Difference between revisions of "Alcohol withdrawal"

Line 15: Line 15:
  
 
==Treatment ==
 
==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
  
* Do not need meds for more than 7 days unless have DT's
+
*Benzodiazapines PRN
 +
**Valium 5-10mg IV or Ativan 2-4mg IV Q10min until no tremor, then Q1hr
 +
**Valium quicker to theraputic CNS levels
 
   
 
   
 +
*Dilantin
 +
*Consider in non-classic cases
  
BANANA BAG
+
Medications
 
 
100mg thiamine IV
 
 
 
1mg folate IV (cheaper PO)
 
 
 
1 tab MVI IV (cheaper PO)
 
 
 
2mg magnesium sulfate IV
 
 
 
1 L NS IV
 
 
 
 
 
 
Benzodiazapines PRN
 
 
 
* Valium 5-10mg IV or Ativan 2-4mg IV Q10min until no tremor, then Q1hr)
 
* Valium quicker to theraputic CNS levels
 
 
 
 
Consider Dilantin in non-classic cases
 
 
 
 
 
 
Medicationss
 
  
 
-    benzos- decrease severity of sx, sz, dt
 
-    benzos- decrease severity of sx, sz, dt
Line 56: Line 43:
 
   
 
   
  
Treatment
 
 
-    benzos best of alcohol wd- decrease severity, szs and dt
 
 
-    more abuse if have rapid onset of effect- valium, xanax, ativan,
 
 
-    phenobarb- less abused but poorer safety profile- resp depression
 
 
-    carbemazipine similar to benzos for adverse effects
 
  
 
  
 
Adjuvant Txs- not sole txs but for combination
 
Adjuvant Txs- not sole txs but for combination
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Anticonvulsants
 
Anticonvulsants
 
 
-    dilantin no role
 
-    dilantin no role
  
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==Disposition==
 
==Disposition==
 
+
*Admit:
 
+
**Status
Admission Criteria
+
**DTs
 
+
**Focal/first sz
-status
+
**Decr loc
 
+
**Inability to control withdrawal
-DTs
 
 
 
-focal/first sz
 
 
 
-dec loc
 
 
 
-inability to control wthdl
 
 
 
 
   
 
   
 
 
*Consider D/C with 3 day course if want to quit
 
*Consider D/C with 3 day course if want to quit
 
 
  
 
==See Also==
 
==See Also==
  
  
FEN: Beer Potomania Syndrome
+
[[Beer Potomania Syndrome]]
 
 
Tox: ETOH Intoxication
 
 
 
 
 
  
 +
[[Alcohol (ETOH) Intoxication]]
  
 
[[Category:Tox]]
 
[[Category:Tox]]

Revision as of 17:23, 5 April 2011

Background

  • Withdrawal symptoms due to reduced GABA pathway and increased glutamate transmission
  • Benzos useful due to cross tolerance at ethanol GABA receptor (same place carbemazipine and valproate also work
  • Symptom Triggered Tx- quantify sx and give meds upon reaching threshold- as effective as fixed dose tx and needs less drug and get more rapid detox


Diagnosis

  • Sweating, anxiety, tremor, hallucinations, N/V, HA, visual disturbance, disorientation
  • Alcohol withdrawal symptoms peak in 72 hrs


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 PRN
    • Valium 5-10mg IV or Ativan 2-4mg IV Q10min until no tremor, then Q1hr
    • Valium quicker to theraputic CNS levels
  • Dilantin
  • Consider in non-classic cases

Medications

- benzos- decrease severity of sx, sz, dt

- anticonvulsants- same

- beta blockers- improve vital signs and reduce craving

- alpha agonists- decrease severity of sxs



Adjuvant Txs- not sole txs but for combination

- phenothiazines- reduce signs and sxs but less effective than benzos for sz and dt

- beta blockers/ clonidine- no sz protection, not for benzo wd


Anticonvulsants - dilantin no role

- carb- less emotional distress and has anti sz prop too, does not inhibit mem like benzos, less abuse potential

o can have dizzy, n/v

o not for dts

o has fewer protracted sxs than benzos, less relapse, less side effect

- carb may be used for benzo wd

- valproate- also useful


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