Internal Medicine

P1: SBT

0521779407-02 CUNY1086/Karliner 0 521 77940 7 June 7, 2007 19:18

88 Alcohol Abuse, Dependence, and Withdrawal

management

Alcohol intoxication

Supportive Measures

■Time-limited phenomenon

■Stop alcohol ingestion

■Provide protective environment

■No methods for accelerating alcohol removal or elimination

■In potentially fatal cases, hemodialysis can be used

Alcohol Withdrawal Syndromes

Supportive Measures

■Abstinence from alcohol

■Rest

■Adequate nutrition

■Restrain combative/agitated pts

■Monitor & correct: fluid balance, electrolytes, & vital signs frequen-

tly

specific therapy

■Adequate hydration: avoid overhydration

■Vitamin supplementation:

➣Thiamine IM/PO daily

➣Folate PO daily

➣Multivitamins

➣B complex vitamin daily

➣Vitamin K for bleeding disorder

■Sedation:

➣Benzodiazepines: gold standard treatment for alcohol with-

drawal

➣Benefits:

Excellent cross-coverage w/ all CNS depressants

Effective in ALL facets & degrees of alcohol withdrawal

Low mortality rate, minimal complication rate

➣Long-acting agents (long T1/2), allow for self-taper

➣In severe hepatic damage (& elderly), use lorazepam or oxa-

zepam, primarily metabolized by conjugation

■Alcohol withdrawal – diazepam loading protocol:

➣Mild withdrawal: diazepam 20 mg PO q 1h×^3

➣Moderate/severe withdrawal:

Diazepam 5–10 mg IV q 5–10 min

Repeat doses until sedation has been achieved