ASAM Pocket Guidelines and Patient Guide

Alcohol Withdrawal Management

ASAM Opioid Addiction Treatment GUIDELINES Apps and Pocket Guides brought to you courtesy of Guideline Central. Enjoy!

Issue link: https://eguideline.guidelinecentral.com/i/1254278

Contents of this Issue

Navigation

Page 26 of 45

27 VI. Addressing Complicated Alcohol Withdrawal A. Alcohol Withdrawal Seizure (1) Monitoring Î Recommendation VI.1: Patients should be monitored for alcohol withdrawal seizures even in the absence of other clinically prominent alcohol withdrawal signs or symptoms. Î Recommendation VI.2: Following an alcohol withdrawal seizure, patients should be admitted to a setting with close monitoring available and should be re-assessed every 1–2 hours for 6–24 hours. Patients should be closely monitored for delirium and the need to receive intravenous (IV) fluids, due to potential electrolyte imbalances. (2) Supportive care Î Recommendation VI.3: If available and applicable, existing institutional/hospital-associated delirium protocols can be used for supportive care of patients with an alcohol withdrawal seizure. (3) Pharmacotherapy Î Recommendation VI.4: Following a withdrawal seizure, patients should be immediately treated with a medication effective at preventing another seizure. Benzodiazepines are first-line treatment, and a fast-acting agent such as lorazepam or diazepam is preferred. Phenobarbital is also an option, but benzodiazepines are preferred. Î Recommendation VI.5: Following a withdrawal seizure, parenteral administration of medications is preferred. If available, IV administration is preferred to intramuscular (IM), but IM administration is also effective. Parenteral phenobarbital should be used only in highly supervised settings (e.g., Intensive Care Unit [ICU], CCU) because of risk of over-sedation and respiratory depression. Î Recommendation VI.6: It is not recommended to use alpha2- adrenergic agonists or beta-adrenergic antagonists to prevent or treat alcohol withdrawal seizures because they are ineffective for this purpose. Beta-adrenergic antagonists also can lower the seizure threshold. Phenytoin should not be used unless treating a concomitant underlying seizure disorder. Treatment

Articles in this issue

view archives of ASAM Pocket Guidelines and Patient Guide - Alcohol Withdrawal Management