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Alcohol Withdrawal

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Abstract

Alcohol withdrawal is a common problem afflicting patient in many ICUs around the world and across specialties. This is a force of altered cognition that, if left unchecked, can lead to significant challenges in the care of the critically ill and injured. Alcohol withdrawal is a syndrome borne of the sudden cessation of chronic or heavy alcohol ingestion. Its symptoms present on a spectrum and vary in severity. Severe alcohol withdrawal generally involves the manifestation of delirium in combination with symptomatology consistent with alcohol withdrawal. The mainstay of treatment remains benzodiazepines, although many adjuncts have been described in recent years including barbiturates, propofol, and dexmedetomidine.

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References

  1. American Psychiatric Association. Diagnostic and statistical manual of mental disorders. 5th ed. Washington, DC: American Psychiatric Association; 2013.

    Book  Google Scholar 

  2. Schuckit MA. Recognition and management of withdrawal delirium (delirium tremens). N Engl J Med. 2014;371(22):2109–13.

    Article  Google Scholar 

  3. Kosten TR, O’Connor PG. Management of drug and alcohol withdrawal. N Engl J Med. 2003;18(348):1786–95.

    Article  Google Scholar 

  4. Schmidt KJ, Doshi MR, Holzhausen JM, Natavio A, Cadiz M, Winegardner JE. Treatment of severe alcohol withdrawal. Ann Pharmacother. 2016;50(5):389–401.

    Article  CAS  Google Scholar 

  5. Sullivan JT, Sykora K, Schneiderman J, Naranjo CA, Sellers EM. Assessment of alcohol withdrawal: the revised clinical institute withdrawal assessment for alcohol scale (CIWA-Ar). Br J Addict. 1989;84(11):1353–7.

    Article  CAS  Google Scholar 

  6. Mainerova B, Prasko J, Latalova K, et al. Alcohol withdrawal delirium - diagnosis, course and treatment. Biomed Pap Med Fac Univ Palacky Olomouc Czech Repub. 2015;159(1):44–52.

    PubMed  Google Scholar 

  7. Mayo-Smith MF, Beecher LH, Fischer TL, et al. Management of alcohol withdrawal delirium. An evidence-based practice guideline. Arch Intern Med. 2004;164(13):1405–12.

    Article  CAS  Google Scholar 

  8. Khan A, Levy P, DeHorn S, et al. Predictors of mortality in patients with delirium tremens. Acad Emerg Med. 2008;15(8):788–90.

    Article  Google Scholar 

  9. Gold JA, Rimal B, Nolan A, Nelson LS. A strategy of escalating doses of benzodiazepines and phenobarbital administration reduces the need for mechanical ventilation in delirium tremens. Crit Care Med. 2007;35(3):724–30.

    Article  CAS  Google Scholar 

  10. Duby JJ, Berry AJ, Ghayyem P, et al. Alcohol withdrawal syndrome in critically ill patients: protocolized versus nonprotocolized management. J Trauma Acute Care Surg. 2014;77(6):938–43.

    Article  CAS  Google Scholar 

  11. Carlson RW, Kumar NN, Wong-Mckinstry E, et al. Alcohol withdrawal syndrome. Crit Care Clin. 2012;28(4):549–85.

    Article  Google Scholar 

  12. Schabelman E, Kuo D. Glucose before thiamine for Wernicke encephalopathy: a literature review. J Emerg Med. 2012;42(4):488–94.

    Article  Google Scholar 

  13. Flannery AH, Adkins DA, Cook AM. Unpeeling the evidence for the banana bag: evidence-based recommendations for the management of alcohol-associated vitamin and electrolyte deficiencies in the ICU. Crit Care Med. 2016;44(8):1545–52.

    Article  Google Scholar 

  14. Donnino MW, Vega J, Miller J, Walsh M. Myths and misconceptions of Wernicke’s encephalopathy: what every emergency physician should know. Ann Emerg Med. 2007;50(6):715–21.

