Transcript Alcohol withdrawal

UCI internal medicine
mini-lecture series
By Julia Kao
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Discuss the symptoms and signs of alcohol
withdrawal.
Discuss the management of alcohol
withdrawal.
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70-yo M with unknown PMHx was brought
into ED after being found down. Pt was found
to have displaced hip fracture and was taken to
OR for ORIF. Pt initially did well post-op, but
48 hrs after admission pt started having
tachycardia, hypertension, fever, and agitation.
What are some differential diagnosis?
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Vital signs q4h, cardiac monitoring, pulse
oximetry, fall/seizure/ aspiration precautions.
CIWA scores (components of CIWA: N/V,
sweats, anxiety, agitation, tremor, HA,
auditory/ visual/ tactile disturbances,
orientation and clouding of sensorium).
“banana bag”: NS with 100mg thiamine, 1g
folate, and multivitamin.
PRN IV Ativan 2mg for CIWA 10-15, 4mg for
CIWA> 15.
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Electrolyte replacement: especially watch out
for low K, low Mg, and low phos!
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Status epilepticus
Possible DTs, esp. persistent hyperthermia,
hemodynamic instability
Severe electrolyte or acid/base disturbances
Severe withdrawal symptoms, requiring large
amount of benzodiapezines.
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40-yo M with h/o alcohol abuse presented with
palpitations, nausea/ vomiting, and tremors.
Pt drinks half a gallon of vodka daily and
reports that his last drink was approximately
12 hours prior to admission. On further
questioning, pt reports history of alcohol
withdrawal seizures and has been admitted to
OSH ICUs in the past for alcohol withdrawal.
In the ED, pt is tremulous, afebrile, has regular
tachycardia, slightly hypertensive.
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Which protocol do you initiate to monitor and
manage withdrawal symptoms?
Which electrolytes do you check?
What IVF and medications do you order?
When is the pt at greatest risk for alcohol
withdrawal seizures? For DTs?
Under what circumstances would you call the
ICU?
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Depending on the time of last drink, there are
symptoms/ signs and possible complications
to watch out for and manage.
Initiate CIWA protocol when patient was
admitted with possibility of alcohol
withdrawal, include IV fluid, vitamins, and prn
lorazepam.
Don’t forget to check and replace electrolytes.
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