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Alcohol Withdrawl


- Discussion:
-  onset- usually a few hours to 10 days after last drink (Usually 6-48 hr);
- early symptoms: tend to be mild;
- nausea, vomiting, anorexia, insomnia, diaphoresis, agitation, tachycardia, HTN, if seizures occur,
- common abstinence syndrome, occurring at 6-8 hr, is the earliest withdrawl syndrome and is often present when the patient awakens;
- seizures appear at 7 to 48 hr and are usually single rather than recurrent;
- alcoholic ketoacidosis is usually seen later at 24 to 72 hrs;
- late symptoms: tend to be severe; worsening of above symptoms,
- Delerium Tremens:
- acute psychosis with hallucinations, delusions, disorientation, agitation; DT's 5-15% fatal w/o treatment, <1% treated;
- DT is usually seen at 3-5 days, but may be seen as late as 14 days;

* Treatment:
      - provide thiamine - chlordiazepoxide has been widely marketed and used for ETOH withdrawl.
Diazepam, Lorazepam, Oxazepam have more rapid onset of action and greater anticonvulsant activity;
- both Chlordiazepoxide and Diazepam are poor drugs when given IM because their absorption is slow, erratic, and incomplete;
- when treating ETOH withdrawl, the required dosage of benzodiazepine may be quite large and should be carefully titrated to the symptoms;
- Note that the following are NOT recomended:
- Barbiturates (Resp Depression, Drug Interactions),
- Antihistamines (Anticholinergic effects may worsen toxic psychotic symptoms);
- Antipsychotics (contraindicated because of risk of orthostatic hypotension and Seizures)

Emergency department treatment of alcohol withdrawal seizures with phenytoin.

Comparison of intravenous ethanol versus diazepam for alcohol withdrawal prophylaxis in the trauma ICU: results of a randomized trial.