Blood alcohol concentration for monitoring ethanol treatment to prevent alcohol withdrawal in the intensive care unit

Abstract

There is a high failure rate for i.v. ethanol prophylaxis. None of the methods to determine alcohol concentration were sufficient to monitor suitable ethanol treatment. It therefore seems to be more useful to titrate the individual dose for each patient by closer monitoring of the clinical status, adding additional therapy to counteract AWS if higher ethanol doses are required.

Alcohol withdrawal syndromes in the intensive care unit

“…Outcomes between the two groups were similar with only one patient in the intravenous ethanol group being diagnosed with asymptomatic hyponatremia (78). In a separate set of studies, intravenous ethanol failed to prevent the onset of severe alcohol withdrawal in nearly 35% of at-risk postoperative surgical patients with 10% of treated subjects having symptoms of congestive heart failure in a related study by the same group (compared with 0% for benzodiazepine-containing regimens) (79,80). Again, serum ethanol levels were not predictive of failure (80).…”

Alcohol Withdrawal Syndrome: Turning Minor Injuries Into a Major Problem

“…8 Even with prophylactic treatment to prevent AWS after elective surgery, 25% of patients develop clinical manifestations. 15 Chronic alcohol consumption is associated with a threefold to fourfold risk of infections, sepsis, and cardiac and bleeding complications. 16 It is therefore recommended that patients be evaluated for a history of dependence.…”

“…A total of 6,431 trauma patients aged15 years or younger with an ISS of Ͻ16 were treated at our facility between July 1999 and February 2004. Of this group, 55 (0.9%) developed AWS.…”

A rational approach to the treatment of alcohol withdrawal in the ED

“…However, the many disadvantages of ethanol use for this purpose-the need to monitor blood levels, the unpredictable elimination kinetics, and many other possible adverse effects-make it difficult to use this treatment safely and reliably [54][55][56]. A few recent studies have compared ethanol to other commonly used medications and demonstrated no advantage of ethanol with respect to efficacy or adverse sedative effects [57][58][59].…”