Alcohol withdrawal: Inpatient management - Revision history

Rossdonaldson1: Changed redirect target from Alcohol withdrawal to Ethanol withdrawal

2025-07-30T22:10:56Z

Changed redirect target from Alcohol withdrawal to Ethanol withdrawal

← Older revision		Revision as of 22:10, 30 July 2025
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	#REDIRECT[[~~Alcohol~~ withdrawal]]		#REDIRECT [[Ethanol withdrawal]]

Rossdonaldson1: Redirected page to Alcohol withdrawal

2016-03-23T15:34:07Z

Redirected page to Alcohol withdrawal

← Older revision		Revision as of 15:34, 23 March 2016
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	~~==Management==~~		#REDIRECT[[Alcohol withdrawal]]
	~~''Start aggressive [[Benzodiazepines\|Benodiazepine]] therapy at CIWA score of 8. Consider ICU admission with score >20''~~

	~~===[[Benzodiazepines]]===~~
	*[[Diazepam]] (Valium) 5-10mg IV (depending on severity)
	**May repeat q5-10min for severe withdrawal (double dose until desired effect achieved)
	*[[Lorazepam]] (Ativan) 1-4mg IV (depending on severity)
	**May repeat q15-20min for severe withdrawal (titrated to effect)
	**Rarely causes hepatitis, as opposed to diazepam which may cause a cholestatic hepatitis<ref>National Institute of Diabetes and Digestive and Kidney Diseases. Lorazepam Drug Record. http://livertox.nih.gov/Lorazepam.htm</ref>

	~~====Special Situations====~~
	The propylene glycol diluent in lorazepam, phenobarbital and diazepam, may induce a hyperosmolar anion gap metabolic acidosis if given as a drip in high doses ≥ 48hrs.<ref>Arroliga AC, Shehab N, McCarthy K, Gonzales JP. Relationship of continuous infusion lorazepam to serum propylene glycol concentration in critically ill adults. Critical Care Medicine. 2004;32(8):1709–1714. doi:10.1097/01.CCM.0000134831.40466.39.</ref> Consider alternatives such as propofol or dexmedetomidine if patients need long term sedation for [[Delirum tremens]]

	~~===Alpha-2 agonists ([[Dexmedetomidine]])===~~
	*Decrease severity of sxs, but only supplemental to GABA-ergic first-lines
	* Dexmedetomidine drip, start 0.2 mcg/kg/min, likely needing no more than 0.7 mcg/kg/min

	~~===[[Barbituates]] ([[Phenobarbital]])===~~
	*Used when refractory to [[benzodiazepines]]
	* [[Phenobarbital]] 130-260 mg IV q 15-20 minutes

	~~===[[Ketamine]]===~~
	*May have some use in refractory cases
	*Blocks the NMDA receptor which is excited an unregulated. <ref>Wong, A et al. Evaluation of adjunctive ketamine to benzodiazepines for management of alcohol withdrawal syndrome. Ann Pharmacother. 2015 Jan;49(1):14-9. PMID: 25325907</ref>

	~~===Nutritional supplementation===~~
	*Banana bag
	**Thiamine 100mg IV
	**Folate 1mg IV (cheaper PO)
	**MVI 1 tab IV (cheaper PO)
	**[[Magnesium sulfate]] 2mg IV
	**Normal saline as needed for hydration

	~~==See Also==~~
	*[[Beer Potomania Syndrome]]
	*[[Alcohol ~~(ETOH) Intoxication]]~~
	*[[Alcoholic ketoacidosis]]
	*[[Alcohol withdrawal]]
	*[[Alcohol withdrawal: Inpatient management]]
	*[[Alcohol withdrawal: Outpatient management]]
	*[[Alcohol withdrawal seizures]]
	*[[Altered mental status]]
	*[[Delerium tremens]]
	*[[EBQ:Outpatient use of benzodiazepines for the treatment of acute alcohol withdrawal]]
	*[[Sedative/Hypnotic]]
	*[[Wernicke-Korsakoff Syndrome]]

	~~==External Links==~~
	*[http://www.mdcalc.com/ciwa-ar-for-alcohol-withdrawal~~/#about-calculator MDCalc - CIWA-AR Calculator]~~

