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
- Diaphoresis, anxiety, tremor, hallucinations, N/V, HA, visual disturbance, disorientation
- Symptoms peak in 72hr
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