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Treatment – Inpatient
Î Recommendation V.7: Thiamine should be provided to prevent
Wernicke encephalopathy.
• Intravenous (IV) or intramuscular (IM) administration of thiamine is preferred,
in particular for patients with poor nutritional status, malabsorption, or who are
known to have severe complications of alcohol withdrawal.
• Typical dosing is 100 mg IV/IM per day for 3–5 days. Oral thiamine can also be
offered.
• Patients also receiving glucose can be administered thiamine and glucose in any
order or concurrently.
Î Recommendation V.8: Clinicians should administer thiamine to
patients admitted to the Intensive Care Unit (ICU) to treat alcohol
withdrawal.
Î Recommendation V.9: For patients with hypomagnesemia, cardiac
arrhythmias, electrolyte disturbances, or a previous history of alcohol
withdrawal seizures, magnesium should be administered.
Î Recommendation V.10: If phosphorus is <1 mg/dL, supplementation
should be provided. Otherwise, in the case of moderate
hypophosphatemia (1–2 mg/dL), correction through proper nutrition is
recommended.
Î Recommendation V.11: In patients who are critically ill, folate
supplementation may be considered, since chronic alcohol use is
associated with hyperhomocysteinemia.
C. AUD Treatment Initiation and Engagement
Î Recommendation V.12: The period of alcohol withdrawal management
should be used to engage patients with an alcohol use disorder (AUD)
with comprehensive treatment. When feasible, AUD treatment should
be initiated concurrently with alcohol withdrawal management as
cognitive status permits. If appropriate, clinicians should also offer
to initiate pharmacotherapy for AUD as cognitive status permits.
Clinicians should explain the range of evidence-based treatment
services available at the current site and in the community. Finally,
clinicians should proactively connect patients to treatment services
as seamlessly as possible, including initiating a warm handoff to
treatment providers.
