Medications
Vitamin often supplemented in alcohol withdrawal
What is Thiamine (b1)
Most CIWA questions are based on a scale of how many possible points?
0 - 7 (excluding orientation)
At 6 -36 hours after last drink, we expect to see these symptoms (name at least 3).
Tremulousness, anxiety, headache, diaphoresis, palpitations, anorexia, GI upset
Lab you might get for a patient with alcohol use and abdominal pain (not EtOH level)
Lipase
What is considered one standard drink?
12 oz 5% beer
5oz Wine
1.5oz hard liquor
These two classes of medications can both be used for alcohol withdrawal.
Benzodiazepines and Barbiturates
Aspects of CIWA that are visible to the clinician
Anxiety, agitation, tremor, sweating, vomiting
When can you discharge an alcohol withdrawal patient
CIWA < 10, not needing PRNs, able to tolerate diet, mentating well, ambulating independently
Most important history question in alcohol withdrawal
Time since last drink!
This is a kind of respiratory monitoring employed in alcohol withdrawal
What is EtCO2?
Long acting medication often used for alcohol Withdrawal
Chlordiezepoxide (Librium)
Subjective elements of CIWA (4 elements)
Headache, nausea, visual disturbance, auditory disturbances, tactile disturbances
Time period in which Delirium Tremens can develop.
48-96 Hours
Patient found down, EtOH positive, WBC count elevated. What infectious processes are you worried about?
Aspiration pneumonia, SSTI
How many drinks in a fifth?
How many drinks in a handle?
Or tell us volume
Fifth: ~16 (750mL)
Handle: 40! (1.75L)
Medications we can offer at discharge for alcohol use disorder.
What is Gabapentin, Naltrexone, Acamprosate
Call ICU for these CIWA scores.
Two consecutive scores > 15
One score > 20
Clinical scenarios in which you would consult ICU
Not protecting airway, seizures, persistent CIWA > 15, decreased respiratory rate, approaching max dose of barbiturates (15 -20 mg/kg/24hrs)
Patient presents altered. EtOH level pending. What other workup should we still be doing?
Acute Encephalopathy workup:
CT Head, CXR, UDS, UA, TSH, b12, aspirin/salicylates, CBC, CMP
What is the onset time for oral vs IV Phenobarbital OR Diazepam
Phenobarbital: 60min (oral) 5min (IV)
Diazepam: 15-60min (oral) 1-3min (IV)
Provide acceptable dosing tiers for Phenobarbital OR Diazepam
Phenobarbital:
scores 8-10, give Phenobarbital 32.5- 65mg PO
scores 10-15, give Phenobarbital 130mg PO
scores >15, given Phenobarbital 260mg PO
if 2 consecutive scores > 15 then call ICU
Diazepam:
scores 8-10, give diazepam 5mg PO
scores 10-15, give diazepam 10mg PO
scores >15, given diazepam 15mg PO
if 2 consecutive scores > 15 then call ICU
Besides CIWA, what other clinical scale can you use to monitor alcohol withdrawal?
RASS (Richmond agitation sedation scale)
Time frame after patient's last drink in which seizures can develop.
6 - 48hrs
Other comorbidities you may want to workup in patients with alcohol withdrawal (name at least 3)
Cirrhosis
Varices
Pancreatitis
Coagulopathy
Hepatitis
Other substances
Weirneke's encephalopathy/dementia
Psychiatric
HIV
Seeing this kind of animal is a euphemism for delirium tremens
What is "Pink Elephants"