Factors predictive of complicated or severe alcohol withdrawal in alcohol dependent inpatients

Mennecier, D; Thomas, Michael C.; Arvers, Philippe; Corberand, D.; Sinayoko, L.; Bonnefoy, S.; Harnois, Florence; Thiolet, C

doi:10.1016/j.gcb.2008.06.004

Cited by 37 publications

(61 citation statements)

References 16 publications

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“…Severe AWS more than doubles the length of stay and frequently requires treatment at the ICU. A complicated AWS includes epileptic seizures and/or delirium tremens (DT), the occurrence of which may be as high as 15% in AUD patients 4, 5. Delirious patients show high rates of comorbidities, and their mortality rate is comparable to patients having severe malignant diseases.…”

Section: Introduction ‐ Medical Burden Of Alcohol Abusementioning

confidence: 99%

Alcohol withdrawal syndrome: mechanisms, manifestations, and management

et al. 2016

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The alcohol withdrawal syndrome is a well‐known condition occurring after intentional or unintentional abrupt cessation of heavy/constant drinking in patients suffering from alcohol use disorders (AUDs). AUDs are common in neurological departments with patients admitted for coma, epileptic seizures, dementia, polyneuropathy, and gait disturbances. Nonetheless, diagnosis and treatment are often delayed until dramatic symptoms occur. The purpose of this review is to increase the awareness of the early clinical manifestations of AWS and the appropriate identification and management of this important condition in a neurological setting.

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Section: Introduction ‐ Medical Burden Of Alcohol Abusementioning

confidence: 99%

Alcohol withdrawal syndrome: mechanisms, manifestations, and management

et al. 2016

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“…Though the inherent risks of alcohol withdrawal are undisputed, a recently published study concluded that the mortality rate attributed to alcohol withdrawal syndrome has decreased since the beginning of the last century, especially in critical care units (20, 21). A number of factors have contributed to these improved survival rates, including improved management of delirium tremens, placement of patients in a carefully monitored ICU setting, and increased rates of timely endo tracheal intubation (21, 22). Improved nursing management of these patients has also led to improved survival through early identification of patients at risk and development of standardized care protocols (17, 23, 24).…”

Section: Discussionmentioning

confidence: 99%

Alcohol Withdrawal Prevention: A Randomized Evaluation of Lorazepam and Ethanol--A Pilot Study

Fullwood

Mostaghimi²,

Granger³

et al. 2013

American Journal of Critical Care

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Background Alcohol withdrawal syndrome, characterized by a hyperadrenergic state with confusion, agitation and hallucinations, has detrimental effects on patient safety in the context of acute myocardial infarction (MI). Unexpected hospitalization and sudden cessation of alcohol consumption may result in adverse outcomes including in-hospital complications, increased length of stay, and death. Strategies for safe and effective patient management have not been rigorously studied. Purpose We conducted a randomized evaluation of lorazepam and ethanol/lorazepam to evaluate the safety and efficacy of two strategies for the prevention of alcohol withdrawal syndrome in patients with acute coronary syndromes. Methods Patients (n=57) with myocardial infarction were screened for alcohol dependence using the CAGE questionnaire and randomized to lorazepam or to ethanol with lorazepam. Demographic group differences and complication rates were analyzed using chi square (categorical variables) and t-tests (continuous variables). Safety (composite complication rates) of the treatment strategy was evaluated using Fisher’s exact test. Length of stay was analyzed using Wilcoxon rank-sum test. Results Safety-associated complication rates (self-extubation, delirium tremens, re-infarction) were not different between groups (24% lorazepam vs. 18% ethanol; p=0.56). A trend toward fewer complications in the ethanol group was noted. In addition, no difference was detected between the treatment groups for days spent in the CCU (6.9% lorazepam vs. 2.4% ethanol; p = 0.32) or overall hospital stay (6.2% lorazepam vs. 6.4% ethanol; p = 0.72). Conclusions These findings suggest that a randomized evaluation of treatment strategies to prevent complications associated with alcohol withdrawal in acute MI is safe and feasible. A larger study may provide important evidence for improving clinical outcomes for patients experiencing alcohol withdrawal during acute myocardial infarction.

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“…20 ). Other reviews showed the expectation of experiencing withdrawal delirium to be 4-15% for alcoholdependent individuals 21,22 . Delirium develops in 5-20% of patients treated for alcohol withdrawal syndrome 10,11,23,24 , with the rates varying from study to study from 1.25% to 33%.…”

Section: Prevalencementioning

confidence: 99%

“…Low sensitivity of all these laboratory parameters impede their routine clinical use in predicting severe withdrawal 48,49 . A study of 182 alcohol-dependent individuals showed significant association of early emergency management and serum ALT level above 1.5-fold the upper limit and severe withdrawal symptoms 21 . In other studies, the frequency of thrombocytopenia or functional changes of platelets was much higher in patients developing delirium or seizures 12,50 .…”

Section: Preventive Measuresmentioning

confidence: 99%