    Article  Google Scholar 

  15. Mayo-Smith MF. Pharmacological management of alcohol withdrawal. A meta-analysis and evidence-based practice guideline. American Society of Addiction Medicine Working Group on Pharmacological Management of Alcohol Withdrawal. JAMA. 1997;9(2):144–51.

    Article  Google Scholar 

  16. Lejoyeux M, Solomon J, Adès J. Benzodiazepine treatment for alcohol-dependent patients. Alcohol Alcohol. 1998;33(6):563–75.

    Article  CAS  Google Scholar 

  17. Kleber HD, Weiss RD, Anton Jr. RF, et al. American Psychiatric Association. [Online]; 2006 [cited 2017 Jan. Available from https://www.psychiatry.org/psychiatrists/practice/clinical-practice-guidelines.

  18. World Health Organization. [Online]; 2012 [cited 2017 Jan. Available from http://www.who.int/mental_health/mhgap/evidence/alcohol/q2/en/.

  19. Weaver MF, Hoffman HJ, Johnson RE, Mauck K. Alcohol withdrawal pharmacotherapy for inpatients with medical comorbidity. J Addict Dis. 2006;25(2):17–24.

    Article  Google Scholar 

  20. Saitz R, Mayo-Smith MF, Roberts MS, et al. Individualized treatment for alcohol withdrawal. A randomized double-blind controlled trial. JAMA. 1994;272(7):519–23.

    Article  CAS  Google Scholar 

  21. Daeppen JB, Gache P, Landry U, et al. Symptom-triggered vs fixed-schedule doses of benzodiazepine for alcohol withdrawal: a randomized treatment trial. Arch Intern Med. 2002;162(10):1117–21.

    Article  CAS  Google Scholar 

  22. Jaeger TM, Lohr RH, Pankratz VS. Symptom-triggered therapy for alcohol withdrawal syndrome in medical inpatients. Mayo Clin Proc. 2001;76(7):695–701.

    Article  CAS  Google Scholar 

  23. Rosenson J, Clements C, Simon B, et al. Phenobarbital for acute alcohol withdrawal: a prospective randomized double-blind placebo-controlled study. J Emerg Med. 2013;44(3):592–8.

    Article  Google Scholar 

  24. Pandharipande PP, Pun BT, Herr DL, et al. Effect of sedation with dexmedetomidine vs lorazepam on acute brain dysfunction in mechanically ventilated patients: the MENDS randomized controlled trial. JAMA. 2007;298(22):2644–53.

    Article  CAS  Google Scholar 

  25. Riker R, Shehabi Y, Bokesch P, et al. Dexmedetomidine vs midazolam for sedation of critically ill patients: a randomized trial. JAMA. 2009;301(5):489–99. Skrupky LP, Drewry AM, Wessman B, et al. Clinical effectiveness of a sedation protocol minimizing benzodiazepine infusions and favoring early dexmedetomidine: a before-after study. Crit Care. 2016;19(136).

    Google Scholar 

  26. Crispo AL, Daley MJ, Pepin JL, et al. Comparison of clinical outcomes in nonintubated patients with severe alcohol withdrawal syndrome treated with continuous-infusion sedatives: dexmedetomidine versus benzodiazepines. Pharmacotherapy. 2014;34(9):910–7.

    Article  CAS  Google Scholar 

  27. Lizotte RJ, Kappes JA, Bartel BJ, et al. Evaluating the effects of dexmedetomidine compared to propofol as adjunctive therapy in patients with alcohol withdrawal. Clin Pharmacol. 2014;31(6):171–7.

    Google Scholar 

  28. Frazee EN, Personett HA, Leung JG, et al. Influence of dexmedetomidine therapy on the management of severe alcohol withdrawal syndrome in critically ill patients. J Crit Care. 2014;29(2):298–302.

    Article  CAS  Google Scholar 

  29. Mueller SW, Preslaski CR, Kiser TH, et al. A randomized, double-blind, placebo-controlled dose range study of dexmedetomidine as adjunctive therapy for alcohol withdrawal. Crit Care Med. 2014;42(5):1131–9.

