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Grand Rounds

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Grand Rounds

  1. 1. PATIENT ASSESSMENT •IS THIS PATIENT AT RISK FOR ACUTE ALCOHOL WITHDRAWAL SYNDROME? •CAGE TOOL • SIMPLE, FAST, EASY, RELIABLE • A SCORE OF 2-4 = AT RISK FOR ALCOHOL WITHDRAWAL • OBTAIN DETAILED ALCOHOL HISTORY
  2. 2. CLINICAL INSTITUTE OF WITHDRAWAL ASSESSMENT OF ALCOHOL – CIWA-AR • ASSIGNS A NUMERIC VALUE TO THE PATIENT’S LEVEL OF ALCOHOL WITHDRAWAL ~ 0 TO 67 • BASED ON THE SEVERITY OF PHYSICAL AND PSYCHOLOGICAL SYMPTOMS • ⬆ SCORE = ⬆ SEVERITY OF WITHDRAWAL • DETERMINES FREQUENCY OF PATIENT ASSESSMENT • ALLOWS CALCULATION OF SYMPTOM-TRIGGERED BENZODIAZEPINE DOSAGE • NAUSEA/VOMITING • TREMOR • PAROXYSMAL SWEATS • ANXIETY • AGITATION • TACTILE DISTURBANCES • AUDITORY DISTURBANCES • VISUAL DISTURBANCES • HEADACHES/FULLNESS IN HEAD • ORIENTATION/CLOUDING OF SENSORIUM
  3. 3. BENZODIAZEPENES • SYMPTOM-TRIGGERED DOSAGE SIGNIFICANTLY DECREASES BOTH THE DURATION OF TREATMENT AND THE TOTAL BENZODIAZEPINE USAGE DURING ACUTE ALCOHOL WITHDRAWAL (“BENZODIAZEPINES ARE THE MAINSTAY,” 2014) • BASED ON THE INDIVIDUAL PATIENT’S SCORE AND WHETHER OR NOT IT IS IMPROVING • REQUIRES OBJECTIVE WITHDRAWAL ASSESSMENT SCALE
  4. 4. DELIRIUM TREMENS • LIFE THREATENING FORM OF ALCOHOLWITHDRAWAL • SYMPTOMS CAN INCLUDE HALLUCINATIONS, IRREGULAR HEARTBEAT AND TONIC-CLONIC SEIZURES • ADMINISTER HALOPERIDOL IN ORDER TO MANAGE SYMPTOMS (NORTHWEST HOSPITAL, 2015) • LOW PLATELET COUNT AND HIGH BLOOD LEVEL OF HOMOCYSTEINE ARE PREDICTORS OF DELIRIUM TREMENS; VITAMINS B12, B6, AND FOLIC ACID COULD PREVENT DELIRIUM TREMENS (KIM, KIM, BAE, PARK, & KIM, 2015)
  5. 5. WARNICKE-KORSAKOFF SYNDROME • WARNICKE’S ENCEPHALOPATHY CAN CAUSE ATAXIA, NYSTAGMUS, ALTERED MENTAL STATUS AND CAN PROGRESS TO A COMA OR DEATH • KORSAKOFF’S PSYCHOSIS CAUSES SEVERE BRAIN DAMAGE THAT CAN CAUSE HALLUCINATIONS, SEVERE MEMORY LOSS AND THE INABILITY TO FORM NEWMEMORIES • ALL PATIENTS WHO ARE EXPERIENCING ALCOHOL WITHDRAWAL SHOULD RECEIVE ORAL THIAMINE AND THOSE AT HIGH RISK FOR WARNICKE’S ENCEPHALOPATHY SHOULD RECEIVE THIAMINE PARENTALLY FOR THREE DAYS (“MANAGING ALCOHOL WITHDRAWAL,” 2012)
  6. 6. MANAGEMENT OF ACUTE ALCOHOL WITHDRAWAL SYNDROME • EARLY INTERVENTION – CAGE TOOL • SYMPTOM-TRIGGERED DOSAGE OF BENZODIAZEPINES • USE HALOPERIDOL TO MANAGE SYMPTOMS OF DELIRIUM TREMENS • ADMINISTER THIAMINE TO PREVENTWARNICKE-KORSAKOFF SYNDROME
  7. 7. REFERENCES Benzodiazepines are the mainstay of treatment for acute alcohol withdrawal syndrome. (2014). Drugs & Therapy Perspectives, 30, 395-398. http://dx.doi.org/10.1007/s40267-014-0152-2 Kim, D. W., Kim, H. K., Bae, E.-K., Park, S.-H., & Kim, K. K. (2015). Clinical predictors for delirium tremens in patients with alcohol withdrawal seizures. American Journal of Emergency Medicine, 33, 701-704. http://dx.doi.org/10.1016/j.ajem.2015.02.030 Management of alcohol withdrawal. (2012). Retrieved May 10, 2016, from http://www.who.int/mental_health/mhgap/evidence/alcohol/q2/en/ Northwest Hospital. (2015) Acute alcohol withdrawal symptom management (nursing). (Policy Number A-2). Randallstown, MD.

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