Grand Rounds
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Transcript of Grand Rounds
WHAT IS THE BEST WAY TO MANAGE ACUTE ALCOHOL WITHDRAWAL SYNDROME?
OLIVIA J. WARNER | THE COMMUNITY COLLEGE OF BALTIMORE COUNTY | MAY 2016
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
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
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
DELIRIUM TREMENS• LIFE THREATENING FORM OF ALCOHOL WITHDRAWAL• 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)
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 NEW MEMORIES
• 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)
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 PREVENT
WARNICKE-KORSAKOFF SYNDROME
REFERENCESBenzodiazepines 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.