Version June 2024
| To obtain emergency consultation with a medical toxicologist, in the United States, call 1-800-222-1222 for the nearest regional poison control center. Contact information for poison control centers around the world is available at the WHO website and in the UpToDate topic on regional poison control centers (society guideline links). |
| Syndromes |
| Alcohol tremulousness – occurs early; characterized by hypertension, tachycardia, tremors, and anxiety with normal mental status |
| Alcohol withdrawal seizures – occurs early; usually single or brief flurry of seizures with short postictal period |
| Alcoholic hallucinosis – occurs early; no evidence of autonomic instability |
| Delirium tremens – occurs late; characterized by delirium and autonomic instability |
| History |
| Pattern of alcohol use, history of withdrawal symptoms; inquire about reasons for cessation of alcohol |
| Physical examination |
| Vital signs, mental status, presence of tremor; examine for signs of trauma, abdominal tenderness, other findings consistent with complications of chronic alcohol use |
| Laboratory testing |
| No test truly assesses withdrawal; ancillary data (eg, serum ethanol concentration, lumbar puncture [CSF], head CT, lipase) frequently needed to assess patient and rule out coexistent illness |
| Treatment |
| Benzodiazepines |
| First-line therapy for ALL alcohol withdrawal syndromes |
| Most patients with symptoms require IV therapy initially |
| Give: |
|
|
| Massive doses (>2000 mg diazepam in 48 hours) may be required |
| Clinically stable patients with minimal symptoms may be treated with oral medications |
| Barbiturates |
| Synergistic with benzodiazepines; give if patient refractory to high-dose benzodiazepines |
| Phenobarbital 130 to 260 mg IV, repeat every 15 to 20 minutes |
| Intubation frequently required with concurrent benzodiazepine and barbiturate use |
| ALL patients requiring barbiturates are monitored in an intensive care unit |
| Propofol |
| Excellent agent if patient refractory to benzodiazepines and barbiturates |
| Intubation almost always required |
| 1 mg/kg IV push as induction agent for intubation; titrate continuous infusion for sedation |
| Supportive care |
| Ensure adequate fluid and provide electrolyte replacement as needed |
| Give parenteral thiamine* 100 to 200 mg and glucose daily |
| Give multivitamin containing or supplemented with folic acid |
| Ensure adequate caloric support |
CSF: cerebrospinal fluid; CT: computed tomography; IV: intravenous.
* The thiamine dose range provided is for the prevention of Wernicke encephalopathy (WE). Treatment of diagnosed WE requires higher doses. Refer to UpToDate topic discussing WE for details.آیا می خواهید مدیلیب را به صفحه اصلی خود اضافه کنید؟
