Alcohol withdrawal syndrome in medical patients

Abstract

The authors provide a critical review focusing on pharmacotherapy of alcohol withdrawal syndrome in hospitalized patients who are not critically ill. They outline recommendations for patient assessment and monitoring.

Implementing managed alcohol programs in hospital settings: A review of academic and grey literature

“…Patients who are undertreated for withdrawal may have difficulty maintaining abstinence which is frequently a necessary condition for receiving inpatient care [13]. Patients experiencing uncomfortable symptoms or cravings may leave the unit and return intoxicated, consume hand sanitiser or other sources of non-beverage alcohol, leave against medical advice, or be prematurely discharged for intoxication or erratic behaviour [13,16,[22][23][24][25][26][27][28][29]. As a result, patients with AUDs are at an increased risk of readmission within 15 days for the same initial diagnosis when compared to other patients [30].…”

“…Although many health‐care providers will encounter patients with AUDs, there is currently no single accepted protocol for treating alcohol withdrawal syndrome (AWS) in hospital inpatients . AWS is typically treated with benzodiazepines using either symptom‐triggered or fixed‐dose regimens .…”

Substance use disorders: diagnosis and management for hospitalists

“…Thiamine should be administered before administration glucose-containing fluids in order to prevent acute onset or worsening of preexisting Wernicke encephalopathy. Severe electrolyte abnormalities that are often found in alcohol withdrawal should be treated to prevent cardiac arrhythmias [14]. Patients with alcohol withdrawal should be assessed periodically by the Revised Clinical Institute Withdrawal Assessment for Alcohol (CIWA-Ar) protocol [15].…”

“…Lorazepam remains the most common benzodiazepine used for withdrawal because of its short half-life and lack of active metabolites [17]. Oxazepam is also short acting with no active metabolite, whereas diazepam and chlordiazepoxide are long-acting benzodiazepines and have long-acting metabolites [14].…”

“…Thiamine should be administered before administration glucose-containing fluids in order to prevent acute onset or worsening of preexisting Wernicke encephalopathy. Severe electrolyte abnormalities that are often found in alcohol withdrawal should be treated to prevent cardiac arrhythmias [ 14 ].…”