Will This Hospitalized Patient Develop Severe Alcohol Withdrawal Syndrome?

Wood, Evan; Albarqouni, Loai; Tkachuk, Stacey; Green, Carolyn J.; Ahamad, Keith; Nolan, Seonaid; McLean, Mark; Klimas, Jan

doi:10.1001/jama.2018.10574

Cited by 76 publications

(82 citation statements)

References 61 publications

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“…The majority of individuals with alcohol use disorder who are at risk for AWS-those with prolonged and heavy drinking-experience only minor, uncomplicated withdrawal symptoms. [20][21][22] These symptoms include increased anxiety, headache, nausea, vomiting, insomnia, and mild tremors. Uncomplicated alcohol withdrawal can also include mild to moderate autonomic hyperactivity of tachycardia, hypertension, and hyperthermia.…”

Section: Stages Of Awsmentioning

confidence: 99%

“…23 Hallucinations begin 8-12 hrs after the last drink and include auditory, visual, tactile, gustatory and olfactory hallucinations. 20,23 In this stage of AWS, individuals may experience paranoia and other delusions as well, though importantly they maintain a clear sensorium, thus differentiating it from DTs. Alcohol withdrawal hallucinations should be only judiciously treated with antipsychotics as these medications can mask the symptoms of progressing withdrawal and delay definitive treatment.…”

Section: Stages Of Awsmentioning

confidence: 99%

“…21 PAWSS has been found to be the most accurate of predictive tools in inpatient medical settings. 20 The PAWSS factors in the Blood Alcohol Level (BAL) and the presence of autonomic hyperactivity, as well as the presence or absence of several other factors detailed in Figure 2; 21 anecdotally, some services have found a higher, more specific cutoff necessary for guiding treatment.…”

Section: Stages Of Awsmentioning

confidence: 99%

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<p>Management of Alcohol Withdrawal in the Emergency Department: Current Perspectives</p>

Wolf

Curry

Nacht

et al. 2020

OAEM

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Alcohol withdrawal syndrome (AWS) is a common, heterogenous, and lifethreatening complication of alcohol use disorder (AUD). AUD is a leading cause of worldwide mortality, and many patients with AUD will develop AWS during their ED course. This review summarizes the epidemiology, pathology, and management of AWS and AUD in the emergency setting. The time course of AWS and its impact on ED treatment is emphasized. Once AWS is diagnosed, symptom-triggered benzodiazepine administration remains the most commonly provided treatment but may not be appropriate for patients with significant medical or psychiatric comorbidity or pending discharge. In these cases, ED clinicians may consider short courses of barbiturates or alternative regimens based on novel anticonvulsants. Specific treatment protocols are enumerated for clinical practice. Finally, emergency providers must not only manage acute patients' AWS but also lay the foundation for successful treatment of AUD. An approach to the disposition of the patient with AUD is presented. The authors examine shortcomings in the extant literature and suggest opportunities for further study.

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Section: Stages Of Awsmentioning

confidence: 99%

Section: Stages Of Awsmentioning

confidence: 99%

Section: Stages Of Awsmentioning

confidence: 99%

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<p>Management of Alcohol Withdrawal in the Emergency Department: Current Perspectives</p>

Wolf

Curry

Nacht

et al. 2020

OAEM

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“…Screening of patients at risk of developing AWS is usually based on validated questionnaires about alcohol consumption habits and biomarkers [19]. For the perioperative setting, question-based self-reporting tests can detect AUD.…”

Section: Identifying Patients At Risk: Screening and Prophylaxismentioning

confidence: 99%

Perioperative Management of Alcohol Withdrawal Syndrome

et al. 2020

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Background: In the perioperative course, alcohol withdrawal syndrome (AWS) can occur in any setting, especially in aero-digestive and acute trauma surgery. Challenging issues are the overlap of other forms of delirium in perioperative and intensive care settings as well as general anesthesia masking the onset of withdrawal symptoms. In contrast to other etiologies of delirium, the pathophysiology and thus treatment strategy of AWS is different: the key point is the tolerance to GABAergic molecules of alcohol-dependent subjects resulting in central nervous hyperactivity once the effect of alcohol or other GABA-stimulating agents is decreased. Summary: Despite limitations due to insufficient accuracy of self-reporting questionnaires and limited feasibility in emergency settings, the AUDIT and the shortened AUDIT-C are the standard tools for detection of alcohol use disorders (AUD), as well as predicting AWS risk and severity in approximately half of these AUD patients. The most important risk factors for AWS are a high blood alcohol concentration at hospital admission, AWS episodes in medical history, and lack of control of alcohol use. Patients considered at risk for severe AWS must be treated with prophylactic medication before the onset of symptoms. Thiamine supplementation is required for all malnourished alcohol-dependent patients. Writing down alcohol-related diagnoses in the medical records requires the patient's presumed consent after shared decision-making. These reports should remain strictly confidential if the patient desires. Psychological support for the perioperative period as well as the following course should be offered to all AUD patients including support in short-and long-term detoxification. Alternative diagnoses must be ruled out with no timely delay, especially if fever and coma are the leading symptoms. The backbone of AWS therapy is the symptom-triggered administration of intravenous benzodiazepines (BZO) in escalating doses until the aimed revised Clinical Institute Withdrawal Assessment for Alcohol Scale (CIWA-Ar) or Richmond Agitation-Sedation Scale (RASS) score is achieved. Clonidine, dexmedetomidine, baclofen, ketamine, and neuroleptics may be used as symptom-orientated adjuncts. The therapeutic administration of ethanol or clomethiazole is considered to be harmful in critically ill patients after the onset of AWS. General supportive and intensive care including high-dose thiamine supplementation are mandatory in severe AWS cases. The timely differential diagnosis of delirium is important-and AWS is a diagnosis of exclusion-because BZO are strongly recommended for AWS patients but may not be the treatment of

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“…Ein Delir ist eine mögliche Komplikation eines Alkoholentzuges und wird diagnostiziert, wenn beide Symptomkomplexe, Delir und Alkoholentzugssymptomatik, zeitgleich auftreten. Es wurde geschätzt, dass bis zu 5 % der PatientInnen, die wegen eines Alkoholentzugs stationär aufgenommen werden, ein schweres Delir entwickeln [70]. Alkohol hat GABAA-agonistische und NMDA-Rezeptor-antagonistische Effekte.…”

Section: Alkoholentzugsdelirunclassified