Alcohol withdrawal: Difference between revisions
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Revision as of 20:28, 23 March 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
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
- anticonvulsants- same
- beta blockers- improve vital signs and reduce craving
- alpha agonists- decrease severity of sxs
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
- 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
Admission Criteria
-status
-DTs
-focal/first sz
-dec loc
-inability to control wthdl
- Consider D/C with 3 day course if want to quit
See Also
FEN: Beer Potomania Syndrome
Tox: ETOH Intoxication