Alcohol withdrawal: Inpatient management: Difference between revisions

Revision as of 17:28, 15 February 2016

Start aggressive Benodiazepine therapy at CIWA score of 8. Consider ICU admission with score >20

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^[1]

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

↑ National Institute of Diabetes and Digestive and Kidney Diseases. Lorazepam Drug Record. http://livertox.nih.gov/Lorazepam.htm

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 ==Management==
+''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>
+===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
 ==External Links==