Caring for hospitalized patients with alcohol withdrawal syndrome

Elliott, Dolores Y.

doi:10.1097/01.ccn.0000578828.37034.c2

Cited by 10 publications

(28 citation statements)

References 23 publications

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“…39 Adjuvant medications for AWS Barbiturates, such as phenobarbital, have been used as an adjuvant alternative to BZDs because they stimulate GABA receptors and inhibit the production of NMDA receptor sites. 8,13,14,44 However, phenobarbital produces more respiratory depression than BZDs, especially in older adults and patients with pulmonary disease. 13,14,44 Dexmedetomidine (I.V.)…”

Section: Nursing Considerationsmentioning

confidence: 99%

“…13 They lower BP and heart rate and are a valuable adjuvant to BZDs, but they do not prevent seizures or DTs. 8,13 Baclofen, a selective agonist of the GABA-B receptor, treats muscle spasticity. Baclofen has been used as an adjuvant treatment to reduce agitation and alcohol cravings in AWS.…”

Section: Selected Assessment Findings Suggestive Of Audmentioning

confidence: 99%

“…Perceptual alterations can include having nightmares, hearing voices, and seeing animals crawling in the room or on the person 29. Nonpharmacologic interventions include frequent reality orientation and reassurance 8,13,14,16,29. Approximately 3% to 10% of people with AWS develop DTs 8,13,14,16,29…”

Section: Nursing Considerationsmentioning

confidence: 99%

“…Dexmedetomidine (I.V.) is an alpha-2 agonist that reduces anxiety and autonomic hyperactivity and has shown promising results as an adjuvant to BZDs for patients with AWS in the ICU 13. Propofol (I.V.…”

Section: Nursing Considerationsmentioning

confidence: 99%

“…The hyperexcitability state occurs 6 to 24 hours after a person' s last drink following a period of EAC and may last 3 to 7 days. 7,13,14 EAC is defined as when a man consumes 4 or more drinks in a day or 14 or more in 7 days, and a woman consumes 3 or more drinks in a day or 7 or more in 7 days. 15 A person who consumes more than 8 drinks daily for several days is more likely to experience AWS (see US standard drink sizes).…”

Section: Clinical Manifestationsmentioning

confidence: 99%

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Alcohol withdrawal syndrome

Pullen

2023

Nursing

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Section: Nursing Considerationsmentioning

confidence: 99%

Section: Selected Assessment Findings Suggestive Of Audmentioning

confidence: 99%

Section: Nursing Considerationsmentioning

confidence: 99%

Section: Nursing Considerationsmentioning

confidence: 99%

Section: Clinical Manifestationsmentioning

confidence: 99%

See 3 more Smart Citations

Alcohol withdrawal syndrome

Pullen

2023

Nursing

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Does electronic medical record redesign increase screening of risk for pressure injury, falls and substance use in the Emergency Department? An implementation evaluation

Curtis

Qian

et al. 2021

Australasian Emergency Care

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Phenobarbital treatment of alcohol withdrawal in the emergency department: A systematic review and meta‐analysis

Lee,

Dillon,

Tahir

et al. 2024

Academic Emergency Medicine

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ObjectiveDespite frequent treatment of alcohol withdrawal syndrome (AWS) in the Emergency Department (ED), evidence for phenobarbital as an ED alternative therapy is mixed. We conducted a systematic review and meta‐analysis comparing safety and efficacy of phenobarbital (PB) to benzodiazepines (BZD) for treatment of AWS in the ED.MethodsWe searched articles and references published in English in PubMed, Web of Science, and Embase from inception through May 2022. We included randomized trials and cohort studies comparing treatment with phenobarbital to benzodiazepine controls, and excluded studies focused on non‐AWS conditions. Review was conducted by two blinded investigators and a third author; 8 of 59 (13.6%) abstracts met inclusion criteria for review and meta‐analysis using a random‐effects model. Treatment superiority was evaluated through utilization, pharmacologic, and clinical outcomes. Primary outcomes for meta‐analysis were the proportion of patients (1) admitted to the intensive care unit (ICU), (2) admitted to the hospital, (3) readmitted to the ED after discharge, and (4) who experienced adverse events.ResultsEight studies (2 randomized controlled trials, 6 retrospective cohorts) comprised data from 1,507 patients in 2,012 treatment encounters for AWS. All studies were included in meta‐analysis for adverse events, 7 for hospital admission, 5 for ICU admission, and 3 for readmission to the ED after discharge. Overall methodological quality was low‐moderate, risk of bias moderate‐high, and statistical heterogeneity moderate. Pooled relative risk of ICU admission for those treated with PB vs. BZD was 0.92 (95% CI 0.54‐1.55). Risk for admission to the hospital was 0.98 (95% CI 0.89‐1.07) and for any adverse event was 1.1 (95% CI 0.78, 1.57); heterogeneity prevented meta‐analysis for ED readmission.ConclusionsThe current literature base does not show that treatment with phenobarbital significantly reduces ICU admissions, hospital admissions, ED readmissions, or adverse events in ED patients with AWS compared with benzodiazepines alone.

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Caring for hospitalized patients with alcohol withdrawal syndrome

Cited by 10 publications

References 23 publications

Alcohol withdrawal syndrome

Alcohol withdrawal syndrome

Does electronic medical record redesign increase screening of risk for pressure injury, falls and substance use in the Emergency Department? An implementation evaluation

Phenobarbital treatment of alcohol withdrawal in the emergency department: A systematic review and meta‐analysis

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