Treatment of Severe Alcohol Withdrawal

@article{Schmidt2016TreatmentOS,
  title={Treatment of Severe Alcohol Withdrawal},
  author={Kyle J Schmidt and Mitesh Doshi and Jenna M. Holzhausen and Allycia Natavio and Megan L. Cadiz and Jim E. Winegardner},
  journal={Annals of Pharmacotherapy},
  year={2016},
  volume={50},
  pages={389 - 401}
}
Objective: Approximately 50% of patients with alcohol dependence experience alcohol withdrawal. [] Key Method Data Sources: PubMed (January 1960 to October 2015) was searched using the search terms alcohol withdrawal, delirium tremens, intensive care, and refractory. Supplemental references were generated through review of identified literature citations. Study Selection and Data Extraction:

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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.

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TLDR
Benzodiazepines are suitable agents for alcohol withdrawal, with choice among different agents guided by duration of action, rapidity of onset, and cost, and Dosage should be individualized, based on withdrawal severity measured by withdrawal scales.

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TLDR
Symptom-triggered benzodiazepine treatment for alcohol withdrawal is safe, comfortable, and associated with a decrease in the quantity of medication and duration of treatment.

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The role of currently published alcohol withdrawal syndrome pharmacologic strategies (benzodiazepines, ethanol, clomethiazole, antipsychotics, barbiturates, propofol, and dexmedetomidine) is detailed and recommendations as to nicotine replacement therapy and management of iatrogenic drug withdrawal in ICU patients are recommended.

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TLDR
Ketamine appears to reduce BZD requirements and is well tolerated at low doses and Prospective dose range evaluations in the management of AWS would be helpful in determining its place as an adjunctive agent.

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TLDR
The administration of phenobarbital in this patient allowed improved symptom control, minimized the potential for propylene glycol toxicity, was not associated with respiratory depression, and facilitated successful weaning of benzodiazepines.

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.

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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.

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TLDR
Symptom-triggered therapy individualizes treatment, decreases both treatment duration and the amount of benzodiazepine used, and is as efficacious as standard fixed-schedule therapy for alcohol withdrawal.
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