    Article  CAS  Google Scholar 

  30. Bielka K, Kuchyn I, Glumcher F. Addition of dexmedetomidine to benzodiazepines for patients with alcohol withdrawal syndrome in the intensive care unit: a randomized controlled study. Ann Intensive Care. 2015;5(33)

    Google Scholar 

  31. Liu J, Wang LN. Baclofen for alcohol withdrawal. Cochrane Database Syst Rev. 2013;28(2):1–33, CD008502.

    Google Scholar 

  32. Wong A, Benedict NJ, Armahizer MJ, Kane-Gill SL. Evaluation of adjunctive ketamine to benzodiazepines for management of alcohol withdrawal syndrome. Ann Pharmacother. 2015;49(1):14–9.

    Article  Google Scholar 

  33. Eyer F, Schreckenberg M, Hecht D, et al. Carbamazepine and valproate as adjuncts in the treatment of alcohol withdrawal syndrome: a retrospective cohort study. Alcohol Alcohol. 2011;46(2):177–84.

    Article  CAS  Google Scholar 

  34. Pani PP, Trogu E, Pacini M, Maremmani I. Anticonvulsants for alcohol dependence. Cochrane Database Syst Rev. 2014;(2):CD008544.

    Google Scholar 

  35. Fullwood JE, Mostaghimi Z, Granger CB, et al. Alcohol withdrawal prevention: a randomized evaluation of lorazepam and ethanol--a pilot study. Am J Crit Care. 2013;22(5):398–406.

    Article  Google Scholar 

  36. Gipson G, Tran K, Hoang C, Treggiari M. Comparison of enteral ethanol and benzodiazepines for alcohol withdrawal in neurocritical care patients. J Clin Neurosci. 2016;31:88–91.

    Article  CAS  Google Scholar 

  37. Gower WE, Kersten H. Prevention of alcohol withdrawal symptoms in surgical patients. Surg Gynecol Obstet. 1980;151(3):382–4.

    CAS  PubMed  Google Scholar 

  38. Hansbrough JF, Zapata-Sirvent RL, Carroll WJ, et al. Administration of intravenous alcohol for prevention of withdrawal in alcoholic burn patients. Am J Surg. 1984;148(2):266–9.

    Article  CAS  Google Scholar 

  39. Eggers V, Tio J, Neumann T, et al. Blood alcohol concentration for monitoring ethanol treatment to prevent alcohol withdrawal in the intensive care unit. Intensive Care Med. 2002;28(10):1475–82.

    Article  Google Scholar 

  40. Weinberg JA, Magnotti LJ, Fischer PE, et al. Comparison of intravenous ethanol versus diazepam for alcohol withdrawal prophylaxis in the trauma ICU: results of a randomized trial. J Trauma. 2008;64(1):99–104.

    Article  CAS  Google Scholar 

  41. DiPaula B, Tommasello A, Solounias B, McDuff D. An evaluation of intravenous ethanol in hospitalized patients. J Subst Abus Treat. 1998;15(5):437–42.

    Article  CAS  Google Scholar 

  42. Nunn J, Erdogan M, Green RS. The prevalence of alcohol-related trauma recidivism: a systematic review. Injury. 2016;47(3):551–8.

    Article  Google Scholar 

  43. Gentilello LM, Duggan P, Drummond D, et al. Major injury as a unique opportunity to initiate treatment in the alcoholic. Am J Surg. 1988;156(6):558–61.

    Article  CAS  Google Scholar 

  44. Gentilello LM, Rivara FP, Donovan DM, et al. Alcohol interventions in a trauma center as a means of reducing the risk of injury recurrence. Ann Surg. 1999;230(4):473.

    Article  CAS  Google Scholar 

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Correspondence to Alison Wilson .

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Khan, U., Wilson, A. (2018). Alcohol Withdrawal. In: Salim, A., Brown, C., Inaba, K., Martin, M. (eds) Surgical Critical Care Therapy . Springer, Cham. https://doi.org/10.1007/978-3-319-71712-8_5

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  • DOI: https://doi.org/10.1007/978-3-319-71712-8_5

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