&lt;p&gt;Management of Alcohol Withdrawal in the Emergency Department: Current Perspectives&lt;/p&gt;

Wolf, Chelsea; Curry, Ashley; Nacht, Jacob; Simpson, Scott A.

doi:10.2147/oaem.s235288

Cited by 55 publications

(58 citation statements)

References 93 publications

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“…Among heavy alcohol users admitted for hospital management, the incidence of alcohol withdrawal syndrome is estimated to be 1.9 to 6.7% [ 6 ]. Many patients with alcohol use disorder will require management of alcohol withdrawal during their ED visit [ 7 , 8 ]. Alcohol withdrawal in the ED has been associated with increased use of critical care resources [ 9 ], and frequent ED visits for alcohol-related presentations have been associated with high relative mortality rates [ 1 , 10 ].…”

Section: Introductionmentioning

confidence: 99%

“…ED clinicians are responsible for risk-stratifying patients with alcohol withdrawal syndrome under time and resource constraints, and must reliably identify those who are safe for outpatient management versus those who require more intensive levels of care [7]. Published clinical guidelines recommend stratifying patients with alcohol withdrawal based on their risk of developing complications (e.g., generalized tonic-clonic seizures and delirium tremens) [15][16][17][18].…”

mentioning

confidence: 99%

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Prevention of alcohol withdrawal seizure recurrence and treatment of other alcohol withdrawal symptoms in the emergency department: a rapid review

et al. 2021

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Background Patients who experience harms from alcohol and other substance use often seek care in the emergency department (ED). ED visits related to alcohol withdrawal have increased across the world during the COVID-19 pandemic. ED clinicians are responsible for risk-stratifying patients under time and resource constraints and must reliably identify those who are safe for outpatient management versus those who require more intensive levels of care. Published guidelines for alcohol withdrawal are largely limited to the primary care and outpatient settings, and do not provide specific guidance for ED use. The purpose of this review was to synthesize published evidence on the treatment of alcohol withdrawal syndrome in the ED. Methods We conducted a rapid review by searching MEDLINE, Embase, and the Cochrane Central Register of Controlled Trials (1980 to 2020). We searched for grey literature on Google and hand-searched the conference abstracts of relevant addiction medicine and emergency medicine professional associations (2015 to 2020). We included interventional and observational studies that reported outcomes of clinical interventions aimed at treating alcohol withdrawal syndrome in adults in the ED. Results We identified 13 studies that met inclusion criteria for our review (7 randomized controlled trials and 6 observational studies). Most studies were at high/serious risk of bias. We divided studies based on intervention and summarized evidence narratively. Benzodiazepines decrease alcohol withdrawal seizure recurrence and treat other alcohol withdrawal symptoms, but no clear evidence supports the use of one benzodiazepine over another. It is unclear if symptom-triggered benzodiazepine protocols are effective for use in the ED. More evidence is needed to determine if phenobarbital, with or without benzodiazepines, can be used safely and effectively to treat alcohol withdrawal in the ED. Phenytoin does not have evidence of effectiveness at preventing withdrawal seizures in the ED. Conclusions Few studies have evaluated the safety and efficacy of pharmacotherapies for alcohol withdrawal specifically in the ED setting. Benzodiazepines are the most evidence-based treatment for alcohol withdrawal in the ED. Pharmacotherapies that have demonstrated benefit for treatment of alcohol withdrawal in other inpatient and outpatient settings should be evaluated in the ED setting before routine use.

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Section: Introductionmentioning

confidence: 99%

mentioning

confidence: 99%

Prevention of alcohol withdrawal seizure recurrence and treatment of other alcohol withdrawal symptoms in the emergency department: a rapid review

et al. 2021

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“…1,10 ED clinicians are responsible for risk-stratifying patients with alcohol withdrawal syndrome under time and resource constraints, and must reliably identify those who are safe for outpatient management versus those who require more intensive levels of care. 7 Published clinical guidelines recommend stratifying patients with alcohol withdrawal based on their risk of developing complications (e.g., generalized tonic-clonic seizures and delirium tremens). [11][12][13][14] These guidelines are largely limited to the primary care and outpatient settings and do not provide speci c guidance for ED clinicians.…”

Section: Rationalementioning

confidence: 99%

“…6 Many patients with alcohol use disorder will require management of alcohol withdrawal during their ED visit. 7,8 Alcohol withdrawal in the ED has been associated with increased use of critical care resources, 9 and frequent ED visits for alcohol-related presentations have been associated with high relative mortality rates. 1,10 ED clinicians are responsible for risk-stratifying patients with alcohol withdrawal syndrome under time and resource constraints, and must reliably identify those who are safe for outpatient management versus those who require more intensive levels of care.…”

Section: Introduction Rationalementioning

confidence: 99%

Treatment of alcohol withdrawal syndrome in the emergency department: a rapid review