	~~==References==~~
	~~<references/>~~

	~~[[Category:Toxicology]][[Category:Psychiatry~~]]

Ostermayer: Text replacement - "Category:Tox" to "Category:Toxicology"

2016-03-22T16:23:20Z

Text replacement - "Category:Tox" to "Category:Toxicology"

← Older revision		Revision as of 16:23, 22 March 2016
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	<references/>		<references/>

	[[Category:~~Tox~~]][[Category:Psychiatry]]		[[Category:Toxicology]][[Category:Psychiatry]]

Ostermayer: Text replacement - "Category:Psych" to "Category:Psychiatry"

2016-03-22T16:02:59Z

Text replacement - "Category:Psych" to "Category:Psychiatry"

← Older revision		Revision as of 16:02, 22 March 2016
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	<references/>		<references/>

	[[Category:Tox]][[Category:~~Psych~~]]		[[Category:Tox]][[Category:Psychiatry]]

3amrbadawy at 17:47, 15 February 2016

2016-02-15T17:47:52Z

← Older revision		Revision as of 17:47, 15 February 2016
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	==External Links==		==External Links==
			*[http://www.mdcalc.com/ciwa-ar-for-alcohol-withdrawal/#about-calculator MDCalc - CIWA-AR Calculator]

	==References==		==References==
	<references/>		<references/>

			[[Category:Tox]][[Category:Psych]]

3amrbadawy at 17:46, 15 February 2016

2016-02-15T17:46:27Z

← Older revision		Revision as of 17:46, 15 February 2016
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	====Special Situations====		====Special Situations====
	The propylene glycol diluent in lorazepam, phenobarbital and diazepam, may induce a hyperosmolar anion gap metabolic acidosis if given as a drip in high doses ≥ 48hrs.<ref>Arroliga AC, Shehab N, McCarthy K, Gonzales JP. Relationship of continuous infusion lorazepam to serum propylene glycol concentration in critically ill adults. Critical Care Medicine. 2004;32(8):1709–1714. doi:10.1097/01.CCM.0000134831.40466.39.</ref> Consider alternatives such as propofol or dexmedetomidine if patients need long term sedation for [[Delirum ~~Tremens~~]]		The propylene glycol diluent in lorazepam, phenobarbital and diazepam, may induce a hyperosmolar anion gap metabolic acidosis if given as a drip in high doses ≥ 48hrs.<ref>Arroliga AC, Shehab N, McCarthy K, Gonzales JP. Relationship of continuous infusion lorazepam to serum propylene glycol concentration in critically ill adults. Critical Care Medicine. 2004;32(8):1709–1714. doi:10.1097/01.CCM.0000134831.40466.39.</ref> Consider alternatives such as propofol or dexmedetomidine if patients need long term sedation for [[Delirum tremens]]

	===Alpha-2 agonists ([[Dexmedetomidine]])===		===Alpha-2 agonists ([[Dexmedetomidine]])===

3amrbadawy at 17:44, 15 February 2016

2016-02-15T17:44:39Z

← Older revision		Revision as of 17:44, 15 February 2016
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	**May repeat q15-20min for severe withdrawal (titrated to effect)		**May repeat q15-20min for severe withdrawal (titrated to effect)
	**Rarely causes hepatitis, as opposed to diazepam which may cause a cholestatic hepatitis<ref>National Institute of Diabetes and Digestive and Kidney Diseases. Lorazepam Drug Record. http://livertox.nih.gov/Lorazepam.htm</ref>		**Rarely causes hepatitis, as opposed to diazepam which may cause a cholestatic hepatitis<ref>National Institute of Diabetes and Digestive and Kidney Diseases. Lorazepam Drug Record. http://livertox.nih.gov/Lorazepam.htm</ref>

			====Special Situations====
			The propylene glycol diluent in lorazepam, phenobarbital and diazepam, may induce a hyperosmolar anion gap metabolic acidosis if given as a drip in high doses ≥ 48hrs.<ref>Arroliga AC, Shehab N, McCarthy K, Gonzales JP. Relationship of continuous infusion lorazepam to serum propylene glycol concentration in critically ill adults. Critical Care Medicine. 2004;32(8):1709–1714. doi:10.1097/01.CCM.0000134831.40466.39.</ref> Consider alternatives such as propofol or dexmedetomidine if patients need long term sedation for [[Delirum Tremens]]

