Symptom-Triggered Therapy for Alcohol Withdrawal Syndrome in Medical Inpatients

Symptom Triggered Therapy in Delirium Tremens

“…These findings are akin to existing literature, which shows a reduction in benzodiazepines requirement and duration of treatment [6]. Although benzodiazepine use and duration of treatment did not differ significantly in Mayo clinic protocol, researchers advocated symptom triggered therapy as effective treatment in alcohol withdrawal syndrome as well as for reducing the risk of delirium tremens while emphasizing further studies to appreciate other benefits [4]. Withdrawal features abated in a week and he was discharged in two weeks.…”

“…A symptomtriggered approach to dosing benzodiazepenes may have significant advantages over a fixed schedule therapeutic approach. These include the ability to individualise treatment, reduction in treatment duration and reduced occurrence of delirium tremens [1,4]. Previous studies have shown equally efficacious results with a symptom triggered approach [5].…”

Hospitalists and alcohol withdrawal: Yes, give benzodiazepines but is that the whole story?

“…Jeager et al did a pre-comparison and post-comparison of the implementation of a PRN CIWA protocol by chart review. 23 They found a reduction in delirium in patients treated with PRN dosing, but no different in total benzodiazepine given. Because it was chart review, the authors acknowledge that defining delirium tremens was less reliable, and controlling for comorbidities was difficult.…”

“…[22][23][24][25][26][27] While ideally these articles should apply to a hospitalist's patients, 2 of the studies excluded anyone with acute medical illness. 24,27 From the remaining 4, what do we learn?…”

Alcohol withdrawal delirium - diagnosis, course and treatment

“…In inpatients, some authors prefer the so-called symptomtriggered (ST) schedule to FD with a maximum loading dose of up to 30 mg of diazepam equivalent, or a frontloading regimen comprising an initial high dose followed by ST or FD (ref. 11,[63][64][65] ). However, there is a suggestion that even in outpatients, this regimen may help to motivate the patients to start their dependence treatment 60,61 .…”