- Discussion:
- onset- usually a few hours to 10 days after last drink (Usually 6-48 hr);
- early symptoms: tend to be mild;
- nausea, vomiting, anorexia, insomnia, diaphoresis, agitation, tachycardia,
HTN, if
seizures occur,
- common abstinence syndrome, occurring at 6-8 hr, is the earliest withdrawl syndrome and is often present when the patient awakens;
-
seizures appear at 7 to 48 hr and are usually single rather than recurrent;
- alcoholic ketoacidosis is usually seen later at 24 to 72 hrs;
- late symptoms: tend to be severe; worsening of above symptoms,
- Delerium Tremens:
- acute psychosis with hallucinations, delusions, disorientation, agitation; DT's 5-15% fatal w/o treatment, <1% treated;
- DT is usually seen at 3-5 days, but may be seen as late as 14 days;
* Treatment:
- provide
thiamine -
chlordiazepoxide has been widely marketed and used for ETOH withdrawl.
-
Diazepam,
Lorazepam,
Oxazepam have more rapid onset of action and greater anticonvulsant activity;
- both Chlordiazepoxide and Diazepam are poor drugs when given IM because their absorption is slow, erratic, and incomplete;
- when treating ETOH withdrawl, the required dosage of benzodiazepine may be quite large and should be carefully titrated to the symptoms;
-
Note that the following are NOT recomended: - Barbiturates (Resp Depression, Drug Interactions),
- Antihistamines (Anticholinergic effects may worsen toxic psychotic symptoms);
-
Antipsychotics (contraindicated because of risk of orthostatic hypotension and
Seizures);
Emergency department treatment of alcohol withdrawal seizures with phenytoin.
Comparison of intravenous ethanol versus diazepam for alcohol withdrawal prophylaxis in the trauma ICU: results of a randomized trial.
