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V. Inpatient Management of Alcohol Withdrawal
A. Monitoring
Î Recommendation V.1: The following monitoring schedule is
appropriate:
• In patients with moderate to severe withdrawal or those requiring
pharmacotherapy, re-assess every 1–4 hours for 24 hours, as clinically indicated.
Once stabilized (e.g., CIWA-Ar score <10 for 24 hours), monitoring can be
extended to every 4–8 hours for 24 hours, as clinically indicated.
• Patients with mild withdrawal and low risk of complicated withdrawal may be
observed for up to 36 hours, after which more severe withdrawal is unlikely to
develop.
Î Recommendation V.2: Monitor patients' vital signs, hydration,
orientation, sleep, and emotional status including suicidal thoughts.
Î Recommendation V.3: Monitor patients receiving pharmacotherapy
for alcohol withdrawal for signs of over-sedation and respiratory
depression.
Î Recommendation V.4: Signs and symptoms of alcohol withdrawal
should be monitored during withdrawal management with a validated
assessment scale (see Alcohol Withdrawal Scales Table for a summary
of scales and their associated features).
B. Supportive Care
Î Recommendation V.5: Supportive care is a critical component of
alcohol withdrawal management. Frequent reassurance, re-orientation
to time and place, and nursing care are recommended non-
pharmacological interventions. Providers should ensure patients are
educated about what to expect over the course of withdrawal, including
common signs and symptoms and how they will be treated. Patients
with severe alcohol withdrawal should be cared for in an evenly lit,
quiet room. Patients should be offered hope and the expectation of
recovery.
Î Recommendation V.6: Supportive care for alcohol withdrawal patients
includes adherence to safety measures and protocols (e.g., assess risk
for fall/syncope). If available and applicable, existing institutional/
hospital-associated delirium protocols can be used for supportive care
of patients with severe alcohol withdrawal.
Treatment – Inpatient
