *Banana Bag | ||
**Thiamine 100mg IV | **Thiamine 100mg IV | ||
| Line 41: | Line 41: | ||
*Multiple seizures: 60% of pts | *Multiple seizures: 60% of pts | ||
*Progression to DTs: 33% of pts | *Progression to DTs: 33% of pts | ||
* | *Treat with benzos (not phenytoin) | ||
===Alcoholic Hallucinosis=== | ===Alcoholic Hallucinosis=== | ||
*Onset after last drink | *Onset after last drink: 12-24hr | ||
*Visual hallucinations are most common | *Visual hallucinations are most common | ||
*Different from delirium tremens | *Different from delirium tremens | ||
**Resolves | **Resolves within 24-48 from last drink (before onset of DTs) | ||
**No delirium | **No delirium | ||
**Normal vital signs | **Normal vital signs | ||
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***Can double subsequent doses until achieve goal | ***Can double subsequent doses until achieve goal | ||
*Propfol | *Propfol | ||
**Consider intubation + propofol | **Consider intubation + propofol drip if benzo-nonresponsive | ||
*Thiamine 100mg | *Thiamine 100mg | ||
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==Source== | ==Source== | ||
UpToDate | *UpToDate | ||
[[Category:Tox]] | [[Category:Tox]] | ||
Revision as of 16:43, 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
- Benzos
- PO route (appropriate for mild withdrawal)
- Diazepam 10-20mg PO q1-2hr
- Chlordiazepoxide 50-100mg PO q1-2hr
- IV route (appropriate for moderate-severe withdrawal)
- Diazepam 5-10mg IV q5-10min (titrated to effect)
- Lorazepam 2-4mg IV Q15-20min (titrated to effect)
- PO route (appropriate for mild withdrawal)
- 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: 6-48h
- 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