Alcohol withdrawal: Inpatient management: Difference between revisions

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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==

Revision as of 17:28, 15 February 2016

Management

Start aggressive 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[1]

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)

Ketamine

  • May have some use in refractory cases
  • Blocks the NMDA receptor which is excited an unregulated. [2]

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

References

  1. ↑ National Institute of Diabetes and Digestive and Kidney Diseases. Lorazepam Drug Record. http://livertox.nih.gov/Lorazepam.htm
  2. ↑ 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
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