An alcoholic who has been binge drinking and brought by brother, has not had alcohol in 24 hrs.
a. List 2 conditions he is at risk of.
b. List one class of medications to prevent the above complication.
c. List 2 other medications you can give him now
Answers
a. Seizures, delirium tremens
b. Benzodiazepines
c. Thiamine, multivitamins (with folate)
Comments
1. Keep in mind that the goals of medically supervised alcohol withdrawal are to: manage symptoms of alcohol withdrawal; prevent serious events (seizures, delirium tremens or death); and transition patients to treatment for maintaining long-term recovery
2. Categorise AWS very mild, mild, moderate, and severe, based on level of autonomic system activation, agitation, and the presence of hallucinations, disorientation, and seizures- use CIWA-Ar) scale calculator 1
3. If mild: Medically supervised alcohol withdrawal can be effectively and safely provided in an ambulatory setting in carefully selected patients, principally patients with or at risk of mild alcohol withdrawal (CIWA-Ar <15) and no history of seizures or delirium tremens. (See 'Ambulatory criteria' above.)
● benzodiazepine rather than gabapentin or other medications
● use symptom-triggered dosing to treat very mild withdrawal symptoms (CIWA-Ar <10); fixed dosing is a reasonable alternative for mild symptoms (CIWA-Ar = 10 to 15) (table 3).
● oral supplements of multivitamins with thiamine and folate.
● Postwithdrawal treatment: give explicit plans for follow-up care prior to discharge from the supervised withdrawal program; follow-up may involve ongoing treatment through primary care or a specialized alcohol treatment program.