Is your medical/surgical patient withdrawing from alcoho

Abstract

Look beyond the stereotype. Any hospitalized patient could be dependent on alcohol-and at risk for alcohol withdrawal syndrome.

Alcohol Withdrawal: Development of a Standing Order Set

“…Such comorbid conditions include dehydration, infection, respiratory disease, thyrotoxicosis, anticholinergic drug poisoning, amphetamine or cocaine use, hemorrhage, and withdrawal from sedative-hypnotic agents. 1,4,16 The signs and symptoms of alcohol withdrawal may be confused with other problems common in critical care patients such as electrolyte imbalances, pain, and infection. 3 Delirium tremens typically begin between 2 and 4 days after the last drink and last less than a week.…”

“…Thiamin is also needed for the metabolism of glucose. 9,16 As a result, thiamine, folic acid, and multivitamins were included in the 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.…”

“…1,13,16 Patients with AWS experience electrolyte imbalances in potassium, magnesium, and phosphate due to changes in renal function, altered absorption/reabsorption, poor dietary intake, and vomiting. Alcohol also induces a diuretic effect that leads to dehydration.…”