Koh¹,

Malczewska²,

Doyle‐Waters³

et al. 2021

Preprint

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Background Patients who experience harms from alcohol and other substance use often seek care in the emergency department (ED). Many ED patients with alcohol use disorder will require management of alcohol withdrawal. ED clinicians are responsible for risk-stratifying these patients under time and resource constraints and must reliably identify those who are safe for outpatient management versus those who require more intensive levels of care. Published guidelines for alcohol withdrawal are largely limited to the primary care and outpatient settings, and do not provide specific guidance for ED use. The purpose of this review was to synthesize published evidence on the treatment of alcohol withdrawal syndrome specifically in the emergency department setting. Methods We conducted a rapid review by searching MEDLINE, Embase, and the Cochrane Central Register of Controlled Trials (1980 to 2020). We also searched for grey literature on Google and hand-searched the conference abstracts of relevant addiction medicine and emergency medicine professional associations (2015 to 2020). We included interventional and observational studies that reported outcomes of clinical interventions aimed at treating alcohol withdrawal syndrome in adults in the ED. Results We identified 13 studies that met inclusion criteria for our review (7 randomized controlled trials and 6 observational studies). Most studies were at high/serious risk of bias. We divided studies based on intervention and summarized evidence narratively. Benzodiazepines decrease alcohol withdrawal seizure recurrence, but no clear evidence supports the use of one benzodiazepine over another. It is unclear if symptom-triggered benzodiazepine protocols are effective for use in the ED. More evidence is needed to determine if phenobarbital, with or without benzodiazepines, can be used safely and effectively to treat alcohol withdrawal in the ED. Phenytoin does not have evidence of effectiveness at preventing withdrawal seizures in the ED. Conclusions Few studies have evaluated the safety and efficacy of pharmacotherapies for alcohol withdrawal specifically in the ED setting. Benzodiazepines are the most evidence-based treatment for alcohol withdrawal in the ED. Pharmacotherapies that have demonstrated benefit for treatment of alcohol withdrawal in other inpatient and outpatient settings need to be evaluated in the ED setting before routine use.

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“…Єдиним шляхом убезпечення хворих є адекватна седація [2]. Препарати бензодіазепінового ряду є пріоритетними для забезпечення належного її рівня [10]. Багато досліджень повідомляють, що в людей з великим стажем зловживання алкоголю та з наявними попередніми епізодами делірію, формується так званий синдром резистентності до бензодіазепінів [8].…”

Section: вступunclassified

Comparative characteristics of ketamine and sodium oxybutyrate as adjuvant sedation in patients with alcoholic delirium

Havrylov¹,

Гомон²,

Slobodyanyuk³

et al. 2021

Rep. of Vinnytsia Nation. Med. Univ.

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Annotation. Today, the number of benzodiazepine-resistant alcoholic deliriums is growing. It is actually to search for an optimal scheme of sedation with a combination of two sedatives. The aim of the study was to compare efficacy of standard sedation with added barbiturates and the schemes with using ketamine and sodium oxybutyrate. We tested 60 cases of delirium tremens which were randomized into three groups. In the control group we conducted the traditional sedation with added sodium thiopental. In the first research group we combined the infusion of ketamine with diazepam. In the second one we gave sodium oxybutyrate with diazepam. We evaluated the duration of delirium, hemodynamics parameters, serum cortisol and serotonin, laboratory indicators of kidneys and liver condition. We used such statistical methods as Mann-Whitney test, Wilcoxon T-criterion and Kruskal-Wallis H-criterion. The duration of delirium was significantly lower in research groups in comparison with the control one. There was no difference of the duration of delirium between research groups. It indicates a comparable effect of using either ketamine, or sodium oxybutyrate. All groups showed significant reduction of hemodynamics parameters in the process of the treatment, however we observed more cases of hypertension and tachycardia on the third day of the treatment in the research groups than in the control one. These data suggest an insufficient effect of the combination of diazepam with both ketamine and sodium oxybutyrate on the sympatho-adrenal system. Serum cortisol was significantly reduced in all the groups, there was no difference between control and research groups. Serotonin was equally increased in all the groups on the third day. The obtained results indicate that the effectiveness of the combination of benzodiazepines with both ketamine and sodium oxybutyrate is comparable to the standard sedation regimen and does not differ in the reaction of these biomarkers. The laboratory indicators of kidneys condition on the third day increased only in the research groups, which indicates more negative influence on kidneys by both ketamine and sodium oxybutyrate. The indicators of liver condition were significantly reduced only in the group of ketamine, there were no difference in the rest groups. The use of ketamine and sodium oxybutyrate as adjuvant sedation may reduce the duration of a delirium episode, but has insufficient effect on hemodynamics and may adversely affect renal function.

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<p>Management of Alcohol Withdrawal in the Emergency Department: Current Perspectives</p>

Cited by 55 publications

References 93 publications

Prevention of alcohol withdrawal seizure recurrence and treatment of other alcohol withdrawal symptoms in the emergency department: a rapid review

Prevention of alcohol withdrawal seizure recurrence and treatment of other alcohol withdrawal symptoms in the emergency department: a rapid review

Treatment of alcohol withdrawal syndrome in the emergency department: a rapid review

Comparative characteristics of ketamine and sodium oxybutyrate as adjuvant sedation in patients with alcoholic delirium

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