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Journal of Medical Toxicology

, Volume 2, Issue 2, pp 55–60 | Cite as

Resistant alcohol withdrawal: Does an unexpectedly large sedative requirement identify these patients early?

  • J. B. HackEmail author
  • R. S. Hoffman
  • L. S. Nelson
Toxicology Investigations

Abstract

Introduction

While most patients with alcohol withdrawal (AW) respond to standard treatment that includes doses of benzo-diazepines, nutrition and good supportive care (non resistant alcohol withdrawal-NRAW), a subgroup may resist therapy (resistant alcohol withdrawal-RAW). This study describes a distinct group of AW patients, their sedative requirements, and hospital courses.

Methods

Over a period of 6 months, AW patients requiring 50 mg diazepam IV in the first hour were followed. We recorded admission indices and diazepam doses with vital signs at 1, 2, 3, 6, 12, and 24 hours. Patients were considered to have RAW if they required additional sedatives for control of symptoms and/or were having persistent abnormal vital signs despite the physicians’ choices of therapy.

Results

Nineteen patients were enrolled; all had similar admission indices. While the 4 NRAW had normal vital signs within 3 hours, all 15 RAW patients had abnormal vital signs; 15 RAW patients required escalating diazepam doses — 14 required barbiturates, 7 were intubated, and 5 had hypotension. Comparing groups: interval and total diazepam doses were not different at 1, 2, and 3 hours; interval doses at 6 and 12 hours, and total doses at 6, 12, and 24 hours were significantly different.

Conclusions

RAW patients require large doses of benzodiazepine administration, additional sedatives, and undergo complicated hospitalizations.

Keywords

alcohol withdrawal delirium resistance 

References

  1. 1.
    Saitz R, Mayo-Smith MF, Roberts MS, Redmond et al. Individualized treatment for alcohol withdrawal: a randomized double-blind controlled trial. JAMA1994; 272(7): 519–523.PubMedCrossRefGoogle Scholar
  2. 2.
    Aaronson LM, Hinman DJ, Okamoto M. Effects of diazepam of ethanol withdrawal. J Pharmacol Exp Ther1982; 221(2): 319–25.PubMedGoogle Scholar
  3. 3.
    Wasilewski D, Matsumoto H, Kur E, Dziklinska A, Wozny E, Stencka K, Skalski M, Chaba P, Szelenberger. Assessment of diazepam loading dose therapy of delirium tremens. Alcohol Alcohol.1996; 31(3): 273–8.PubMedGoogle Scholar
  4. 4.
    McCowan C, Marik P. Refractory delirium tremens treated with propofol: a case series. Crit Care Med.2000; 28(6): 1781–4.PubMedCrossRefGoogle Scholar
  5. 5.
    Vinson DC, Menezes M. Admission alcohol level: a predictor of the course of alcohol withdrawal. J Fam Pract.1991; 33(2): 161–7.PubMedGoogle Scholar
  6. 6.
    Manikant S, Tripathi BM, Chavan BS. Loading dose diazepam therapy for alcohol withdrawal state. Indian J Med Res.1993; 98: 170–3.PubMedGoogle Scholar
  7. 7.
    Jaeger TM, Lohr RH, Pankratz VS. Symptom-triggered therapy for alcohol withdrawal syndrome in medical inpatients. Mayo Clin Proc.2001; 76(7): 695–701.PubMedCrossRefGoogle Scholar
  8. 8.
    Isbell H, Fraser HF, Wikler A, Belleville RE, Eisenman AJ. An experimental study of the etiology of “rum fits” and delirium tremens. QJ Studies Alcohol1955; 16(1): 1–33.Google Scholar
  9. 9.
    Follesa P, Biggio F, Mancuso L, Cabras S, Caria S, Gorini G, Manca A, Orru A, Biggio G. Ethanol withdrawal-induced up-regulation of the alpha2 subunit of the GABAA receptor and its prevention by diazepam or gamma-hydroxybutyric acid. Brain Res Mol Brain Res.2004; 120(2): 130–7.PubMedCrossRefGoogle Scholar
  10. 10.
    Goldstein DB, Kakihana R. Alcohol withdrawal reactions in mouse strains selectively bred for long or short sleep times. Life Sci.1975; 17 (6): 981–5.PubMedCrossRefGoogle Scholar

Copyright information

© American College of Medical Toxicology 2006

Authors and Affiliations

  1. 1.New York City Poison CenterNew York
  2. 2.Brody School of MedicineEast Carolina UniversityGreenville
  3. 3.New York UniversityNew York

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