How is alcohol withdrawal syndrome best managed in the emergency department?

Jane, Louise

doi:10.1016/j.ienj.2009.09.001

Cited by 6 publications

(2 citation statements)

References 29 publications

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“…One of the features of chronic alcohol intake is the development of physical dependence, resulting in physical withdrawal reactions after cessation of alcohol. Alcohol withdrawal includes symptoms such as neural excitation (seizures), disorientation, anxiety and agitation [ 27 ].…”

Section: Discussionmentioning

confidence: 99%

Role of Standardized Plant Extracts in Controlling Alcohol Withdrawal Syndrome—An Experimental Study

et al. 2021

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Patients with alcohol use disorder experience alcohol withdrawal syndrome due to the sudden cessation of alcohol. This study was designed to evaluate the protective effect of Ashwagandha and Brahmi on alcohol withdrawal in rats. Thirty rats of either sex were taken and randomly divided into 6 groups (n = 5). Their normal diet was replaced by a modified liquid diet (MLD). Ethanol was added gradually except in the MLD group for a period of 21 days and withdrawn suddenly. Four treatment groups were administered Ashwagandha (3.75 mg of withanolide glycosides per kg body weight), Brahmi (10 mg of bacosides per kg body weight), Ashwagandha + Brahmi (3.75 mg withanolide glycosides + 10 mg bacosides per kg body weight) orally and diazepam (1 mg/kg body weight, i.p.) 45 min before alcohol withdrawal. Rats were assessed for behavioural changes (agitation score and stereotypic behaviour), anxiety and locomotor activity at 2nd and 6th hours of alcohol withdrawal. Pentylenetetrazol (PTZ) kindling seizures were assessed at 6th hour of alcohol withdrawal. Ashwagandha and Brahmi alone and in combination significantly reduced the behavioural changes in alcohol withdrawal rats at 2nd hour and their combination in 6th hour. Ashwagandha and Brahmi suppressed PTZ kindling seizures effectively and improved locomotory activity at 2nd hour and 6th hour of alcohol withdrawal. Reduction in anxiety was significant among Ashwagandha at 2nd hour and the combination group at 2nd and 6th hour. The results were comparable to diazepam. Ashwagandha and Brahmi have beneficial effects in controlling the behavioural changes, anxiety and seizures in alcohol withdrawal symptoms in rats and improved locomotory activity.

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Section: Discussionmentioning

confidence: 99%

Role of Standardized Plant Extracts in Controlling Alcohol Withdrawal Syndrome—An Experimental Study

et al. 2021

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“…While undertreatment of AWS patients requiring benzodiazepines is a concern, unnecessary administration of benzodiazepines to patients with mild withdrawal symptoms is also problematic . Excessive benzodiazepine treatment is likely to increase sedation, potentially prolong ED length of stay and divert nursing resources from other ED patients.…”

Section: Discussionmentioning

confidence: 99%

Evaluation of a Web‐based Educational Program to Teach the Identification and Management of Alcohol Withdrawal in the Emergency Department

Thompson

McLeod

Perelman

et al. 2018

AEM Education and Training

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Background: Ideal management of alcohol withdrawal syndrome (AWS) incorporates a symptom-driven approach, where patients are regularly assessed using a standardized scoring system (Clinical Institute Withdrawal Assessment for Alcohol-Revised [CIWA-Ar]) and treated according to severity. Accurate administration of the CIWA-Ar requires experience, yet there is no training program to teach this competency. The objective of this study was to develop and evaluate a curriculum to teach clinicians how to accurately assess and treat AWS.Methods: This was a three-phase education program consisting of a series of e-learning modules containing core competency material, an in-person seminar to orient learners to high-fidelity simulation, and a summative evaluation in an objective structured clinical examination setting using a standardized patient. To determine the impact of the AWS curriculum, we recorded how often the CIWA-Ar was appropriately applied in the emergency department (ED) before and after training. A CIWA-Ar protocol breach was defined as inappropriate administration of benzodiazepines (CIWA-Ar < 10) and failure to administer benzodiazepines when required (CIWA-Ar ≥ 10). ED length of stay, amount of benzodiazepines administered in the ED, discharge prescriptions, and unit doses (takeaway bottle of four tablets) of benzodiazepine given were recorded.Results: Seventy-four ED nurses completed the curriculum over an 8-week period. In the 5 months prior to the educational program delivery, we identified 144 of 565 (25.5%) CIWA-Ar protocol breaches, compared to 64 of 547 (11.7%) in the 5 months after training (Δ13.8%, 95% confidence interval [CI] = 9.3%-18.3%). Program completion resulted in a reduction in the median total dose of diazepam administered in the ED (40 mg vs. 30 mg, Δ10 mg, 95% CI = 0-20 mg) and no change was detected in ED length of stay and benzodiazepines prescribed.Conclusions: Completion of this curriculum resulted in better compliance with the CIWA-Ar protocol by those who administer the CIWA-Ar; however, changes in inappropriate benzodiazepine prescribing practice will require future interdisciplinary initiatives.

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