Successfully reported this slideshow.
We use your LinkedIn profile and activity data to personalize ads and to show you more relevant ads. You can change your ad preferences anytime.

Alcohol withdrawal

1,928 views

Published on

Alcohol withdrawal

Published in: Healthcare
  • You can hardly find a student who enjoys writing a college papers. Among all the other tasks they get assigned in college, writing essays is one of the most difficult assignments. Fortunately for students, there are many offers nowadays which help to make this process easier. The best service which can help you is ⇒ www.HelpWriting.net ⇐
       Reply 
    Are you sure you want to  Yes  No
    Your message goes here

Alcohol withdrawal

  1. 1. Alcohol withdrawal By- Dr. Armaan Singh
  2. 2. Objectives  Discuss the symptoms and signs of alcohol withdrawal.  Discuss the management of alcohol withdrawal.
  3. 3. Case 1  70-yo M with unknown PMHx was brought into ED after being found down. Pt was found to have displaced hip fracture and was taken to OR for ORIF. Pt initially did well post-op, but 48 hrs after admission pt started having tachycardia, hypertension, fever, and agitation.  What are some differential diagnosis?
  4. 4. Withdrawal symptoms timeline
  5. 5. What’s in Quest CIWA order set?  Vital signs q4h, cardiac monitoring, pulse oximetry, fall/seizure/ aspiration precautions.  CIWA scores (components of CIWA: N/V, sweats, anxiety, agitation, tremor, HA, auditory/ visual/ tactile disturbances, orientation and clouding of sensorium).  “banana bag”: NS with 100mg thiamine, 1g folate, and multivitamin.  PRN IV Ativan 2mg for CIWA 10-15, 4mg for CIWA> 15.
  6. 6. What is not in the order set?  Electrolyte replacement: especially watch out for low K, low Mg, and low phos!
  7. 7. When do you call the ICU?  Status epilepticus  Possible DTs, esp. persistent hyperthermia, hemodynamic instability  Severe electrolyte or acid/base disturbances  Severe withdrawal symptoms, requiring large amount of benzodiapezines.
  8. 8. Case 2  40-yo M with h/o alcohol abuse presented with palpitations, nausea/ vomiting, and tremors.  Pt drinks half a gallon of vodka daily and reports that his last drink was approximately 12 hours prior to admission. On further questioning, pt reports history of alcohol withdrawal seizures and has been admitted to OSH ICUs in the past for alcohol withdrawal.  In the ED, pt is tremulous, afebrile, has regular tachycardia, slightly hypertensive.
  9. 9.  Which protocol do you initiate to monitor and manage withdrawal symptoms?  Which electrolytes do you check?  What IVF and medications do you order?  When is the pt at greatest risk for alcohol withdrawal seizures? For DTs?  Under what circumstances would you call the ICU?
  10. 10. Summary  Depending on the time of last drink, there are symptoms/ signs and possible complications to watch out for and manage.  Initiate CIWA protocol when patient was admitted with possibility of alcohol withdrawal, include IV fluid, vitamins, and prn lorazepam.  Don’t forget to check and replace electrolytes.
  11. 11. References  UpToDate.com  Diagram courtesy of Google Images

×