Severe manifestations include alcohol withdrawal seizures and delirium tremens. In patients who present with seizures, a thorough neurological and general alcohol withdrawal seizure medical evaluation is a must to detect alternative cause of seizures. Patients with new onset seizures should preferably undergo brain imaging.
However, it should be noted that the mean dose of phenobarbital used in this latter study was 260mg versus the 10mg/kg dose of phenobarbital used in the original study. Various regimens are described for outpatient management of alcohol withdrawal syndrome, but the simplest involve administering benzodiazepines with a short half-life and few metabolites to prevent the accumulation of sedating compounds. This drug is initially administered frequently and in higher doses, with gradual lengthening of the dosing interval and reduction of the dose over 1 week. Our review supports the use of benzodiazepines as first-line treatment of severe alcohol withdrawal in the ED.
You’re also at risk for AWS if you’ve previously had withdrawal symptoms or needed medical detox for a drinking problem. Benzodiazepines–are widely considered to be the drugs of choice to treat alcohol withdrawal and to prevent seizures. Clearly, detoxification and withdrawal are best handled with the aid of medical professionals. This is particularly true if you have a severe or long-term addiction to alcohol.
Timothy J. Legg, PhD, PsyD, CAADC, CARN-AP, MACAnswers represent the opinions of our medical experts. All content is strictly informational and should not be considered medical advice. We comply with applicable Federal https://ecosoberhouse.com/ civil rights laws and Minnesota laws. We do not discriminate against, exclude or treat people differently because of race, color, national origin, age, disability, sex, sexual orientation, gender, or gender identity.
Risk and severity-based management
Lum E, Gorman SK, Slavik RS. Valproic acid management of acute alcohol withdrawal. Barrons R, Roberts N. The role of carbamazepine and oxcarbazepine in alcohol withdrawal syndrome. The DTs are a very serious health emergency that can emerge during alcohol detox rather suddenly. The DTs are most common among those who have been heavy drinkers for a long time.
In such patients, diagnostic testing for other causes of altered mental status should be undertaken. Gamma hydroxybutyrate withdrawal can initially be treated with high doses of benzodiazepines, although anecdotally, refractory cases have responded to other sedative agents, such as pentobarbital, chloral hydrate, and baclofen. On occasion, patients in advanced alcohol withdrawal may be too combative to safely transport them or to apply physical restraints. In these cases, administer a sedative, such as lorazepam, before transport is attempted. However, more controlled clinical trials are needed to measure the efficacy of nonbenzodiazepines in the treatment of AWS and AUD.
Patients who are found to be in status epilepticus require escalating pharmaceutical intervention that may include concomitant airway management. Most treatment algorithms progress from benzodiazepines to phenytoin or fosphenytoin and then on to phenobarbital, valproic acid, propofol and pentobarbital. Once the patient is stabilized and immediate life threats are identified, the provider can move to further characterize the nature of the presentation. Sedative-hypnotic drugs are the primary agents for treatment of alcohol withdrawal syndrome because they are cross-tolerant drugs that modulate GABA functions. These medications commonly include benzodiazepines, barbiturates, dexmedetomidine, ketamine, propofol, and ethanol.
The current literature does not support the use of valproic acid/divalproex as a stand-alone treatment for AWS, though it may have some use as an adjunct. So, how do you use phenobarbital for AW in the ED and admitted patient? One is to load the patient with phenobarbital over a 30-minute period, with most studies and protocols using a 10mg/kg of ideal body weight loading dose. Phenobarbital doses of 130mg can be repeated every 30 minutes as needed and titrated to symptom relief, with a maximum of 1040mg in 24 hours.