Alcohol Withdrawal Notes Flashcards
Nurses in critical care settings are alert to the symptoms of withdrawal from chemical substances, but a full substance use assessment is often omitted in emergency admissions.
Without treatment, withdrawal from alcohol typically begins 6 to 8 hours after reducing or quitting alcohol after heavy and prolonged use. The classic sign of alcohol withdrawal is tremulousness, commonly called the shakes or the jitters. Within 24 to 72 hours, vital signs—systolic and diastolic blood pressure, pulse, and body temperature—tend to increase. Sleep disturbance, nausea and vomiting, agitation, and anxiety are other symptoms. Chlordiazepoxide (Librium) is generally useful for these mild to moderate symptoms.
Psychotic and perceptual changes may begin within 2 to 4 days after heavy alcohol cessation. At this point, patients are at risk for unconsciousness and delirium. Generalized tonic clonic seizures are another serious symptom of alcohol withdrawal.
Diazepam (Valium) given intravenously is a common treatment for these seizures.
Alcohol withdrawal delirium, also known as delirium tremens (DTs), is the most serious consequence of abstaining from alcohol.
Commonly used medications for withdrawal symptoms include the benzodiazepines,
Alcohol Withdrawal
Critically ill patients who are alcohol dependent and were drinking before hospital admission are at risk of severe AWS. AWS is associated with an increased risk of delirium, hallucinations, seizures, need for mechanical ventilation, and death. When hyperactive agitated delirium is caused by alcohol withdrawal, it is termed delirium tremens (DTs).
Management of alcohol withdrawal involves close monitoring of AWS-related agitation and administration of intravenous benzodiazepines, generally diazepam or lorazepam.
Benzodiazepines should be administered in response to increased signs of agitation associated with DTs, with dosage guided by a clinical protocol.
Additionally, a variety of nonbenzodiazepine adjunctive medications may be added to protocols, including dexmedetomidine, clonidine, propofol, ketamine, barbiturates, and haloperidol.
Multivitamins, including thiamine (vitamin B1), are administered prophylactically to prevent additional neurologic sequelae. Delirium related to alcohol withdrawal is pharmacologically managed very differently from delirium from other causes.
ALCOHOL WITHDRAWAL SYNDROME AND DELIRIUM TREMENS
