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(3) Monitoring
Î Recommendation VII.15: In patients who are hospitalized, monitor
their vital signs. Fluid intake and output and serum electrolytes should
be monitored as clinically indicated.
Î Recommendation VII.16: Signs and symptoms of alcohol withdrawal
should be monitored during the course of withdrawal with a validated
symptom assessment scale. Assess the risk for scores on a symptom
assessment scale to be confounded by the use of certain medications,
the presence of certain medical conditions (e.g., fever from infection),
or a patient's difficulty communicating. Among general medical/
surgical patients, low withdrawal scores can typically be interpreted
with confidence, while high scores should be interpreted with caution.
The use of alternative scales for patients with difficulty communicating
is appropriate.
Î Recommendation VII.17: Patients with a reduced level of
consciousness who are at risk for the development of alcohol
withdrawal should be monitored for the appearance of alcohol
withdrawal signs. If a co-occurring clinical condition worsens, do not
assume it is related to alcohol withdrawal among alcohol withdrawal
patients. However, immediate treatment is required if alcohol
withdrawal develops after surgery or trauma.
(4) Supportive care
Î Recommendation VII.18: Clinicians should administer thiamine to
ICU patients with signs or symptoms that mimic or mask Wernicke
encephalopathy.
(5) Pharmacotherapy
Î Recommendation VII.19: Prophylactic treatment of alcohol withdrawal
should be provided in the ICU to patients who are suspected to be
physiologically dependent on alcohol.
Î Recommendation VII.20: Implementing an alcohol withdrawal
management protocol in the ICU is appropriate. When using a
symptom-triggered dosing protocol, use a validated scale to monitor
signs and symptoms. For patients being treated in ICU settings for
alcohol withdrawal, existing scales that are appropriate to use for
monitoring withdrawal include the Richmond Agitation-Sedation Scale
(RASS). Administration of medications via the intravenous route is
preferred because of the rapid onset of action and more predictable
bioavailability.
