Experience with an Adult Alcohol Withdrawal Syndrome Practice Guideline in Internal Medicine Patients

Abstract

This pilot project suggests that internal medicine patients at risk for AWS can be managed with a standardized, symptom-triggered approach using decreased amounts of benzodiazepine in combination with adjunctive agents to treat adrenergic hyperactivity and delirium. Further data are necessary to determine the impact of the practice guideline on patient outcome measurements.

Alcohol withdrawal delirium - diagnosis, course and treatment

“…The total daily dose should be administered in at least 3-4 doses. It should not be used in patients with an increased risk of epilepsy because of its potential to lower the seizure threshold 91,92 . In delirium tremens, tiapride alone has not shown to be effective enough so its use should be limited to uncomplicated withdrawal 93 .…”

Alcohol Withdrawal: Development of a Standing Order Set

“…Studies 6,16,18,20 have shown that symptom-based treatment requires less benzodiazepine use. These studies suggest that symptom-triggered therapy allows more flexibility in dosing with fluctuations in scores on the Clinical Institute Withdrawal Assessment for Alcohol, revised (CIWA-Ar) and level of sedation, which results in less medication being required.…”

“…6 Less medication also lowers the cost for treatment of alcohol withdrawal. 6,16,18,20 Benzodiazepines possess better efficacy, a greater margin of safety, and lower abuse potential compared with barbiturates. 21 Long-acting benzodiazepines, such as chlordiazepoxide, are used for alcohol withdrawal because they have the advantage of self-tapering after stabilization.…”

“…Haloperidol was not recommended because it lowered the seizure threshold and prolonged the QT interval. 1,20 Oral chlordiazepoxide and/or intravenous lorazepam were chosen as the drugs to be incorporated into the standing order set. 1,6,15,17 Lorazepam was chosen because it has no active metabolites and has multiple dosing routes.…”

Avaliação do uso da clonidina para sedoanalgesia de pacientes sob ventilação mecânica prolongada, internados em unidade de terapia intensiva

“…Esses fármacos parecem ter mais efeito sedativo que analgésico 14,15 . A clonidina, um fármaco utilizado a longa data para o controle da hipertensão arterial, tem sido indicada para o controle de quadros de abstinência e para a otimização do controle da dor e da ansiedade durante procedimentos anestésicos [16][17][18][19][20][21][22][23] . Entretanto, existem poucos estudos que analisam esse fármaco como um sedoanalgésico para o controle da dor e da ansiedade dos pacientes críticos.…”