Alcohol withdrawal: Difference between revisions
m (moved ETOH Withdrawl to Alcohol Withdrawl) |
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==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 | |||
* | *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 | - benzos- decrease severity of sx, sz, dt | ||
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Adjuvant Txs- not sole txs but for combination | Adjuvant Txs- not sole txs but for combination | ||
Line 77: | Line 54: | ||
Anticonvulsants | Anticonvulsants | ||
- dilantin no role | - dilantin no role | ||
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==Disposition== | ==Disposition== | ||
*Admit: | |||
**Status | |||
**DTs | |||
**Focal/first sz | |||
**Decr loc | |||
**Inability to control withdrawal | |||
*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== | ||
[[Beer Potomania Syndrome]] | |||
[[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