Treatment of mild alcohol withdrawal is chiefly
benzodiazepines, chiefly Ativan or diazepam.
With more severe withdrawal, in which patients begin experiencing
delirium tremens, or begin to present as potential failure to maintain airway,
more intensive protocols should be used.
Increasing amounts of benzodiazepines is central for treatment, reducing
withdrawal sx, delirium tremens rates, seizures, and need for intubation. There are two other medications that have
been proven to effectively treat alcohol withdrawal. Phenobarbital
can be used as an adjunct with benzodiazepines, reducing length of stay and ICU
admission. In refractory alcohol
withdrawal cases Propofol is often used.
Propofol administration almost always requires intubation, and leads to
patients having a shorter hospital stay and shorter ICU stay. While CIWA protocol is commonly used for
admitted patients undergoing mild to moderate alcohol withdrawal, there is no
commonly used or accepted protocol for withdrawal in the acute setting or for
more severe withdrawal. Below is a
simple protocol using the above three medications suggested by Scott Weingart,
MD.
Weingart, adapted from Gold, et al in critical care journal
form 2010
Rosenson J, et al: Phenobarbital for acute alcohol withdrawal: a prospective randomized double-blind placebo-controlled study. J Emerg Med 2013 44:592-8
Sohraby R, et al: Use of propofol-containing versus benzodiazepine regimens for alcohol withdrawal requiring mechanical ventilation. Ann Pharmacother 2014 48:456-61.
from Dr. Aaron Ginster
special thanks to Neeraj Chhabra.
From Dr. Aaron Ginster
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