The emergency medicine management of severe alcohol withdrawal

@article{Long2017TheEM,
  title={The emergency medicine management of severe alcohol withdrawal},
  author={Drew Long and Brit Long and Alex Koyfman},
  journal={American Journal of Emergency Medicine},
  year={2017},
  volume={35},
  pages={1005–1011}
}

Figures and Tables from this paper

[Assessment and Treatment of Alcohol Withdrawal Syndrome].
TLDR
After the treatment of AWS, most patients should be managed or treated by the continuing care, including the psychosocial treatments, community-based management, and programs for preventing recurrence of AWS.
Clinical Management of the Alcohol Withdrawal Syndrome.
TLDR
Key elements of the clinical management of Medically assisted withdrawal, necessary adjustments for pregnancy and older adults, likely outcome of an episode of MAW, factors that might prevent completion of the MAW process, and ways of overcoming barriers to ongoing treatment of alcohol use disorder are discussed.
Prevention of alcohol withdrawal seizure recurrence and treatment of other alcohol withdrawal symptoms in the emergency department: a rapid review
TLDR
Benzodiazepines are the most evidence-based treatment for alcohol withdrawal in the ED, and pharmacotherapies that have demonstrated benefit for treatment of alcohol withdrawals in other inpatient and outpatient settings should be evaluated in theED setting before routine use.
Management of Alcohol Withdrawal in the Emergency Department: Current Perspectives
TLDR
This review summarizes the epidemiology, pathology, and management of AWS and AUD in the emergency setting, and an approach to the disposition of the patient with AUD is presented.
Diagnosis and treatment of acute alcohol intoxication and alcohol withdrawal syndrome: position paper of the Italian Society on Alcohol
TLDR
A task force of specialists drew up recommendations for the treatment of alcohol withdrawal syndrome with the following main results: while mild AWS may not require treatment, moderate and severe AWS need to be pharmacologically treated.
The Effectiveness and Tolerability of Anti-Seizure Medication in Alcohol Withdrawal Syndrome: A Systematic Review, Meta-Analysis and GRADE of the evidence.
TLDR
This systematic review and meta-analysis of randomised controlled trials (RCTs) from database inception to March 2020 found no evidence to support general first line clinical use of anti-seizure medications in alcohol withdrawal syndrome treatment.
Clonidine as early adjunctive therapy for alcohol withdrawal in the emergency department
TLDR
In conclusion, adjunctive clonidine administration to BZD in AWS initiated in the ED was not associated with a decrease in 12 hour BzD requirements.
...
...

References

SHOWING 1-10 OF 79 REFERENCES
Management of alcohol withdrawal delirium. An evidence-based practice guideline.
TLDR
Control of agitation should be achieved using parenteral rapid-acting sedative-hypnotic agents that are cross-tolerant with alcohol, andequate doses should be used to maintain light somnolence for the duration of delirium.
Alcohol withdrawal delirium - diagnosis, course and treatment.
TLDR
When not early recognized and treated adequately, delirium tremens may result in death due to malignant arrhythmia, respiratory arrest, sepsis, severe electrolyte disturbance or prolonged seizures and subsequent trauma.
Use of propofol infusion in alcohol withdrawal-induced refractory delirium tremens.
TLDR
This study suggests that treatment with propofol is viable in refractory delirium tremens, and establishing indication, dose, duration, and long-term effects of prop ofol treatment of deliria tremens requires further investigation.
The role of diazepam loading for the treatment of alcohol withdrawal syndrome in hospitalized patients.
TLDR
Diazepam loading significantly improved a number of important outcomes in AWS, including time in DTs, compared to traditional treatment strategies, and is an effective treatment option for hospitalized patients experiencing AWS.
Resistant alcohol withdrawal: Does an unexpectedly large sedative requirement identify these patients early?
TLDR
RAW patients require large doses of benzodiazepine administration, additional sedatives, and undergo complicated hospitalizations, according to physicians’ choices of therapy.
A rational approach to the treatment of alcohol withdrawal in the ED.
Intravenous Ethanol for the Treatment of Alcohol Withdrawal Syndrome in Critically Ill Patients
TLDR
Because of the paucity of well‐designed clinical trials, and because of intravenous ethanol's questionable efficacy, inconsistent pharmacokinetic profile, and relatively narrow therapeutic index, routine use of this drug is not recommended in critically ill patients who have alcohol withdrawal syndrome or are at risk for it.
Alcohol withdrawal syndrome
TLDR
The optimal care of patients with alcohol withdrawal syndrome is dependent on a multidisciplinary approach to provide appropriate evaluation, treatment, and follow-up.
Use of Propofol-Containing Versus Benzodiazepine Regimens for Alcohol Withdrawal Requiring Mechanical Ventilation
TLDR
Propofol and Benzodiazepine-treated patients with AWS requiring mechanical ventilation experienced similar days of AWS symptoms, length of stay, and mechanical ventilation.
A strategy of escalating doses of benzodiazepines and phenobarbital administration reduces the need for mechanical ventilation in delirium tremens*
TLDR
New guidelines emphasizing escalating bolus doses of diazepam, and barbiturates if necessary, significantly reduced the need for mechanical ventilation and showed trends toward reductions in ICU length of stay and nosocomial infections.
...
...