	===Alpha-2 agonists ([[Dexmedetomidine]])===		===Alpha-2 agonists ([[Dexmedetomidine]])===

3amrbadawy at 17:40, 15 February 2016

2016-02-15T17:40:30Z

← Older revision		Revision as of 17:40, 15 February 2016
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	==See Also==		==See Also==
			*[[Beer Potomania Syndrome]]
			*[[Alcohol (ETOH) Intoxication]]
			*[[Alcoholic ketoacidosis]]
	*[[Alcohol withdrawal]]		*[[Alcohol withdrawal]]
			*[[Alcohol withdrawal: Inpatient management]]
			*[[Alcohol withdrawal: Outpatient management]]
	*[[Alcohol withdrawal seizures]]		*[[Alcohol withdrawal seizures]]
	*[[~~Alcohol withdrawal: Outpatient management~~]]		*[[Altered mental status]]
	*[[Delerium tremens]]		*[[Delerium tremens]]
			*[[EBQ:Outpatient use of benzodiazepines for the treatment of acute alcohol withdrawal]]
			*[[Sedative/Hypnotic]]
			*[[Wernicke-Korsakoff Syndrome]]

	==External Links==		==External Links==

3amrbadawy at 17:29, 15 February 2016

2016-02-15T17:29:19Z

← Older revision		Revision as of 17:29, 15 February 2016
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	**[[Magnesium sulfate]] 2mg IV		**[[Magnesium sulfate]] 2mg IV
	**Normal saline as needed for hydration		**Normal saline as needed for hydration

			==See Also==
			*[[Alcohol withdrawal]]
			*[[Alcohol withdrawal seizures]]
			*[[Alcohol withdrawal: Outpatient management]]
			*[[Delerium tremens]]

	==External Links==		==External Links==

3amrbadawy at 17:28, 15 February 2016

2016-02-15T17:28:56Z

← Older revision		Revision as of 17:28, 15 February 2016
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	**May repeat q15-20min for severe withdrawal (titrated to effect)		**May repeat q15-20min for severe withdrawal (titrated to effect)
	**Rarely causes hepatitis, as opposed to diazepam which may cause a cholestatic hepatitis<ref>National Institute of Diabetes and Digestive and Kidney Diseases. Lorazepam Drug Record. http://livertox.nih.gov/Lorazepam.htm</ref>		**Rarely causes hepatitis, as opposed to diazepam which may cause a cholestatic hepatitis<ref>National Institute of Diabetes and Digestive and Kidney Diseases. Lorazepam Drug Record. http://livertox.nih.gov/Lorazepam.htm</ref>

	===Alpha-2 agonists ([[Dexmedetomidine]])===		===Alpha-2 agonists ([[Dexmedetomidine]])===
	*Decrease severity of sxs, but only supplemental to GABA-ergic first-lines		*Decrease severity of sxs, but only supplemental to GABA-ergic first-lines
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	*Used when refractory to [[benzodiazepines]]		*Used when refractory to [[benzodiazepines]]
	* [[Phenobarbital]] 130-260 mg IV q 15-20 minutes		* [[Phenobarbital]] 130-260 mg IV q 15-20 minutes

			===[[Ketamine]]===
			*May have some use in refractory cases
			*Blocks the NMDA receptor which is excited an unregulated. <ref>Wong, A et al. Evaluation of adjunctive ketamine to benzodiazepines for management of alcohol withdrawal syndrome. Ann Pharmacother. 2015 Jan;49(1):14-9. PMID: 25325907</ref>

			===Nutritional supplementation===
			*Banana bag
			**Thiamine 100mg IV
			**Folate 1mg IV (cheaper PO)
			**MVI 1 tab IV (cheaper PO)
			**[[Magnesium sulfate]] 2mg IV
			**Normal saline as needed for hydration

	==External Links==		==External Links==